According to the National Institute on Drug Abuse, there are over fourteen thousand, five hundred specialized treatment facilities for drug addiction in America. The most common types available include residential rehab programs, outpatient rehab programs, partial hospitalization, and detox programs (including both inpatient and outpatient options). Some treatment programs work with health insurance companies and accept insurance as a form of payment (provided the plan allows), while others do not accept any type of insurance. Further, it is important to note that although there is an abundance of addiction treatment programs available, not all medical insurance plans provide coverage for every facility and/ or program available.
Understanding Medical Insurance
There are a plethora of different medical insurance companies in America. Each medical insurance company offers its own set of tiered medical coverage plans that consist of distinct in and out-of-network benefits, deductibles, monthly premiums, and related coverage. Typically, plans that require less expensive monthly premiums often provide less expansive coverage. The plans offered by health insurance companies, as well as the intricacies of each of the tiered insurance plan options usually change each year. As a member, it is best to request clarity each year in order to remain updated regarding any possible adjustments to the coverage provided by one’s medical insurance plan.
Federal Laws
The Mental Health Parity and Addiction Equity Act of 2008 were passed, which had grave implications for the insurance companies. This act stipulates that insurance companies are no longer able to deny coverage or discriminate against individuals that struggle with substance abuse and/ or addiction. Not long after, the Affordable Care Act of 2010 was passed. This act classified mental health, including addiction treatment services, as essential healthcare benefits. With the passing of these two acts, insurance companies are obliged to provide the same level of coverage for the treatment of mental health ailments, including substance abuse treatment, as is provided for the treatment of other physical illnesses.
The Fine Print
There are loopholes that insurance companies may employ at the expense of their members. Common stipulations associated with health insurance coverage payouts for substance abuse and/ or addiction treatment programs could include:
- Denying coverage if you have previously attended rehab
- Changing coverage based on the type of addiction
- Changing coverage based on the duration of treatment
- Not providing coverage for detox
- Changing coverage based on the type of treatment (inpatient vs. outpatient)
- Only covering the use of “in-network” providers
Full coverage of substance abuse and/ or addiction treatment is not necessarily provided, regardless of how exceptional one’s medical insurance plan may be. Prior to making any commitments, it is best to consult one’s insurance company regarding their plan’s specific coverage related to substance abuse and/ or addiction treatment.
For Information and Support
Substance abuse and addiction can be incredibly dangerous and can result in severe short and long-term consequences. 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 leading happy, healthy, and fulfilling lives. There is no reason to go through this alone, and we are here to help. Please feel free to reach out to us for further information or with any questions regarding substance abuse or addiction. We are available anytime via telephone at: 213-389-9964, or you can always email us at: info@friendlyhousela.org.
