Insurance companies shoulder, by far, the major part of the cost of addiction treatment. It is not un-common for the insurance company to pay 100% of the cost. The deciding factors for the percent of the total cost vary by company and policy. Here are some general guidelines.
In Network or Out?
Policies that provide services based on a network model usually will severely limit reimbursement for out of network services, particularly drug rehab. If they offer an in-network facility, it's sometimes tough to "win" a slot or match up schedules.
This doesn't mean your HMO won't pay for out of network treatment, just that they may pay less than 100% of the total cost. That is why a person knowledgeable with insurance policies has to get involved and make the assessment. The assessment is based on the type, severity and the duration of the addiction. At AlcoholAndDrugHelpline.com there are trained dedicated personnel that after obtaining an assessment from doctors and licensed therapists try to figure out your insurance benefits and the percentage of the overall cost you (or your family) will have to pay. They will argue on your behalf for the maximum possible coverage when talking to your insurance agent.
It is very important that our utilization review department (fancy word for the department that its job is to figure out what part of your insurance policy applies to your current medical needs) gets involved at the earliest possible.
It is quite impossible to have your insurance company tell you everything there is to know about your policy and how it applies to your benefits regarding your current condition.
Types of Insurance Covered Addictions
Addiction treatment generally falls under the top category of mental health care and specific types of addictions are subcategories of mental health care. That means an accepted diagnosis, like depression or alcohol abuse syndrome, is more likely to be covered by insurance plans than, for example, shopping addiction. It helps to know where your particular addiction falls according to the Diagnostic Services Manual used by the psychiatric professionals. It also helps to have the diagnosis provided by one of the recognized professionals by the insurer. On the other hand there are established courses of treatment for certain addictions that which are widely accepted for coverage by various insurance companies. For example methadone is a widely accepted method of treatment for heroin addiction where a physician provides the input and the standardized treatment plan accepted by insurance companies. This is in contrast to for example, marijuana addiction where many addiction treatment facilities offer services that may or may not follow a set course of treatment and the treatment should and generally is negotiated, on a case by case basis, with the insurance company.
Length of Addiction Treatment Covered by Insurance
Regardless of the addiction treatment specialist recommendation, insurance companies often set limits on the length of the treatment. Policies also have a dollar maximum set or a time limit set or both. This is why reputable rehab facilities always work closely with their clients beyond the limit set by the insurance company when needed.
Is Detox Covered by Insurance?
Generally, an insurance policy that covers addiction will pay for drug and alcohol detox, especially for an inpatient treatment facility. Also it often pays for the follow up care that requires drugs to fight cravings or treat other mental health issues such as anxiety and depression. Generally, once the detoxification process is completed, most insurance companies have a set dollar amount assigned for the rest of treatment. In our treatment center, through different types of arrangements such as partial payment plan or even scholarships, we offer the needed term of rehab to those who qualify and their insurance plan does not cover the full term of their rehab.
How to Find Out About Your Policy
We recommend you start with getting help from professionals that specialize in this field and are doing this on a daily basis. If you are seeking treatment within our treatment network we have trained individuals who are dedicated to getting the maximum benefits available to you per your plan coverage, according to your particular medical needs. Having said that, it doesn't mean that you should not call your insurer’s agent and ask for detailed information on the exact section in your policy, which talks about addiction treatment and the coverage that it provides. If you feel that the agent helping you is not exactly answering your questions or is not knowledgeable enough, call us and our dedicated staff will be glad help you with the process of getting this information. It is a fact that the rehab centers will often have an upper hand in being able to help you negotiate and get the most out of your insurance benefits.