Insurance

 

Treatment Costs


Addiction treatment is a highly personal experience, and the costs associated with treatment depend upon a number of issues, including the specific nature of your problem being treated, the amount of time you will need to remain in treatment and the presence of any co-occurring disorders.

Accessing insurance for addiction treatment can be intimidating, especially at a time of crisis.  Phoenix House is an in-network provider for many major insurance carriers, Our experienced staff advocates for you and is skilled at working with all types of insurance providers to help you access the treatment you need. managed care programs, and Medicaid. If we’re not an in-network provider for you, you may be able to use out-of-network benefits to help cover the cost of treatment.

Our admissions counselors are available to arrange admissions, facilitate transportation, schedule evaluations, and assist with all of your insurance needs. We advocate for you and help you navigate the insurance system so that you can get the care you need.

Once we determine the most appropriate level of care for you or your loved one, we’ll contact your insurance company to provide a pre-certification assessment, explore your coverage and explain to your insurance company why you meet the clinical criteria for your level of care.

We are committed to being honest and transparent about the cost of your treatment plan and will work with you to find the funding source that’s best for you.  If your insurance stops funding treatment or if you don’t have coverage, we work with you to ensure you can continue to get care through a self-pay program.

Many people assume they cannot afford treatment or are under the impression that getting addiction treatment is out of their reach financially. However, our treatment costs are covered by many insurance plans. When you first call our Treatment Consultants, they will help you determine what percentage, if any, of the treatment costs are covered by your insurance plan.

Our representatives will verify the client’s insurance benefits for free, with no obligation. Many people contact us and aren’t sure whether their insurance plan covers the cost of treatment. That’s okay. We can help determine your insurance plan benefits, co-pays, or other payment plans that can help you or your loved one get the critical help you need.

Sometimes for personal reasons, clients don’t want to pay for addiction treatment by submitting claims through their health insurance plans. Some prefer this payment option as it allows for increased confidentiality. In addition, individuals without insurance may choose the private payment option to pay for their rehabilitation treatment.

Our highly-trained Treatment Consultants can assist in determining the payment option that best meets the client’s needs. In reality, many insurance plans cover treatment costs. Our Treatment Consultants will help you find a way to pay for treatment, figure out co-pays, or work out a payment plan with a healthcare lending company. We’ll assist in finding the path to recovery for you or your loved one.

 

HOW HEALTH INSURANCE COVERAGE HELPS PAY FOR REHAB

Until very recently, health insurance coverage didn’t pay for drug or alcohol rehab. But the landscape of healthcare was drastically changed through the Affordable Care Act and other legislation. Now, patients are able to gain the drug and alcohol rehab they need with financial support from their insurance policies.

Additional help came from the American Medical Association with that leading healthcare organization’s recognition of addiction as a legitimate disease requiring medical treatment. Through this acknowledgement of addiction as a medical disease, doors to better health insurance coverage of treatment were opened even farther.

To find out what level of care you can receive from a drug and alcohol rehab using your health insurance coverage, call the rehab facility and have your insurance verified. Through verification, you can find out if you’re eligible for insurance policy coverage of rehab. 

 

Once you or your loved one decides to get help, the immediate questions you’ll face include where to get treatment and how to pay for it or does my insurance cover drug rehab? The following information can help you understand health insurance coverage for drug rehab and some important laws that impact coverage. Understanding your coverage can help you to get the best care possible and all of the benefits that you are entitled to receive.

Our counselors can help you locate a drug rehab that will work with your insurance to help find a quality treatment program accessible and available to your loved one. Call today to learn more about your insurance coverage for drug addiction treatment.

Parity Laws

To understand how health insurance works when paying for drug rehab, it’s helpful to first understand federal and state parity laws.

Federal Parity Law

In the past, most health plans have provided more limited coverage for substance abuse (if any) than for other medical conditions. On Oct. 3, 2008, President Bush signed into law the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. (We’ll call it the “Parity” Act for short.) This new federal law became effective for most plans on January 1, 2010.

The Parity Act requires large employer (companies with more than 50 employees) group health plans that offer coverage (benefits) for mental illness and alcohol and drug rehabilitation to provide those benefits in a way that is no more restrictive than coverage for other medical and surgical care. The Parity Act does not require group health plans to cover mental health and substance use treatment. But, when these plans do cover this treatment, they must do so with “parity”— in a way that is equal to the way benefits for medical and surgical care are doled out.

The intent of the law is to recognize (show an understanding of) the close relationship between mental health and overall health, and to make sure that more people get the treatment they need to overcome addiction.

Keep in mind, the Parity Act does not apply to small employers — those with fewer than 51 employees, and it doesn’t apply to individual plans — plans you don’t get through an employer, but go out and buy directly from an insurer yourself. The Parity Act also doesn’t apply to Medicare and Medicaid, but sometimes there are exceptions depending on how these plans are administered (handled).

State Parity Laws

Many states had already passed similar laws, so most larger employers were already paying benefits for drug and alcohol treatment in less restrictive ways than for medical and surgical care. However, certain employers with “self-insured” medical plans — companies that pay benefits with their own money rather than with the insurer’s money — don’t have to follow most state-mandated laws, but they are required to comply with the Parity Act. Still, a self-funded employer could choose not to cover substance abuse at all, and then it wouldn’t have to comply with either federal or state law. Overall, 96 percent of employers say they provide coverage for substance use treatment (and mental health).

When the plan is bound by both the (federal) Parity Act and a state parity law, the one that provides the greater benefit applies.

Health Insurance When Paying for Drug Rehab

Due to federal and state parity laws and other factors, health insurance coverage for drug rehabilitation varies widely. Your coverage will depend on a number of factors, including whether the Parity Act applies to your plan, what state you live in, and what types of benefits are offered by your plan.

Even when you have coverage, you still need to pay close attention to what that coverage is and how the insurer will manage your case.

 

November 10, 2017