Paying for Rehab with Insurance

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How To Use Insurance To Pay For Rehab

If you have medical insurance, it will most likely cover some form of drug or alcohol abuse treatment program. Some policies did not offer the coverage in the past, or you might have been required to buy a rider to have the coverage included.

Because of two laws, the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, medical plans must offer some sort of coverage for addiction treatment. The Mental Health Parity Law requires that health insurance companies to treat mental health conditions and substance abuse just as they do any medical or surgical problem.

While the law doesn’t require plans to include mental health coverage, but if it does, it must have a similar cost as other forms of medical treatment. As an example, the copay for a medical visit cannot be less than the copay for a mental health visit.

The Affordable Care Act requires most medical insurance plans to include treatment for mental health issues and for addiction and offer preventative care as well.

Questions to Ask Your Health Insurance Provider

You will need to establish whether you have coverage for addiction and substance abuse treatment. Each insurance plan is different, so the best way to determine if you have adequate coverage is to speak directly with your insurance company.

If your insurance is through your place of employment, you can speak to the human resources representative there instead of calling your insurance company. You will need to ask some direct questions and take notes regarding what is said.

  • First, you want to know if your insurance will pay for detoxification, rehabilitation, and the needed aftercare. Most likely, preventative care and an assessment of your condition will be covered completely by your medical insurance. Usually, detox is covered, and most plans cover outpatient treatment. Inpatient, or residential programs, might only be partially covered. You will want to learn more about your treatment options and talk with your physician about any recommendations. Your insurance representative can tell you how much of the cost you will have to cover out of pocket.
  • Prescription drugs are often needed to ease the symptoms of withdrawal and to decrease the chances of a relapse. While some insurance plans specifically state if these drugs are covered, but others might not make it so clear. Call your insurance and ask this question directly, so you can get the answer.
  • Ask your insurance company about copays, coinsurance and deductibles. For example, you might have a $35 copay for each office visit and a 20% responsibility for inpatient care after your deductible has been met. You might have a $7,500 deductible you are responsible for before anything is covered. You need to know this, so you will know how much you will pay before your insurance kicks in. As an example, there are some plans with lower premiums that have higher deductibles.
  • Then, you need to know how long you can be in treatment with your insurance. Treatment programs are available in different lengths, which can range from 30 days to a year or longer. Your insurance might only cover a set number of days or a portion of the program you have chosen. As an example, Medicare will cover unlimited care in a hospital, but it will only cover the cost of 190 days in an inpatient psychiatric facility. Also, ask about networks. Does your primary care provider have to refer you to a mental health specialist for your plan to be covered or can you see any specialist from the list you are provided by your insurance? You don’t want to choose a doctor that isn’t covered by your insurance, as that can be very costly and add to your out of pocket expense.

You will also need to talk with the facility and ask them about how they bill insurance and if your coverage is accepted for treatment there. You need to make sure you understand the cost to you before you get treatment underway.

You don’t want to start a program and then end up in a situation where you cannot afford to finish it. Let the facility make copies of your insurance cards and contact the insurer themselves, so they can come up with an estimation of the cost and payment. T

hat way, you will know exactly what you are looking at as far as cost and care goes.

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