With all of the commotion that has gone on in the past several years about health insurance, it is no wonder that average Americans have difficulty determining what is covered by their policies. It seems as if insurance providers come up with new rules all the time to limit who can receive what services and to delineate specific ways that medical services must be coded.
Because of the Affordable Care Act and Mental Health Parity and Addiction Equality Act, passed in 2008, insurance companies are required to provide coverage to millions of Americans who had previously been denied coverage for mental illness and rehab. Now, substance abuse treatment must be covered to much the same degree as other medical conditions are covered. However, rehab patients must beware of idiosyncrasies with their personal policies as well as changes that determine exactly how much can be covered.
Understanding Your Available Financial Options
In general, all public and private insurance companies will cover assessments for substance abuse. Past that point, they may either mostly or partially cover treatment options. Patients who require detox should be covered as long as they choose traditional methods because rapid detoxes are not usually covered. Additionally, outpatient rehab is usually covered at a far greater percentage than inpatient treatment is. In all instances, the treatments used must be determined to be “medically necessary” in order to be covered. Insurance will not usually pay for extras that are not necessary for treatment, such as private inpatient rooms.
Of course, patients or their designated family members must check their insurance policies themselves so that they will not be caught unaware by a big bill. They should start by calling the member services phone number for the insurance company and should ask about coverage for substance abuse treatment. They should be sure to ask about specifics regarding inpatient versus outpatient rehab as well as whether only in-network providers are covered. Even if they have coverage, they will most likely still have some out-of-pocket expense in the form of a deductible and co-pay.