Under government legislation, healthcare companies must provide insurance coverage for substance use disorder treatment. With the passing of the Affordable Care Act, more US citizens now have access to these types of substance addiction treatment programs. 

Plans will vary in terms of what kind of coverage they’ll provide or the length of coverage for treatment, so it would be wise to check with the rehab program or provider you’re considering. rehab insurance

Also, insurance companies can’t deny coverage for people with preexisting mental disorders. They must offset the cost of preventive services as well, including behavioral health and depression screenings. Furthermore, insurers can’t impose annual or lifetime dollar limits on insurance coverage for addiction therapy services.

What Do Rehab Insurance Policies Cover?

Not all insurance policies cover the same drug rehab services. Although our Los Angeles addiction treatment center offers many of the most common programs that they cover. These include:

Because of government regulations, insurers have to cover treatment for all drug addictions. Whether people have an alcohol addiction or heroin addiction, rehab insurance coverage must pay for at least part of the treatment.

People must pay attention to the types of drugs that a facility treats. For instance, alcohol addiction treatment requires a different approach to recovery than meth addiction. This fact is particularly actual during the detox stage of treatment. The reason is that the withdrawal process differs slightly between drugs.

Aside from traditional therapies, rehab insurance coverage doesn’t always include holistic services. Some examples include acupuncture and massage. Since these are often luxury treatments, insurers are less likely to cover them. However, some policies do.

Does Your Healthcare Provider Cover Addiction Treatment?

Health insurance has been previously deemed a luxury for the wealthy. Those with low-paying jobs and tight budgets might not have had the extra money needed to purchase expensive health care plans. 

This drove them to attempt saving up enough money to enable them to receive care for conditions that were considered life-threatening. All other issues went unaddressed. Usually, that meant substance addictions remained untreated. For individuals without health insurance, receiving medical attention for substance addiction was too expensive to contemplate.

That all changed with the passing of the Affordable Care Act. Now more Americans than ever before are covered by health insurance. The analysis stated that only 13% of US citizens weren’t covered under health insurance in 2014.

Everybody else had the coverage required to receive help with health problems. Those plans usually include coverage for addiction and mental illnesses. But, some limits and stipulations should be known for people to receive the coverage needed at the appropriate time.

The two most prevalent forms of healthcare plans are HMO and PPO. Each person’s insurance provider might cover substance abuse treatment. Below is the difference between HMO or PPO plans that offer the best coverage:

Health Maintenance Organization (HMO)

These plans enable patients to choose their primary care physician and consult them for a majority of their medical needs. This will allow the patient to form a relationship with their doctor who understands their whole health history. 

When inquiring into a physician or specialist outside of the network, a referral will be required by your primary care physician. HMOs have little to no deductibles, and overall coverage costs typically less than PPO. Pros of HMO coverage are for patients who are not looking for a specialist and healthcare providers out of their network while paying less on their premiums.

Preferred Provider Organization (PPO)

These plans enable patients to visit their healthcare providers even out of their network without needing a referral. PPOs usually have higher deductibles than HMO plans. One of the pros of PPO plans is having the option to see specialists and other healthcare providers outside of the network plan without needing a referral from your primary care physician.

Which Mental Health Issues are Covered by Rehab Insurance?

The legislation passed with the Affordable Care Act does addiction care. As part of the bill, plans were also required to provide the same level of care for mental health matters that too do for physical health issues. That indicates programs that offer physician visits for a foot problem for $20 must also provide physician visits for depression for the same cost of $20. Value and care must be equal. 

The American Psychological Association states that these parity laws pertain to a variety of programs, including ones provided by employers, those going through health care changes, and those coming through CHIP and Medicaid.

Parity laws don’t explicitly state what kinds of mental health conditions a plan is obligated to provide care for, but the rules are comparable to those seen in substance addiction. If the programs provide care for mental illness, they typically don’t stipulate that some diseases are covered while others aren’t. That would require an enormous amount of time and paperwork, and most plan administrators don’t have either to spare, so the plans cover everything. 

