The cost of addiction treatment can deter people from seeking treatment. What you may not realize is that in many cases, some or all of the costs of treatment for a substance use disorder are covered by private insurance because addiction to drugs or alcohol is categorized as a medical condition.
So how do you know if your insurance company covers your treatment? With so many types of treatment and variables related to insurance plans, getting all the details together can feel intimidating. Learning what will and won’t be covered by your insurance plan is an excellent way to start finding answers.
Will My Health Insurance Plan Cover the Cost of My Treatment?
While many insurance companies cover all or at least a portion of rehab, a lot of variables work to determine the answer.
One of the biggest factors of coverage is whether you choose an in-network or out-of-network treatment center. Private insurance companies have networks of providers they work with. Policyholders should receive care from within the network of their plan when possible. Out-of-network care is going to be more expensive and may not be covered at all.
The Recovery Village Columbus Drug and Alcohol Rehab is an in-network provider for the following insurance companies:
- Healthcare Solutions Group
- Blue Cross Blue Shield
- Mines and Associates
- First Health
- First Choice
- Medical Mutual
- ClaimBridge Administrators
- America’s Choice Provider Network (ACPN)
- Orlando Healthcare
If you try to receive care from an out-of-network provider, your insurance company may transfer you elsewhere.
There are two types of insurance plans: health maintenance organization (HMO) and preferred provider organization (PPO). An HMO is more restrictive in terms of receiving in-network care, although that comes in exchange for lower premiums. A PPO may allow for more out-of-network care but is generally more expensive than an HMO.
Along with in-network versus out-of-network care, the specific type of policy someone has factored into whether rehab is covered.
For example, the 2019 out-of-pocket limit for a plan offered on the insurance exchanges is $7,900 for an individual plan and $15,800 for a family plan. This limit means you may have to spend quite a bit before your insurance kicks in, limiting the coverage for rehab.
However, some plans have much lower out-of-pocket maximums and deductibles, although the monthly premiums may be higher.
Also, consider referrals and pre-approvals. Many insurance plans require policyholders to get approval before certain types of care are covered.
The Affordable Care Act and Substance Use Disorders
With the implementation of the Affordable Care Act (ACA), there was an expansion in the coverage for substance use disorders and mental health treatment. All plans available on state exchanges, also known as the Marketplace, are required to include treatment for substance use disorders and mental health as essential benefits.
All plans have to cover behavioral health treatment including counseling, psychotherapy and substance use disorder treatment.
Additionally, plans on the Marketplace can’t deny coverage or charge someone more for a pre-existing mental health condition or substance use disorder.
While mental health and substance disorders are essential benefits, the specifics of how much coverage is available depends on the state someone resides in and the plan they choose.
Non-insurance options are also available to pay for rehab. For example, if private insurance won’t cover all of the costs of treatment or if someone doesn’t have insurance, that doesn’t mean they can’t receive the necessary treatment for a substance use disorder.
A rehab center may be able to work out a payment plan or have flexible self-pay options. There are also financing options geared specifically toward medical care.
Learn More About Your Insurance Coverage
Contact the admissions team at The Recovery Village Columbus Drug and Alcohol Rehab to learn more about the costs of treatment, the types of programs available and how to pay for rehab. The admissions team can work with you to verify your coverage and can contact your insurance company on your behalf. They can create a list of what’s covered by your insurance and what exclusions may exist so that you can effectively estimate any out-of-pocket costs.
We can provide you with insurance verification and any necessary pre-approvals. We can also help ensure maximum coverage and that you receive all of the benefits that come with your plan.
- American Society of Addiction Medicine. “Definition of Addiction.” September 2019. Accessed April 12, 2021.
- Abraham AJ, Andrews CM, Grogan CM, et al. “The Affordable Care Act Transformation of Substance Use Disorder Treatment.” Am J Public Health. 2017. Accessed on April 12, 2021.
- Healthcare.gov. “Mental health & substance abuse coverage.” 2021. Accessed on April 12, 2021.