There is no question that addiction is a serious medical condition. When someone is struggling with addiction, their health and well-being are at risk. This is why it is so important that addiction be treated as soon as possible. The problem is that many people cannot afford to pay for treatment on their own. Does this mean that they have to go without treatment? Should medical insurance cover the cost of addiction treatment?
The good news is, medical insurance are now required to cover substance abuse treatment as mandated by the US government. There are standards on the coverage and what services should be included. We will explore more of these in this article.
What is Drug and Alcohol Rehab Insurance?
Treatment for drug and alcohol addiction is available in a variety. However, many people who suffer from addiction often do not have the opportunity to seek help from a drug or alcohol rehab program as the cost is high. The cost of rehabilitation is sometimes prohibitive and might discourage some people from trying to find recovery programs. These realities are what were mainly considered when the US government mandated all health insurance companies to include coverage on addiction treatment.
Under the Affordable Care Act (ACA), all plans must now offer what is called “essential health benefits”. This includes mental and behavioral health services, which addiction treatment falls under. This means that if you have a health insurance plan that was created after the ACA was put into effect, then your plan should cover some form of addiction treatment. If you have an older plan, your insurer might still be required to provide you with some form of coverage, but this will depend on your state.
Should medical insurance cover the cost of addiction treatment? Given the government’s mandate, the answer is clearly yes. But, keep in mind that there are standards for coverage so it may still be possible that the quality of your desired facility or services will not be covered.
Mental Health is Essential Health
Mental health is essential to our overall well-being. It should be considered just as important as physical health. This is why the US government has mandated that all health insurance plans should offer coverage for mental and behavioral health services, which addiction treatment falls under.
There are still some people who believe that addiction is not a real medical condition and that those who suffer from it should just be able to quit on their own. But, the reality is that addiction is a serious medical condition that requires professional treatment.
If you or someone you know is struggling with addiction, don’t hesitate to seek help. There are many resources available to you and there is no shame in getting the help you need to recover. Remember, addiction is a medical condition and should be treated as such.
What should my addiction treatment insurance cover?
The level of coverage that you have for addiction treatment will differ depending on your health insurance provider and plan. However, there are some general things that should be covered under most plans. These include:
- Screening and assessment for addiction
- Inpatient and outpatient treatment
- Detoxification services
- Medication assisted treatment
- Aftercare and relapse prevention
The early stage of screening and assessment for addiction is already covered by health insurance. This is the process of determining if someone has a drug and alcohol addiction and what level of care they will need. So when you are asking should medical insurance cover the cost of addiction treatment, not only that they should, but they shall also cover the parts for these kinds of pre-evaluation.
The next step is inpatient or outpatient treatment. Inpatient treatment is when someone stays at a treatment center facility for a certain period of time to receive care. Outpatient care is when someone comes in for appointments but does not stay overnight.
Detoxification services are also covered under most plans. This is the process of getting rid of the toxins from drugs or alcohol in someone’s system. Medication assisted treatment is also covered. This is when someone takes medication to help with withdrawal symptoms or cravings.
Aftercare and relapse prevention are also important aspects of addiction treatment that should be covered by insurance. Aftercare is when someone has completed a treatment program and they receive follow-up care. Relapse prevention is when someone receives care to prevent them from relapse.
Examples of Addiction Insurance Coverage
If you are in the lookout in the health insurance marketplace, here are a few examples of addiction insurance coverage:
- Blue Cross
- Blue Shield
- Aetna
- Cigna
One example is Blue Cross and Blue Shield. They have a health insurance plan called the Federal Employee Program. This program covers inpatient and outpatient treatment, as well as detoxification services. Another example is Aetna. They have a plan that covers inpatient and outpatient treatment, as well as medication assisted treatment.
Cigna is another example of an insurance company that covers addiction treatment. They have a plan that covers inpatient and outpatient treatment, as well as aftercare and relapse prevention.
These are just a few examples of the many insurance companies that cover substance abuse treatment. If you are unsure if your insurance company covers addiction treatment, you can call them and ask. Alternatively, if you now currently have a current target among American Addiction Centers or rehab centers, you can contact them thru phone or their website, then check which insurance they do accept.
