Two of the most significant barriers that people often find themselves up against when seeking treatment are cost and, if you have insurance, the difficulty navigating what your insurance may or may not cover in regard to substance abuse treatment.
Cost should never be the reason that someone is unable to get the help that they need, especially when it comes to addiction treatment, which for many can mean the difference between life and death.
At The Palm Beach Institute, we work with you to help understand all of your addiction treatment insurance coverage options and provide a comprehensive review of your insurance benefits to make the financial part of getting into rehabilitation treatment as stress-free as possible.
Below, we’ve answered some of the most frequently asked questions people have about health insurance and how it relates to different recovery treatment programs and options. If you’d like to speak to an intake specialist now, just call us or reach out online.
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:
If you do not see your insurance provider, we still encourage you to give us a call 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 valuable 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:
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 best opportunity for a 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.
Addiction treatment is a personalized process that should adapt to your needs. You may go through medical detox to guide you through withdrawal symptoms. Then you could go through inpatient treatment or outpatient treatment depending on your needs. The therapies you take part in through your treatment program will also depend on your specific needs.
You will likely go through group and individual therapy and some form of behavioral therapy. If you have needs that require a specialist like schizophrenia, you might be referred to people that can help you address needs that can’t be effectively treated at your treatment center. For that reason, the cost of treatment can vary based on what you need.
Like most healthcare procedures and programs, addiction treatment can be expensive. Is it actually worth the cost? Treatment has proven to reduce a person’s exposure to potentially dangerous illicit drugs, it helps avoid legal issues, and it can help you keep and maintain employment.
Active addiction can take a heavy toll on your life, even from just a financial standpoint. Funding an addiction can cost a lot of money, especially if your drug of choice is expensive. Even if it’s not, active addiction often leads to legal problems and job loss, two things that can be expensive.
According to the National Institute on Drug Abuse, every dollar invested in treatment yields a return of four to seven dollars in reducing crime-related legal costs. Substance use disorders can also lead to medical complications that cost money to treat.
Yes, most private insurance companies offer coverage for addiction treatment. The amount of coverage you get will depend on your needs, your insurance policy, and the treatment center you attend.
For instance, if you have a substance use disorder that involves marijuana, you may not get coverage for medical detox because marijuana isn’t known to cause severe withdrawal symptoms. However, to figure out how much coverage you will get for your treatment program, you can speak with an intake coordinator at your treatment center, or with your insurance representative.
Many addiction treatment centers, like the Palm Beach Institute, will accept most forms of private health insurance. However, some centers will not accept some insurance options. The best way to answer this question for your specific insurance plan is to call your preferred treatment center.
It’s harder to find addiction treatment that will accept Medicaid coverage than it would be to find someone that would accept private insurance. Federal health insurance options often come with a lot of red tape for healthcare providers. The administrative costs are often prohibitive and deter many treatment centers from going through the process of accepting Medicaid patients. Plus, Medicaid often takes a long time to deliver payouts, and when it does, the payouts are small. Many treatment centers consider Medicaid more trouble than it’s worth. However, some treatment centers may accept Medicaid in an effort to reach more people with addiction treatment.
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. Call now or fill out the form below:
National Institute on Drug Abuse. (n.d.). How effective is drug addiction treatment? from from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment
National Institute on Drug Abuse. (2018, January). Is drug addiction treatment worth its cost? from from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost
National Institute on Drug Abuse. (2016, February). 8: Medical detoxification. from from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification
ScienceDirect. (n.d.). Long Term Residential Care. from from https://www.sciencedirect.com/topics/medicine-and-dentistry/long-term-residential-care
T, B, (June, 2019). The Costs of Drug Use to Society. Verywell Mind. Retrieved August, 2019 from from from https://www.verywellmind.com/what-are-the-costs-of-drug-abuse-to-society-63037