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This monthly series focuses on addiction treatment: making the choice to begin, finding a facility that meets your needs, and more.
In recent years, the public perception of mental health and substance use disorders has come a long way. More and more, we are recognizing that these conditions are medical illnesses, not moral failings. And as such, expanding and protecting access to high-quality treatment has become necessary.
In 2008, The Mental Health Parity and Addiction Act was passed. In a nutshell, this legislation placed mental health and substance use insurance benefits on equal footing with surgical or medical coverages. Although the act does not obligate an insurance provider to cover these disorders, if their offered plans do extend such coverages, they are prohibited from limiting benefits in ways they do not for physical medicine. (There are exceptions, but they are few and far between.) This measure, along with the Affordable Care Act (ACA) (also known as Obamacare) signed into law in 2010, makes it near impossible today to find a marketplace insurance plan that does not cover mental health and addiction treatment in some capacity.
That being said, costs and levels of care covered vary widely. It is important to understand the nuances of your specific plan as you decide on a treatment provider for yourself or a loved one. Choosing the center that works for you can be confusing, and understanding how your care will be paid for is an important element of the process.
Health insurance benefits fall into 6 basic classifications:
If your plan offers coverage within these categories for physical health needs, they must concurrently be offering these benefits for those seeking treatment for addiction. There are, however, types of insurance plans that just plain do not cover some of these categories. For example, there are plans that do not offer out-of-network coverage under almost any circumstances. If that is true of your plan and the treatment facility you have chosen is out-of-network for your specific insurance provider, it is usually not the right option for you.
There can be other details that require clarification as well. Do you need a referral from a doctor? What level of care do you or your loved one require? Is inpatient withdrawal management (otherwise known as detox) needed? And so on.
Let’s take a quick look at the key types of insurance plans typically available in the marketplace. Which type of plan do you have?
Before you begin looking for addiction treatment, make sure you understand what your insurance plan will cover. Knowing your type of plan is a great start, but I also recommend making a phone call to your insurance provider to discuss further. As I’m sure you know, navigating health insurance coverage for any type of illness can be complex, and even frustrating. Addiction treatment is no exception. So don’t be shy: Ask for help and guidance.
After you’ve spoken with someone at your health insurer, you’ll also need to speak directly with the treatment providers you are considering. Most treatment providers will have a specialist on staff that can help walk you through the process and iron out any issues that you may encounter. Utilize their expertise!
As someone begins the process of recovery, the primary focus needs to be on treating the disease. Worrying about the paperwork and costs is an extra burden. But by doing your best to understand the options and coverage available to you, you can help reduce some of this burden and focus on what really matters: Getting well.
Roy Viger is the Executive Director for Avenues Recovery Center, and is responsible for business oversight for all Avenues Louisiana facilities. He is deeply committed to the field of addiction, the patients and families we serve, and proud to work with a talented and hardworking staff. Roy has a Bachelor’s degree in accounting from Southeastern Louisiana University and is distinguished as a certified public accountant.