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How Outpatient Insurance Works

Many people struggling with a drug or alcohol addiction believe outpatient addiction treatment is out of reach due to cost.

According to the 2014 National Survey on Drug Use and Health, 39% of those surveyed said they didn’t seek treatment because they could not afford it or didn’t have health insurance.1

Perceived unaffordability prevents many people from seeking the treatment they so desperately need. It may in part help explain why only 2.6 million (11 percent) of the 23 million people struggling with alcohol and drug addiction in the U.S. receive treatment.2

It’s vital to ask the question: Does health insurance cover rehab? Your insurance plan may very well cover some or all the cost of inpatient or outpatient treatment—or both.

 

How Insurance Works

Outpatient Rehab InsuranceYour insurance works the same way with addiction treatment as it does for regular medical services. The insurance company pays a certain amount for covered services, and you’re responsible for the rest.

Copayments, coinsurance amounts, and deductibles still apply, just like with regular medical services.

It helps to look at an example. Suppose your health plan has an annual deductible of $1,000. In general, this is the amount you must pay for covered services before your plan will begin to pay.

But, it gets a little more complicated.

Other plans don’t require you to meet your deductible before they will start to pay for a portion of covered services. For example, suppose you have a plan with a $1,000 deductible, a coinsurance split of 80/20 (this means the insurance company pays 80% and you pay 20%), and a copayment of $50 for clinic visits.

On a $500 bill, you might be required to pay the $50 copayment, plus 20% (your coinsurance share) of the remaining $450, which comes to $90.

In all you pay $140 of the $500 bill. That $140 goes toward your $1,000 annual deductible. Once you’ve met your deductible, your plan may cover 100 percent of your expenses.

The bottom line: Health insurance policies are extremely varied in their coverage. That’s why it’s important to find out exactly what your plan covers.

 

Substance Abuse Treatment Under the New Healthcare Law

Whether you have an individual health insurance plan you purchased on your own, a group plan through work, or a public plan through the Affordable Care Act (ACA), sometimes called “Obamacare,” your plan may cover substance abuse treatment.

The new healthcare law prohibits insurance companies from denying coverage for preexisting conditions—which includes substance abuse. Importantly, it also states that insurance plans must provide the same level of coverage for mental health and substance abuse treatment as for regular medical care.

There’s one catch: These rules only apply to policies that began on or after January 1, 2014. Policies issued before that date may be “grandfathered,” which means they may be allowed to exclude or restrict coverage for substance abuse treatment.

 

Your insurance company can help you understand what coverage you have for substance abuse treatment. It’s worth the phone call.

If you have a plan through the Affordable Care Act (purchased through healthcare.gov or your state marketplace) you can be sure of the following:

  • Coverage for substance abuse treatment/mental health is one of 10 “essential benefits” on these policies.
  • Coverage for addiction treatment must be equivalent to treatment for any other medical procedure.
  • You can’t be denied coverage for a preexisting substance use disorder.
  • Coverage will usually include things like:
    • Addiction evaluation
    • Alcohol and drug testing
    • Clinic visits
    • Home health visits
    • Family counseling
    • Anti-craving medication

If you enroll in a plan through the ACA, you may also be eligible for subsidies to help reduce the cost of your plan. Eligibility for subsidies/tax credits is based on your income and other factors, including your employment status and whether your employer offers affordable health insurance coverage. Learn more here and here.

 

World-Class Outpatient Care at RECO Intensive

Ready for outpatient addiction treatment? Our Delray Beach outpatient treatment program provides world-class care overseen by an outstanding team of clinicians and therapists. We accept most insurance plans, including BlueCross/BlueShield, HealthNet, Aetna, and many others.

 

The cost of rehab doesn’t have to keep you or a loved one from getting the care you deserve.

Our skilled administration team in Delray Beach will help you determine what’s covered by insurance and what’s not. If you don’t have insurance, we can help you find an alternative to inpatient or outpatient insurance. The most important thing is that you get treatment. We’re here to help. Call us to learn more at (844) 792-7181.

 

Sources:

  1. http://pdas.samhsa.gov/#/survey/NSDUH-2014-DS0001
  2. https://drugfree.org/learn/drug-and-alcohol-news/new-data-show-millions-of-americans-with-alcohol-and-drug-addiction-could-benefit-from-health-care-reform/