So You Want to Use Your Health Insurance – It’s a Process
If you’re seeking help for an addiction problem, you may think you want to use your health insurance to help cover or fund your treatment stay. After all, you pay for health insurance to be there when you need it, right? The problem with health insurance and addiction treatment is that addiction treatment is covered as a behavioral health service and there are different coverage benefits and rules for getting through that process than with medical and surgical claims.
Insurance coverage for addiction treatment are covered as behavioral health services with the exception of medical detoxification*. Most health insurance provides coverage at a rate of 50-90% for addiction treatment. The average rate is 75%, leaving you with the remaining 25% of the total cost. The remainder is what you will pay, in addition to any deductibles you must pay prior to your health insurance coverage applying.
Most insurance companies will also determine what services and rates they will reimburse under their treatment coverage so it’s important to be aware of this. Ask your insurance provider and any potential treatment provider(s) you’re considering about any services, fees, or costs not typically covered under your insurance policy as these costs will be your responsibility to pay in total in addition to any deductible and your co-pay. For example, you might be advised to add or you may want to have massage therapy as part of your treatment program. Your insurance provider may not recognize massage therapy as a covered service for addiction treatment and exclude its cost. You could suddenly find yourself at the end of your stay with a bill for uncovered services in addition to your deductible and co-pay amounts.
The Right Questions Can Help You Avoid Costly Mistakes
When looking for addiction help and considering using insurance, you need to:
- Determine what you need to succeed vs. what you want – Don’t compromise on meeting a need (finding an effective program within your budget) to get a “want” met (another facility has a pool and yoga but their program isn’t a great fit for you or has undisclosed success rates)
- Compare apples to apples – The range of costs for services can vary greatly so you need to understand exactly what is available and what you are paying for from each potential provider
- Ask potential provider(s) what is included in their service pricing specifically and get it in writing if at all possible
- Ask to speak to past patients of potential providers – Ask them about program effectiveness for them, what their total costs amounted to, and any issues with insurance reimbursement or appeals, if using insurance
- Ask your insurance provider what services they will and won’t reimburse and at what rates
- Ask for a cash only price for services to be able to compare accurately
- Don’t discount self-pay options– Depending on the program, you may find the end cost comparable to your insurance co-pay and/or deductible outlay
Private Pay May Save You Money and Headaches
Private pay is another option to explore and compare with the total costs incurred if you use your insurance. Some private pay program costs will be comparable or even more affordable than using your insurance when you consider meeting your deductible, co-pays, and any additional costs not covered under insurance.
Many self-pay programs also offer loans, payment options, discounts, and scholarships to make a residential stay more affordable. Private pay can also afford you the added privacy of not generating the paper trail necessary for insurance reimbursement. This privacy can be important to preserve your personal and/or career reputation and avoid a possible vindictive spouse, employer, or legal adversary having access to your private treatment records.
The Cost of Doing Nothing Is More Than You Think
Lastly, if you are dealing with addiction and reading this, you’re aware there are costs you are incurring already – even by doing nothing. It’s estimated that, depending on the substance(s) used and other personal factors, the average person with an addiction problem is already spending $20,000-$100,000 every year on addiction related costs. These costs can include the cost of the substance(s), healthcare costs related to substance use, legal issues, increased insurance costs, absenteeism, job loss, divorce, and other life costs. Loved ones suffer with the pain and chaos that often follows someone with addiction. Our communities suffer with the loss of the person’s well-being and ability to contribute meaningfully or even suffering their loss entirely. Those personal and societal losses are hard to calculate but very real.
Dealing with addiction is costly in every way imaginable. Deciding to deal with addiction is a choice to move in a positive direction for you. You don’t have to stay trapped in addiction and you can move beyond addiction permanently, which will free up time, money, and other resources for you to enjoy life in a different way. If ending addiction is something you are wanting to explore for yourself and those around you, that help is a phone call away. Addiction doesn’t need to remain your default life choice – call today.
*Medical detoxification services are treated as a medical service under health insurance so the coverage rates may be different between the amounts covered for detox versus treatment. In addition for your medical detox to be covered under health insurance, you must generally prove that a medical detox is medically necessary in that you are physically dependent on alcohol, benzodiazepines, and/or have a serious chronic or acute condition that would become unstable or cause you to be in medical danger while going through a standard clinical or natural detox.