Understanding Your Substance Abuse Insurance Coverage
According to the National Institute on Drug Abuse, there are nearly 15,000 different specialized substance abuse treatment facilities across the United States. While a health plan will typically provide addiction treatment insurance coverage, not every facility or treatment type will be covered within a given plan.
In some cases, it’s as simple as if a facility is “in-network,” meaning whether the treatment center has a contract with your insurance company. Other times, if a facility is covered, the amount of coverage provided by your health plan is determined by factors like whether the treatment center is private or public, or in-state or out-of-state.
This is usually fairly easy to verify either through your doctor, your insurance company, or the treatment center you are considering. Here at PBI, we try to make this verification process as simple as possible and have a handy list of the providers we work with below:
- Beacon Health Options
- USA Managed Care Organization
- Behavioral Health Solutions
- Managed Care Concepts
- Beech Street
- American Mental Health Network
- Three Rivers
- Wood & Associates
- Integrated Health Plans
If you do not see your insurance provider, we still encourage you to give us a call at 1-855-960-5456 and let one of our trained coordinators discuss full and partial private-pay options and help work with you to devise a practical financial plan.
One worry that many potential clients have is that treatment for their specific substance dependency will not be covered by their health plan. However, unlike what is often the case with prescription medication, your insurance plan will generally not go as far as to have some specific substances covered and others not.
In other words, they will cover you for alcohol dependency but not heroin. As with many other broadly-termed medical conditions, as long as your plan lists addiction treatment as a covered benefit, then care will be provided, regardless of the source of the addiction.
While some plans may keep some things simple by including all substances when it comes to health insurance that covers substance abuse, it doesn’t necessarily mean that all treatment or therapy types will be covered.
Because of this, it’s important to know what types of substance abuse treatment your coverage can be used for. Depending on the specifics of your health plan, you may be covered for the following services:
- Medical detox, which may include maintenance medications
- Outpatient care with an approved, in-network provider
- Long-term residential care at an approved, in-network facility
- Co-occurring disorders or mental health issues
- Aftercare counseling or therapy
While many insurance companies are typically more likely to provide full coverage for outpatient care over inpatient or residential care, what matters most is selecting the treatment that provides the greatest opportunity for successful recovery.
A particular insurance company may also view aftercare as an unnecessary extra and therefore not cover it, but it is still a crucial part of the recovery process, especially when it comes to relapse prevention.
This is why, if a plan will not cover certain treatments or services, or maybe just doesn’t cover them completely, The Palm Beach Institute works with you to create a partial private-pay plan that is within your means and makes the necessary treatment a practical option.
Treatment duration is the other major variable when it comes to what your insurance covers. Depending on your plan, your insurance provider may be willing to cover the full length of your treatment, while others can only cover a set amount of days, which can be difficult if you require a longer detox period or residential stay.
The length of treatment that your insurance company will cover may also be determined based on whether you are at a private or public treatment facility. Private facilities can be more costly, and therefore you might hit the maximum amount of treatment covered faster than you would at a public treatment center.
However, the priorities when choosing a treatment center should be quality, credentials, and treatment plans that have a proven track record of success. As we previously mentioned, if your insurance company does not cover or provide full coverage for the recovery treatment services that you need, The Palm Beach Institute is here to help.
The Palm Beach Institute Makes It Easy to Get Into Treatment
The staff at PBI collaborates with insurance professionals and advocates on behalf of patients to make optimal use of available insurance benefits and explore alternative financing options to ease the burden that paying for treatment can create.
So don’t let fears about cost and coverage be the thing that stops you from getting life-saving treatment for you or your loved one. Our specialists are standing by 24/7 to answer your call and provide you with the information you need. So call 1-855-534-3574 now or fill out the form below: