Will my insurance cover treatment?

The high cost of treatment is a fundamental concern for those needing addiction treatment and is one of the biggest reasons why some remain untreated. Insurance in general is very complex, regardless of the situation. The individual’s situation and the services provided determine insurance coverage. Since addiction is incurable and has high rates of relapse, insurance in this area can be tricky. Like other incurable diseases, like cancer, working with insurance companies can be a challenge.

Each treatment facility has their own insurance and coverage policy. When purchasing health insurance, most do not include to cover drug and alcohol rehab services. Because of this, many insurance policies do not cover these costs. However, drug rehab is a medical cost and its possible that your health insurance policy does cover it in some extent. Specifics will vary from policy to policy, so calling your insurance agent will be your best bet.

There is no add-on insurance policy that covers drug rehab only. Insurance companies will override coverage when questioning whether or not you have a pre-existing condition. Addiction is in fact a medical disease, so you may require medical treatment. Health insurance policies should cover the costs.

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Insurance coverage depends on your individual situation, but many private insurance companies will cover a part of treatment. Some services may be covered under mental health benefits, while some may limit coverage to outpatient services. A number of facilities have financial counselors who work with patients to check insurance benefits and determine a financial plan. Whether the facility is a nonprofit or for profit organization plays a factor in available funds for the cost of treatment. Financial counselors have gained knowledge of using both in-network and out-of-network benefits and work closely with insurance companies to determine whether aid is available and can be used in combination with insurance benefits.

With the passage of The Mental Health Parity and Addiction Equity Act of 2008, (MHPAEA), which is a federal law that provide participants who already have insurance benefits under mental health, and substance use disorders (MH/SUD) parity coverage, allowing Americans the opportunity to get help for their drug addiction with better coverage. The MHPAEA law, called the Wellstone/Domenici Parity Act, basically says that insurers must provide the same benefits for substance abuse as the do for other medical conditions. The Parity Act and healthcare reform bill reflect an understanding that addiction is a disease and that those struggling with this chronic condition deserve effective treatment as part of their regular healthcare.

The new healthcare reform act and MHPAEA will likely lead to American’s taking advantage of substance abuse treatment that otherwise would have been unavailable before. With parity and healthcare reform including substance abuse treatment under general medical care, treatment agencies should begin developing affiliations with medical organizations. This provides facilities with the opportunity do include new services.