Again, this is a matter that should best be addressed with a plan administrator. But usually, fears that mental health issues will not be covered due to being “bad” are typically baseless. Health insurance coverage doesn’t work that way.

Are Addiction Treatment Medications Covered?

 Maintenance programs, which are part of aftercare treatment, are designed for individuals who can’t function without drugs, even if they’ve been through a rehab program already. Chemical alterations caused by substance abuse is too severe for some, and medications are required to correct those imbalances. This is sometimes the only way they can live a substance-free lifestyle.

Maintenance treatment helps those in recovery from particular substance use disorders, usually long after leaving rehab. For example, opioid maintenance therapy for medication-assisted treatment like Buprenorphine or methadone can help stop withdrawal, minimize cravings, and prevent relapse. This will allow that individual to focus on sobriety and other everyday responsibilities.

Maintenance medications like Suboxone, Antabuse, and Buprenorphine are made for those experiencing those kinds of issues, but the cost can be high. Luckily, a majority of experts recommend that insurance plans typically do cover these medications.

The National Alliance of Advocates for Buprenorphine Treatment states that a majority of health insurance plans do cover maintenance drugs for individuals in addiction recovery. The organization doesn’t define how many programs offer this form of coverage or what standard copayments could be. Still, the group appears confident that a majority of plans do provide this benefit.

The Substance Abuse and Mental Health Service Administration states that Medicare and Medicaid plan only will cover these medications if they are vital for the ongoing health of the individual in addiction recovery. If they are considered to be able to heal without the use of drugs, coverage wouldn’t be granted under these plans. 

These two conflicting views make it apparent that programs may manage addiction maintenance care differently. That’s why it pays for those who need this care should inquire into coverage, copayments, and therapies before receiving them. Some programs might have extensive coverage, while others will not.

How Much Does Rehab Insurance Coverage Pay?

Like the types of services that insurance covers, the amount of the coverage varies from one policy to the next. In California, though, many insurers use different levels of coverage.

In general, bronze-level plans have low monthly premiums, but high deductibles and out-of-pocket costs. Platinum-level policies have high monthly premiums, but low deductibles and out-of-pocket expenses. The silver and gold levels fall in between.

As such, people with bronze rehab insurance coverage Los Angeles pay the most out of pocket for treatment. The insurer might require that they go to an in-network provider as well. However, some bronze plans can offer coverage for out-of-network providers.

In some cases, people have to pay coinsurance for rehab services. 

Other times, rehab insurance coverage Los Angeles has a copay. Most of the time, though, insurers require people to pay their plan deductibles before they start covering the services. For these reasons, people need to understand their benefits before they enroll in a rehab program.

Using Insurance to Cover Addiction Treatment Costs

Health insurance benefits are intended to make health care both accessible and affordable, and there’s no disgrace associated with asking for help. Those who are suffering from substance addiction and who have insurance should use their coverage to get the treatment needed to live an addiction-free lifestyle. Speaking with plan administrators is an excellent place to begin, but keep in mind that addiction treatment facility staff can also be a great help.

In some instances, they can make the path to payment easy so that families can focus on recovery.

Let LA Detox Verify Your Rehab Insurance Policy

You can determine your insurance benefits by reviewing your policy. However, you might come across terms or wording that you don’t fully understand. You aren’t the only one.

Our addiction treatment staff has the means to verify your insurance coverage for you. LA Detox wants to make sure that you get the care that you deserve. To that end, we offer everything from detox and therapy to aftercare services. Some of the treatments that we use include:

When it comes to getting drug addiction detox and rehab, one element that people worry about is paying for it. The high cost of treatment justifies these concerns. However, many people don’t understand how affordable treatment becomes with rehab insurance coverage. They can lay some of their worries to rest by learning more about what and how much that insurance covers. 

Don’t let concerns about paying for detox and rehab keep you from taking the first step toward recovery. Let LA Detox verify your rehab insurance coverage. Contact us today to find out how affordable your treatment can be.