What should I do if my insurance company denies my addiction treatment claim?
Should medical insurance cover the cost of addiction treatment? The answer to this question is yes. The Affordable Care Act stresses that mental health is essential health so it must be a part of any health insurance coverage. If your insurance provider denies your substance abuse treatment claim, you have a few options. The first is to appeal the decision. This can be done by writing a letter to the insurance provider.
You can also contact your state’s department of insurance. The department of insurance can help file complaints against insurance providers. You can also reach out to national institutes like the Substance Abuse and Mental Health Services Administration (SAMHSA) if you need advice to strengthen your case.
If you are not inclined to filing a complaint, you can look into getting a new insurance plan. If you are on an employer-sponsored plan, you might be able to switch to a different one. You can also purchase a private insurance plan.
Where to find substance abuse treatment centers that accept insurance
Now that you know the answer to “should medical insurance cover the cost of addiction treatment?”, where can you find a mental health care center that accepts your health insurance?
Here are a few ways:
- Look up “substance abuse treatment centers near me” and include your insurance type in the search
- Check with your state’s department of health. They should have a list of licensed and certified treatment centers in your state.
- Check with the National Association of Addiction Treatment Providers (NAATP). This is a professional organization for addiction treatment providers.
- Reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA).
- If you have an employee assistance program (EAP), they might be able to help connect you with a treatment center that takes your insurance.
- If you are currently in treatment, ask your treatment center if they have any recommendations for other centers that accept your insurance.
Seeking substance and alcohol addiction treatment is a difficult but brave decision. With the Affordable Care Act, you have the right to treatment.
Can I use insurance on luxury rehab centers?
As people address drug and alcohol addiction, many have been curious to the services and accessibility of luxury rehab treatment centers. Well, as the name suggest, it does come with a high price. The good news is that there are still insurance plans where this high-end services are included. For example, Heal Treatment Center in Florida, which is a very high quality facility for people with substance abuse issues, do accept insurance.
Not all health insurance coverage have luxury rehab treatment centers as part of their plan. In fact, it is not covered by default. So if you are interested in such services, consider that as you go through health insurance marketplace.
If your insurance provider is from the company you are working for, it will often exclude luxury rehab. If this is the case, and you think that a luxury rehab center will help your mental health and is what will make your drug addiction treatment most successful, you might wonder, “how do I pay for addiction treatment?” You may ask the health insurance provider if they are able to share some portion of the cost.
Why does luxury rehab centers gaining popularity in substance abuse treatment?
Luxury rehab centers are becoming more popular because they offer a higher level of care. They also have amenities that other rehab centers do not have. For example, if basic substance abuse treatment centers have a gym, a luxury rehab center might have a full spa.
The one thing that they guarantee to patients is that the facilities are of high standard and they will least likely feel that they are in a rehab. This atmosphere can be detrimental to a patient’s mental health, thus, recovery. A good mindset and a cozy environment does help in the healing process.
Luxury rehab centers also have a lower staff-to-patient ratio. This means that patients will get more one-on-one time with counselors and therapists. They will also be able to create relationships with other patients in the program.
The main goal of any rehab center should be to help people recover from addiction. If a luxury rehab center can do that, then it is worth the cost.
Bottomline
Should medical insurance cover the cost of addiction treatment? As emphasized in this article, yes they must. The Affordable Care Act has put into law that all mental health should be included in any form of health insurance – this clearly covers substance abuse treatment. Mental health has high impact to people’s daily reality. Those seeking addiction treatment must not be denied. Addressing substance abuse not only help an individual but the society as well.
Addiction treatment is costly, but with insurance, it can make this service more affordable to people who need it. If you have been denied coverage for addiction treatment, there are ways to file an appeal or look into other options like a new insurance plan.
Luxury rehab centers are becoming more popular as they offer a higher level of care. If this is something you’re interested in, check with your health insurance company to see if it is covered in your plan. Keep in mind that the end goal of any rehab should be to help people recover from addiction and help your physical and mental health get better. If a luxury rehab can do that, then it would be worth enrolling to.
If you or a loved one is struggling with addiction, know that you are not alone and there is help available.
