Using Insurance for Alcohol Rehab
When you hear a month of medical model residential rehab can cost from $9,000 to $40,000 per month, figuring out how to pay for alcohol rehab might seem like a daunting task, but the best place to start is looking at your insurance. If you have either group insurance through work, private insurance, or a state program, it is best to understand your coverage and benefits before you look any further. People often try to sift through all the paperwork, benefits books, and handouts to determine what part of rehab their insurance will cover, but they quickly find themselves overwhelmed by the confusing vocabulary and all the fine print.
To really understand your coverage, you could call your insurance company directly, but be aware that they will want to pay out as little as possible, so their answers will be a bit biased and vague, and will not alert you to all your options. Better yet, call an alcohol rehab and enlist the help of the professionals there. These experts deal with insurance companies every day, and they will help you get the most out of your insurance coverage. The first step is determining your insurance coverage. After you know that, you can begin to build your treatment plan, and find additional methods for payment, if necessary.
It is important to deal with a facility with a good reputation that will stand by the financial information they relay to you. Many rehabs are only primarily interested in the money, will tell you your payment is one amount, but then bill you for a much higher amount when you are discharged.
Private and Group Insurance
The Affordable Care Act (ACA), passed in 2010, requires insurance companies to cover behavioral and mental health services as completely as they cover other medical conditions. This means that if the company covers 90% of medical services after a deductible is met, this should be the coverage for addiction treatment as well. Under the ACA, addiction is no longer considered a pre-existing condition for insurance purposes. The bottom line is insurance holders now can enjoy better coverage for their alcohol rehab. The result is that more Americans can get the treatment they need for things like addiction and mental health services. They just need to know how to navigate through the insurance maze.
Even though this is the law, some insurance companies and smaller employers don’t have to comply, and to keep costs down, won’t offer mental health or addiction coverage. Again, these loopholes make it important for you to have someone who knows the system talk to your insurance company directly and on your behalf to get to the bottom of what coverage you have and what is the best ethical way to access the coverage you have been paying for or promised.
Keep in mind that better or high premium insurance usually provides more options while covering more services at a higher percentage. Insurance companies can still only pay for a portion of a person’s medical services, depending on the amount of coverage the employer purchased. Some high premium and better insurance plans will cover all or nearly all of an individual’s detox, inpatient, and outpatient rehab. An individual with a lower premium pays less monthly for insurance, but can expect to have to pay for more of their rehab out-of-pocket.
Other variables in your treatment costs are the deductible and copay. The deductible, similar to a car insurance deductible, is a dollar amount you have to pay first before the insurance will pay. Usually a cheaper premium has a higher deductible. The copay is an amount you are co-paying with the insurance company. For residential stay, a copay can be several hundred to several thousand dollars. Some residentials are able to waive or lessen this. It is good to have someone who knows the system negotiate on your behalf. Outpatient copays might be $10-75 depending on whether it is an MD or a therapist.
Medicare is a federal government-sponsored plan for individuals over the age of 65 or who have a chronic disability. Medicare is for those on social security, either for retirement or disability, and provides medical and mental health insurance. In general, Medicare covers the majority of the cost of addiction treatment. However, since Medicare does not reimburse the facility like other insurances, has many restrictions and requirements, and is difficult for treatment centers to work with, most treatment centers do not accept Medicare payments. Due to restrictions on what type of care and length of treatment Medicare will cover, it is helpful to contact your treatment center or a qualified placement specialist to find out specifics.
Medicaid, also Called Medical Assistance
For low income individuals and families, Medicaid provides much-needed health coverage, including mental health services. Each state is in charge of their own Medicaid and creates their own regulations, so leaving the state for treatment with Medicaid is not allowed. Also, because of the many regulations and the low reimbursement to the treatment providers, very few facilities or agencies accept Medical Assistance. It is important to call the number on your Medicaid card to find out the clinics or rehab facilities in your area that will accept your Medicaid or medical assistance. You can also call your local hospital’s Emergency Department, and ask to speak with the Addiction Crisis worker, and they can tell you the number for the clinic or rehab facility which accepts your Medicaid. Lastly, you can call the facility you are interested in to see if they accept your state’s Medical Assistance.
Because of the ACA, Medicaid coverage for addiction and mental health services has been greatly improved. Today, Americans on Medicaid can expect to receive the same kind of coverage for their alcohol addiction rehab as for any other health condition. Under the ACA, when you receive treatment from a Medicaid provider, covered services generally include screening, family counseling, inpatient detox, residential rehab, intervention services, and even medications and are usually fully covered by Medicaid.
How to Best Utilize Your Coverage
Most people with insurance will find that regular doctor visits are covered, and this is a great place to start. Visit your doctor for an assessment to help determine your needs. Be very honest with how much you use, the consequences and struggles in your life, and your desire to stop drinking but having trouble stopping without intensive help. Your doctor can point you in the right direction as far as the level or intensity of care you should need, and your visit will also be documented in your medical records, showing your need for rehab. Find out how to select the right rehab for your needs here.
As much as cost is going to be a concern, your recovery is determined by finding the right rehab for your needs. You should contact various rehab centers or a referral organization to find what each facility offers and how the program will work for you. The most unbiased help you will get will be from a case management or referral agency that doesn’t own a facility. Once they help you find the best option for your addiction, find out if they accept your insurance. If they don’t, you can look for other rehabs that are similar to the one you want that do accept your insurance.
Finally, be assertive and don’t be afraid, embarrassed, or shy to ask questions to find out what will and will not be covered at your rehab of choice. If you find there are too many extras that you want but your insurance won’t cover, you might need to limit your choices or be prepared to pay for some of these services out-of-pocket.