Does Health Insurance Cover Substance Abuse Treatment?

Does Health Insurance Cover Substance Abuse Treatment?

The cost of addiction far exceeds any monetary fund. Studies have proven that the consequences of substance abuse disorder have a ripple effect that touches lives beyond just the individual abusing alcohol and drugs. Friends, family, and even co-workers and employers suffer when addiction takes hold of someone they know. Additionally, addiction also leaves an individual isolated where dependency and spiraling habits reach dangerous levels. Recovery is challenging for numerous reasons, including shame and associate costs.

Even with many new advances in science to aid substance abuse recovery, millions of families question whether a treatment program is a viable option. Does health insurance cover substance abuse treatment? We’re taking a look at some need-to-know facts.

If high costs prevent you from seeking help for substance abuse, contact AspenRidge Recovery directly at (719) 259-1107. We can help you verify your insurance and begin assessments for our treatment services. 

Insurance For Addiction Treatment

Prevalence of Alcohol and Drug Addiction in Colorado

A Denver Public Health study noted that treatment for methamphetamine abuse has doubled between 2012 and 2016. Heroin use rose from 4% in 2012 to 7% by 2016. Fentanyl death rates have more than quadrupled between 2012 and 2016, according to a Colorado Health Institute study.

The National Institute on Drug Abuse noted alarming trends in drug use in the Denver area. Another study published by WalletHub listed Colorado among the top four states with the highest drug use. It used fifteen metrics group under three main categories:

  • Drug Use & Addiction
  • Law Enforcement
  • Drug Health Issues & rehab

Struggles with alcohol and drug use are ubiquitous in the Centennial State. Why aren’t more residents seeking treatment?

Costs Associated with Drug Treatment

Does health insurance cover substance abuse treatment? It’s a critical question for families facing the destruction of drugs and those who may also be dealing with financial struggles. The societal costs of drug abuse are also alarming. According to estimates, the price for all drug use has exceeded $820 billion a year. It results in:

  1. Loss of productivity and inadequate work performance
  2. Expenses associated with the criminal justice system
  3. Intervention and support from the healthcare system

As one of the most troubling diseases – alcohol alone is the third leading cause of preventable death – treatment should focus on every family and individual with SUD. However, that’s not yet the case. Let’s take a look, historically, how treatment programs have functioned.

Between 1900 and 1950, hospitals opened to treat individuals with substance abuse issues, but only those from wealthy means. Treatment costs were $350 a day in the early 1900s. This is equivalent to almost $6,000 today.

Alcohol or drug addiction was first recognized as an illness in 1956 by the American Medical Association (AMA). Addiction wasn’t classified as a disease until 1987. Diseases typically require treatment, yet programs were still largely inaccessible well into the early 2000s. The total spend on substance abuse treatment in the United States was estimated at $21 billion in 2003.

New Policy: Required Insurance Coverage for Addiction Rehab

Insurance companies did agree to pay for treatment or some portion of alcohol and drug rehab in the mid-1960s. The policy didn’t change until 2008. In 2008, the Mental Health Parity and Addiction Equity Act required insurance companies and group health plans to provide substance use treatment and services as part of medical care.

Under the Affordable Care Act of 2010, drug and alcohol rehab became more affordable for all Americans. It is a way to help pay for treatment. Additionally, substance abuse is no longer viewed as a pre-existing condition for Insurance coverage.

The Affordable Care Act expanded rehab and recovery addiction treatment options to include Americans covered by Medicaid or Medicare.

Does Health Insurance Cover Addiction Treatment

Types of Rehab and Recovery Programs Provided by Insurance

Treatment programs vary and will largely depend on individual preferences or arrangements. Some programs offer hospitalization care and medical supervision, while others provide outpatient services. Some facilities provide intensive outpatient programs where addicts attend daily meetings but return home at night. Others have inpatient rehab.

