does insurance help pay for long-term addiction treatment

Does insurance help pay for long-term addiction treatment? No doubt, that's a question many potential patients of Cornerstone of Recovery have. After all, financial obstacles are one of the biggest impediments toward alcoholics and addicts getting the help that they need.

Consider the numbers: According to the 2015 National Survey on Drug Use and Health (NSDUH) [1], 8.1 percent of Americans, or 21.7 million people, ages 12 or older needed addiction or alcoholism treatment during the previous year. However, only 10.8 percent of that number — 2.3 million people ages 12 and older — actually received it. No doubt, the availability of programs and facilities played a role in such a small percentage, but one of the three biggest hurdles is financial, according to a 2012 article in Psychology Today.

However, many individuals who have health insurance don’t realize that they’re entitled to parity — meaning that “under a 2008 federal law, insurers have to consider drug and alcohol addiction the same as any other medical problem, as far as access to treatment goes,” according to a 2015 piece by NPR [2]. In addition, according to the online insurance news agency Insurance Quotes [3], “With the exception of Arizona, Georgia, Indiana, Iowa, Idaho, Oklahoma, and Wyoming, all states currently require commercial group health insurers to cover addiction treatment services as they would any other prescribed medical treatment.”

In other words, federal law requires health insurance plans to pay for drug and alcohol treatment, and so do the laws of 43 states. Activating those benefits, however, may seem like something of a headache.

How Does Insurance Work?

does insurance help pay for long-term addiction treatmentHow do you file any other medical claim under your health insurance? You give the health care provider your necessary insurance information. It works the same way with addiction or alcoholism treatment: Part of the initial Admissions process is to certify your coverage and eligibility, which helps us determine what sort of coverage to which you’re entitled.

If you want to know before you call, you can consult your Summary of Benefits and Coverage (SBC), a cross-company tool created as part of the Affordable Care Act in 2010. Each insurance company details in its SBC what is and is not covered. For example: According to BlueCross BlueShield of Tennessee’s SBC for its Silver S01S Network S plan [4], the deductible is $500 per person or $1,000 per family. After the deductible, the plan pays for 50 percent of both residential inpatient addiction treatment and outpatient addiction treatment, but prior authorization is required, and the facility must be in-network with BCBS of Tennessee.

What this means is that you need to find a facility that accepts BCBS Tennessee and then obtain authorization from the insurance company to seek treatment there. Prior authorization is a process that our trained Admissions staff handles, and because we’re in network with BCBS Tennessee — along with many other private health insurance plans — we’ll get the green light from the company, weigh the amount insurance will pay vs. the cost of treatment and present you with a number that will be your out-of-pocket expenses.

For individuals who seek long-term treatment, there is often a savings involved when all of our services are bundled together. In addition, we can work with you on a payment plan for your out-of-pocket expenses. We understand that the idea of taking on a financial obligation can be scary, especially when addicts and alcoholics don’t always have money available for such expenses. However, there are avenues we can help you explore to finance treatment, because we believe that what you’re purchasing isn’t just a medical procedure — it’s a whole new way of life.

What Does Long-Term Treatment Include?

does insurance help pay for long-term addiction treatmentThe rate for drug and alcohol treatment varies according to the level of care that’s required or desired, but for long-term treatment, it involves services you’ll be hard-pressed to find anywhere else for a comparable price:

  • Medical Detox for three to five days, monitored by nursing staff around the clock and comfort medications to ease withdrawal;
  • Residential inpatient treatment for 28 to 35 days, featuring a variety of different therapies and processes;
  • One-on-one counseling;
  • Family therapy, in individual and group settings;
  • A bed in a two-person room in our spacious on-campus dormitory;
  • Three meals a day;
  • Weekend activities and outings;
  • Ten weeks of Intensive Outpatient treatment;
  • Transportation to and from any outside appointments; and
  • Access to on-campus medical staff for any unexpected medical issues.

At Cornerstone, we believe in a “whole person” approach to addiction treatment that includes recommended standards by the National Institute on Drug Abuse [5]: “In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.”

None of that is possible, however, unless patients commit to getting the help they need. Far too many, unfortunately, buy into the false assumption that treatment is unaffordable or won’t be covered by their insurance plans. At Cornerstone, we’ve worked for 30 years to establish a strong relationship with our insurance providing partners, but our commitment has always remained firm to the individuals who come to us for help.

Insurance can and does cover long-term addiction treatment, but the first step is in letting us help you figure out how.

SOURCES

[1]: https://www.samhsa.gov/data/sites/default/files/report_2716/ShortReport-2716.html

[2]: https://www.npr.org/sections/health-shots/2015/08/16/430437514/when-rehab-might-help-an-addict-but-insurance-wont-cover-it

[3]: http://www.insurancequotes.org/health-insurance/health-resources/addiction-treatment-coverage/

[4]: https://www.bcbst.com/sbc/2019/129800/S01S_SBC.pdf

[5]: https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment