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Does My Health Insurance Cover Addiction Treatment?

Mar 20

Addiction is a devastating disease characterized by compulsive use of substances despite harmful consequences. According to the National Institute on Drug Abuse (NIDA), approximately 21 million people 12 years or older had used illicit drugs at least once during 2017 — a number nearly three times as high as it was in 2002.

The majority who are seeking help for their substance-use problems don’t have access to specialty care such as medication-assisted treatments like buprenorphine/nalbuphine or methadone due to cost constraints. But with the right information, you can easily locate affordable and accessible addiction treatment centers that take your specific insurance plan. Here's how...

In-network addiction treatment centers

Insurance companies often negotiate discounted rates with certain providers. If you're eligible for coverage under one of these plans, they may be able to offer reduced costs when paying out of pocket. This is called "in network" coverage. The Centers for Medicare & Medicaid Services (CMS) provides complete details about which networks exist within each individual insurer. You should also check if any additional discounts apply based on location. A good place to start looking would be InsureMyCare.com, where users can search through multiple insurers' provider directories.

Below is a list of some of the largest insurance carriers along with what percentage of facilities fall into their respective networks. Blue Cross Blue Shield has negotiated agreements with more than 60 percent of the nation’s residential rehabilitation programs, while Cigna covers 70 percent of them. United Healthcare offers coverage agreements with 40 percent of all U.S. hospitals and long-term care facilities. Aetna has reached agreements with 28 percent of hospital facilities, 22 percent of skilled nursing homes and inpatient rehabilitation facilities, and 20 percent of home health agencies.

For example, Anthem Insurance Company currently includes 73 percent of U.S. residential alcohol and drug treatment facilities in its network, including many state psychiatric hospitals and private mental health clinics. If you have questions regarding whether a particular facility falls under your carrier’s network, call customer service directly.

In 2018, NAMI released data showing that only 13 percent of Americans received needed mental health services from a specialist, meaning psychologists, psychiatrists, social workers, etc., instead of primary care physicians. It also found that 27 percent didn't receive any treatment at all because there weren't enough specialists available. To address this issue, NAMI launched #SeeAPlanner campaign urging insurers to better fund behavioral health care.

If necessary, you could contact your insurance company directly to ask about coverage options. Some major players include WellPoint Health Networks Inc., Horizon Blue Cross Blue Shield Association Inc., Humana Health Plan Inc. and Medical Mutual Group Incorporated. For those without insurance, you might want to consider using government resources to pay for treatment. Check out SAMHSA.gov to learn more.

aetna health insurance covers drug rehab

blue cross blue shield insurance covers addiction treatment centers

cigna covers inpatient drug and alcohol detox

Out-of-network addiction treatment centers

As we mentioned earlier, not every rehab center participates in an insurance program's network. These outside facilities typically charge higher prices because they aren't receiving reimbursement from insurance companies. However, patients still need to make sure they qualify for payment assistance before filing claims.

You'll usually see two types of insurance coverage for OOS therapy: PPO and HMO. With a PPO policy, after meeting deductible requirements, you'd likely be responsible for up-front payments. An HMO plan requires members to contribute toward treatment upfront but won't require co-payments until a claim is filed. As a general rule, lower monthly premiums come with fewer benefits. Higher deductibles mean greater exposure.

A few popular insurers offering these plans include Cigna Health Plans LLC, Aetna Health, Empire Blue Cross Blue Shield, Cigna, EmblemHealth GHI, TRIcare, Carefirst BCBS, United Healthcare Health Plus Benefits Program and Beacon Health Options.

Check eligibility online or via phone. Ask about copayment amounts, coinsurance and annual limits so you know exactly how much you owe per month. Don't forget to factor in travel expenses. Find out if the facility near you charges extra fees for driving elsewhere. Also, get specifics on special considerations for pregnant women, seniors and children. And remember, sometimes even though a facility isn't covered by insurance, it doesn't necessarily mean you can’t afford it. There are plenty of creative ways to finance your recovery journey.

Drug rehabs that accept insurance

Another way to save money is to choose a center that takes advantage of your insurance benefit. Most health insurance policies will cover inpatient and outpatient addiction treatment including medical detox. Your benefits may even extend to family member visits and accommodations.

To determine which ones do, first familiarize yourself with your own insurance guidelines. Then, look up lists compiled by industry experts, such as HealthGrades.org, BestRehabOffices.com, and REBTClinicalServices.com. They provide detailed info on everything from locations to patient ratings for different types of rehab therapies. Just enter your zip code to filter results. Once you've settled upon a potential site, reach out to admissions staff and ask about payment methods. Many treatment centers offer an online insurance benefits verifcation option to check what addiction treatment programs your health insurance plan covers 

Here are a couple quick tips to keep in mind: Look for facilities that specialize in specialized populations, such as veterans or families. Avoid chain rehab centers unless you absolutely cannot find anything else nearby. Finally, always inquire about cancellation fees. After making arrangements, confirm dates and time slots with the therapist(s). Make sure to bring someone knowledgeable with you to avoid being blindsided by surprise bills.

1 Solution Detox in West Palm Beach accepts most insurance

While finding a reputable rehab that accepts your insurance is essential, there's no guarantee that the system works smoothly once you arrive. It's crucial to research the background of both therapists and administrators prior to scheduling intake appointments. One solution is to consult third party websites that vet rehabs according to strict criteria.

1 Solution Detox in West Palm Beach, FL evaluates and certifies addiction treatment centers across the country. Their database contains comprehensive profiles, rating reports, and photos submitted by former clients.

Once you've identified a suitable facility, here are some important things to review before booking admission:

Ask about retention rate: What happens if you decide to leave halfway through? Will you lose credits earned? Is there a grace period? How far ahead must you cancel to prevent penalties?

Review waitlists: Does the facility experience overbooking? Are new intakes prioritized over returning patients? Do the waitlist numbers reflect current demand?

Read reviews: Before committing to a specific center, visit its website and read testimonials posted by previous clients. Postings on Yelp and Google My Business are also helpful.

Research credentials: Talk to others who were admitted. See if they agree with the facility’s reputation. Confirm licensing status, accreditation, and training records. Review educational materials provided by the organization. Visit the facility itself. Be wary of “preferred partner” marketing schemes designed to boost profits. Often, preferred partners work hand-in-hand with the actual rehab, ensuring continued revenue streams rather than quality care.

Request free sessions: Request complimentary consultations or trial periods. Take note of the billing practices and procedures. Read contracts carefully so you understand all terms and conditions. Compare pricing structures. Know what services are included. Ask about financial aid packages. Consider asking for a discount for volunteering activities.

Call around: Call several facilities simultaneously to compare prices and availability. Get estimates for lodging, meals, parking, transportation and childcare. Factor in travel expenses. Decide which factors matter most to you. Remember, however: Prices vary greatly depending on location, seasonality, size, type, and clientele.

Don't hesitate! Seeking professional guidance is critical for getting well. Finding the best possible option is another story altogether. So don't waste time searching endlessly online. Instead, speak to representatives from various rehab centers. Schedule an appointment with a counselor. Meet with doctors and nurses. Interview loved ones. Research local support groups. Start planning now. Recovery is waiting.

1 Solution Detox

2901 Broadway, West Palm Beach, FL 33407

15618122527