Does health insurance cover substance abuse treatment and all different types? In 2014, close to 91% of Americans had health insurance. Depending on the plan specifics, those with insurance were able to use their coverage for:

  • Inpatient care in an approved facility
  • Outpatient care with an approved provider
  • Medical detox, including medications
  • Co-occurring mental health conditions
  • Follow-up counseling
  • Maintenance medication

Health insurance was once considered a bit of a luxury. People with tight budgets and low-paying jobs may not have had the extra cash they needed in order to buy expensive health care plans, so they tried to save up enough money to allow them to get care for problems deemed life-threatening. Anything else went unaddressed. Often, that meant addictions went untreated. For people without health insurance, getting medical care for addiction was just too expensive to consider.

Insurance Covering Substance Abuse: HMO vs. PPO

The Affordable Care Act was a catalyst for viewing addiction as a treatable illness requiring support by the health insurance industry. With different insurances, there are two more common types of healthcare plans including HMO and PPO.

HMO (Helath Maintenance Organization): This plan assigns a primary care physician to treat most medical needs. When seeking a specialist or physician outside of the network, a referral is needed by a primary care physician. HMOs typically have lower or no deductibles and overall coverage is usually a lower cost than PPO. The benefit of HMO is the lower premiums. The disadvantages is that referrals can be difficult to obtain.

PPO (Preferred Provider Organization): This plan allows patients to see healthcare providers in and out of their network without referrals. PPOs have higher deductibles. The benefits of having a PPO plan is that it provides the options to see specialists and other healthcare providers outside of your network.

Does Health Insurance Cover Substance Abuse Treatment?

Within the healthcare marketplace, providers must cover addiction care. The National Institute on Drug Abuse reports that there are more than 14,500 specialized treatment facilities for drug addiction in the United States alone. Plans are also required to provide the same level of care for mental health concerns that they do for physical health concerns.

Aftercare treatment like maintenance and medications are usually included in most healthcare plans. Health insurance benefits are designed to make health care both affordable and accessible, and there’s no stigma attached to asking for help. People with addictions and insurance should use their coverage to the fullest in order to get the care they need to leave addictions behind for good.

Why People Don’t Seek Treatment

A report, Making the Wise Investment, by the Colorado Health Institute noted that Colorado drug overdose death rates have doubled since 2000. In 1999, there were just over a hundred deaths. In 2016, more than five times as many people died of drug overdoses. Prevention and treatment are crucial.

According to Addiction Center reports, more than twenty-one million Americans struggle with drug or alcohol addiction. Yet, only ten percent seek treatment.

Fact remains that many individuals don’t seek treatment due to stigma, costs, and denial.

How to Pay for Addiction Care?

While millions of Americans battle with alcohol and drug addiction, they often avoid treatment because they have no idea how to pay for it. Studies have shown that substance abuse is more common among individuals of lower economic status. Accessing care for support and treatment depends on associated costs and payment support programs.

Cost of Addiction Treatment

Recovery programs vary for each rehab center. Factors that influence the cost of drug rehab include:

  1. Program length
  2. Type o f program
  3. Types of amenities
  4. Location

Residential treatment, for example, is among the most expensive types of treatment. Because most residential rehabs require in-house and around-the-clock medical care, costs can easily exceed $30,000. Some luxury facilities can charge more than $100,000 for 30-day treatment options.

Unfortunately, insurance doesn’t always cover everything. Like other health services, patients are usually responsible for some out-of-pocket costs. However, the expenses are well worth it when weighed against the costs of drug abuse and the criminal system.

Getting Help For Substance Abuse

Does AspenRidge Recovery Accept Health Insurance?

Located in Fort Collins, Denver, and Colorado Springs, AspenRidge provides a variety of treatment options to meet the unique needs of its clients. 

The caring professionals at AspenRidge addiction rehab and recovery facilities know how confusing and frustrating it can be to navigate the health insurance business. Trained, knowledgeable, empathetic counselors are prepared to deal with those tricky issues of understanding your benefits and making claims for you.

AspenRidge is prepared to work with insurance company PPO plans. We will provide assistance in verifying your coverage benefits. Our licensed team will sit down with you and explain what your healthcare policy covers and any additional costs you might incur and possible payment options.

AspenRidge staff will work out a flexible plan for rehab and recovery costs not covered by your health insurance. Don’t let costs stand in the way of finding sobriety. We can help provide access to critical care and work with you to eliminate the stresses of financial burdens.

Please call our admissions center at our Colorado addiction treatment centers to gain immediate assistance at 855-281-5588.

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