You’ve chosen to seek treatment to overcome addiction. It took courage. The next step is the most difficult: determining what you’re able to actually afford.
The expense of detox inpatients can stop a large number of people before they begin. You’re probably thinking about whether your insurance plan will cover it, how much you’ll be paying yourself, and if treatment is even feasible now.
First of all, the majority of insurance plans will cover at least a part of inpatient detoxification treatment. The amount they pay depends on the specific plan you have. Knowing the basics can help you get treatment without having to pay for the process.
Here at Wood Mont Treatment We deal with insurance companies each day to provide medical treatment. This guide will help you understand the most important things to consider in terms of the insurance coverage of detox inpatients.
Why Insurance Pays for Detox?
The insurance coverage for addiction was not always provided. However, the Affordable Care Act made things better in 2010 when it made mental health and substance abuse treatment health benefits essential to the overall health of the patient, as are surgeries and prescription medications.
The Mental Health Parity Act also requires insurance companies to cover addiction treatments the same way as they do for physical health issues. They cannot impose more severe limitations on detox as they do in treating an injured arm.
Insurance companies have also discovered an important fact: paying for detox can save them money in the future. In the absence of treatment, addiction can lead to ER visits, hospitalizations for overdoses, as well as car accidents and chronic illnesses that cost far more than paying for detox early.
What Plans Usually Cover Detox?
Private insurance plans from major brands like Blue Cross, Aetna, Cigna, and UnitedHealthcare generally cover some inpatient detox. What you will pay depends on the plan you choose, your deductible, and whether the location is within their network.
Medicare covers detoxification for seniors or those with disabilities. Medicare Part A covers detox at a hospital if the establishment is a recipient of Medicare and your physician says you require it.
Medicaid differs by state, as each has its own Medicaid program. Certain states cover detox inpatients fully, while other states have some restrictions. Many states expanded Medicaid through the ACA, which typically results in greater addiction coverage.
Employer-sponsored plans almost always cover addiction treatment, but the specifics depend on which your employer has selected. You can call the number listed on your credit card to inquire about specifics.
What You’ll Actually Pay?
Coverage doesn’t mean free. A variety of factors affect the final cost.
The deductible is what you pay before insurance is able to help in any way. Are you facing a $3,000 deductible that you’ve not yet met this year? You’re already paying for that first. High-deductible plans are in the news and are causing higher initial costs, even if you have insurance.
After you’ve met your deductible, be required to pay copays or coinsurance. It could be $75 per day, 20 to 30 percent of the total cost. It can add up quickly during a seven-day detox.
In-network or out-of-network affects everything. In-network services have agreements with insurance companies and provide the agreed rates. Out-of-network providers cost you a lot more, as insurance companies pay little or nothing.
The same goes for preauthorization. Specific plans require approval prior to you can begin inpatient treatment. If you don’t do this, insurance could refuse to cover everything, including things that are usually covered.
Finding Out Your Coverage
Make a call to the number listed that is on the insurance policy. Inquire about detox inpatient coverage specifically. Learn about the preauthorization requirements as well as your deductible. Also, find out what facilities are included in the network and the number of days of treatment they allow.
Your benefit paperwork will explain your coverage as well, even though it’s often difficult to understand. Check for alcohol or mental health sections.
A majority of treatment centers review insurance coverage for you at no cost. They will take your information, and they will contact your insurance to determine what’s covered. At Wood Mont Treatment, we take this approach so you can know the costs in advance.
Inpatient Detox Treatment and Health Insurance Coverage
Inpatient detox treatment with health insurance coverage can ease financial stress while you focus on recovery. Learn how insurance plans may help cover safe, supervised detox care and support your first step toward lasting healing.
Get Started NowWhen Insurance Falls Short?
Even a good insurance policy could result in bills that seem impossible. There are options, however.
The payment plans spread costs across months rather than one large installment. Many providers offer flexible plans that are based on what you are able to pay for.
The sliding scale fees are adjusted in accordance with the income. Many nonprofit centers do this. You’ll have to provide documents proving your financial status to be eligible.
Healthcare financing, such as CareCredit, is similar to the medical card. It charges for treatment and then pays over time. Be aware of the higher interest rates following promotions, though.
Assistance programs for employees can provide additional assistance beyond the regular insurance. Counseling sessions are free, or you can get insurance for gaps in treatment.
State-funded health programs are for people who do not have insurance or have limited coverage. These programs have wait lists as well as income guidelines, but they provide a free or inexpensive treatment for those who meet the requirements.
Real Questions People Ask
Que – Does insurance cover all expenses?
Ans – Almost never. The majority of plans cover a large portion of your deductible; however, you’ll be responsible for coinsurance or copays based on your network and plan.
Que – What is the number of days included?
Ans – Usually, 3 to 7 days of medically required detox, based on the drug. Insurance is based upon medical need, which means that your doctor has proven you require an inpatient hospitalization for security reasons.
Que – What if they tell you”no?
Ans – Appeal with documentation from your doctor stating the reason you need detoxification inpatient setting. Facilities can assist with appeals. It is also possible to look at other network-based services or payment options.
Que – Do I require prior approval before I can apply?
Ans – Most plans require prior authorization before admission. The clinic typically handles this by providing the medical information to your insurance before you arrive.
Que – Do Medicare or Medicaid provide coverage?
Ans – Medicare Part A provides medically needed detoxification in centers that accept Medicare. Medicaid is different by state, but most states cover it in part or entirely for people who qualify.
Moving Forward
It’s not a reason to stop you from seeking help. The financial side can be daunting, but there are options. Contact your insurance company or visit a treatment center to review your benefits. Find out the details regarding costs, coverage, and other options when the cost seems excessive.
We work with insurance companies and assist patients in understanding the coverage and ways to make treatment cost-effective. The cost of treatment shouldn’t stop anyone from getting life-saving treatment.
Treatment is expensive in the beginning, but addiction can be costly in terms of personal and financial costs over time. Don’t let insurance questions stop you. You have options as well. Wood Mont Treatment can help you determine the medical and financial aspects of getting started on your recovery.
