Addiction, also known as substance use disorder (SUD), is a chronic brain disease, and is listed as such in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)….
Each plan has extremely specific details surrounding the exact types of medical services that will be considered eligible, which indicate what services will be covered under the plan. Each plan will have a different monthly premium fee, and in many cases if a monthly premium payment is missed the plan is terminated. Some plans cover a portion of fees associating with obtaining services from an out of network professional, and some do not. Each plan has different co-payment fees for different things (i.e. filling a prescription, a specialist visit, surgery, a primary care visit…etc.). Insurance is complicated, and insurance companies change the fine printed information yearly. In order to fully understand the intricacies of one’s healthcare coverage and medical benefits, it will require steadfast diligence. Although it can feel arduous, a general rule to avoid running into trouble with one’s insurance company is to call and specifically request confirmation of coverage from the insurance company for any service before it has occurred.
Affordable Care Act
In 2010, President Obama signed the ACA (Affordable Care Act) into federal law. The purpose for signing the ACA into law was threefold: to create affordable health insurance coverage, enabling more individuals to obtain healthcare; to expand the Medicaid program; and to support “innovative medical care delivery methods designed to lower the cost of health care generally.” Prior to the passing of this litigation, insurance companies were not obligated to cover substance abuse treatment. The ACA requires all health insurance plans to provide coverage for substance abuse treatment and related issues. Furthermore, the ACA stipulates that health insurance companies are obligated to provide similar coverage for the treatment of mental illness.
Insurance companies are now required to offer some type of coverage or partial coverage to its members that need detox. Some health insurance plans cover one hundred percent of the fees associated with detox, while others may collect copayments for attending a detox program. There are large deductible insurance plans, that require an individual to pay out of pocket until they reach the threshold of having paid a certain lump sum prior to covering any portion of any medical service rendered, including attending a detox program. Insurance companies, however, are notorious for evading payments on behalf of members as a result of improper medical coding, misinformation, and an abundance of other reasons, which would place the entire financial burden on the individual in detox. For this reason, it is essential to understand one’s medical care coverage plan as well as one’s out of pocket financial obligation, prior to services rendered. This can help to eliminate receiving any surprise medical bills.
An individual must take into consideration the type of detox facility he or she selects, and its respective associated costs. It is important to note that the cost of detox programs vary, as every detox facility charges its own fees. Some luxury detox facilities will likely be costlier than those that are run in a hospital setting, for example. There are also some detox programs that are outpatient, which will likely be less costly than those that require an individual to reside at the facility for the duration of his or her detox process.
In short, yes, an individual’s medical insurance should cover some portion of detox, but the type of detox covered can be incredibly specific and an insurance company can elect to offer coverage only for a small set of approved facilities. Even in situations where an individual has excellent and expansive medical insurance coverage, there are some detox facilities that do not accept insurance as a form of payment. Therefore, in addition to checking with one’s insurance about the coverage surrounding detox for substance abuse and/ or addiction, it is equally imperative for an individual to discuss acceptable payment options with the detox facility.
Substance abuse and addiction can be incredibly dangerous.
If you or someone you know is suffering from substance abuse or addiction, please get help as soon as possible. The earlier you seek support, the sooner you and your loved ones can return to happy, healthy and fulfilling lives. There is no reason to go through this alone. Please feel free to reach out to us for further information or with any questions regarding substance abuse or addiction.
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Addiction, also known as substance use disorder (SUD), is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic, relapsing neurological disorder. The Mayo…