Is Addiction Treatment Covered by Insurance?
Insurance companies cover, by far, the major part of the cost of addiction treatment. Eventhough it is hard to find one that pays 100% of the cost, no treatment center wants to reject a client who is in need of treatment simply because he or she cannot afford the out of pocket. Generally, the treatment center will minimize or eliminate the out of pocket by working with the client. Here are some general guidelines about insurance coverage.
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 the actual cost to you. 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. We, at Florida Center for Recovery have trained dedicated personnel that after obtaining the assessment from our 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 it's 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.
Type of Addiction
Insurance companies generally base their reimbursement policies on diagnosis. Addiction treatment generally falls under mental health care and below this category fall different types of addiction. That means an accepted diagnosis, like depression or alcohol abuse syndrome, is more likely to be covered than, say, a shopping addiction. It helps to know whether your particular addiction falls within the Diagnostic Services Manual used by the psychiatric profession. It also helps to have a solid diagnosis by a professional who is recognized by the insurer. Some addictions are treated with an established course of therapy, one that is approved and licensed. For example, someone receiving methadone for heroin addiction will be enrolled in an addiction treatment program where a physician provides the input and a standardized treatment plan. These are more widely accepted by insurance companies, as contrasted with a marijuana addiction, where many addiction treatment facilities will offer services that may or may not follow a set course of treatment.
Length of Addiction Treatment Covered by Insurance
Although addiction treatment specialists know that 90 days or more of rehab are needed to give clients a good chance at recovery, insurance companies often set limits. Usually, policies have a dollar maximum set or a time limit set or both. This is why a reputable rehab center such as Florida Center for Recovery will work 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. Unfortunately, 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 long term rehab to those who qualify and their insurance plan did 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 are doing this on a daily basis. Our drug and alcohol rehab center, Florida Center for Recovery, provides individuals dedicated to getting the maximum benefits available to you according to your plan coverage, for your particular medical needs.
Our facility like many drug and alcohol rehab centers are able to give you reliable information and we like many other facilities, will take care of the insurance paperwork for you and will make you aware of any pre-approval that is necessary.
Having said that, it doesn't mean that you cannot call your insurer's agent and ask him or her for 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, ask for a manager. Just keep in mind that the rehab centers will often have an upper hand in being able to help you get the most out of your insurance benefits.
For more information on our addiction treatment programs and therapeutic approaches, call toll free at: 800-960-5041. Florida Center for Recovery offers residential drug and alcohol rehab treatment through 12-Step and Non 12-Step Programs.