The stigma surrounding substance abuse and addiction has shifted dramatically over the past decade in America. While in our no too distant past, addiction was considered to be the result of poor judgment and a lack of control, it is now known as a brain disorder and is listed as such in the Diagnostic and Statistical Manuel of Mental Disorders, 5th Edition (DSM-5). Most health insurance companies do offer some type of coverage for individuals in need of substance abuse and addiction treatment. There are, of course, substance abuse and addiction treatment programs that do not accept insurance as a form of any portion of payment for attendance.
It’s the Law
The Mental Health Parity and Addiction Equity Act of 2008 was passed, which had grave implications for the insurance companies. This act stipulates that insurance companies are no longer able to deny coverage or discriminate against individuals that struggle with substance abuse or addiction. Not long after, the Affordable Care Act of 2010 was passed. This act classified mental health in addition to addiction services as essential healthcare benefits. The passing of these two acts essentially forced insurance companies to treat mental health and substance abuse treatment akin to regular health treatment. While the laws are a move in a positive direction regarding accessible treatment options becoming available to those in need, there are still loopholes that insurance companies often employ at the expense of its members. Understanding your insurance policy and the intricacies surrounding your plans specific coverage limitations is essential.
The Fine Print
There are several common stipulations associated with health insurance coverage for substance abuse and addiction treatment programs. Some examples can include the following:
- Denying coverage if you have previously attended rehab
- Changing coverage based on the type of addiction
- Changing coverage based on the duration of treatment
- Not providing coverage for detox
- Changing coverage based on the type of treatment (inpatient vs. outpatient)
- Only covering the use of “in-network” providers
Full coverage is not necessarily a give in, regardless of how exceptional your health insurance plan may be. Do not hesitate to ask your insurance company questions. Make sure you are familiar with the fine print associated with your health insurance coverage, so as to avoid incurring any unexpected fees.
Relapsing
Although addiction is characterized as a relapsing disorder, many insurance companies regard relapsing as a pre-existing disorder. Insurance companies then use this to deny coverage for attending subsequent substance abuse and addiction treatment programs. It is highly common for an individual to struggle with relapsing when he or she is in recovery. Make sure you are aware of your insurance providers policy with regards to pre-existing disorders and relapsing.
Each specific rehab will have different fees associated with its attendance. Additionally, there are a plethora of different types of insurance carriers as well as insurance plans available, each with varying levels of coverage in regards to substance abuse and addiction treatment programs. It is best to fully understand the benefits associated with one’s specific health insurance plan as well as the entire costs associated with the substance abuse and addiction treatment program of your choice.
For Information and Support
If you are concerned for yourself or a loved one in regards to substance abuse and/ or addiction we recommend reaching out for help as soon as possible. If left untreated, substance abuse can result in long lasting and potentially life threatening consequences. Keep in mind: you are not alone! There is an entire network of professionals that are available to help and support you and your loved one throughout the recovery process. The earlier you seek support, the sooner your loved one can return to a happy, healthy and fulfilling life.
Please do not hesitate to reach out with any questions regarding our specific program at Haven House Addiction Treatment and/ or general substance abuse and/ or addiction treatment related information. Our highly trained staff is readily available to discuss how we might best be able to help you and your loved one.
