substance abuse insurance coverage

Substance Abuse Insurance Coverage

Adam Jasinski General

If you are beginning to take steps to deal with your child’s addiction, whether they are actively addicted or just beginning to abuse substances, you need to be concerned with how you can help pay for their recovery.
With the changes that have recently been made regarding healthcare coverage for both addiction and mental health concerns by insurance companies, it is now a lot easier to get someone the help they need.

Your insurance selection process should involve making sure you have the proper coverage for both your entire family and specifically for those under your care who are actively using. The cost of a good treatment center can run upwards of $30,000 a month. Not having insurance while your kid’s actively using will eventually lead to unneeded medical bills, which can turn into unpaid medical bills, which can destroy credit and make it a lot harder to move forward once your child is sober.

It’s easy to say “My child is an adult now; he can figure it out himself,” and try to give them tough love. However, now the law requires that insurance companies allow your children to be covered under your policy until the age of 26. When I was growing up, I was off my parent’s insurance at the age of 18. This is a game changer in both affordability and the benefit of getting care.

I recommend from the bottom of my heart that if your child is actively using drugs, you find a way to get them proper healthcare coverage. That way, when the time comes to get them help, you can get hundreds of thousands of dollars of care for only a few hundred bucks a month.

Different Types of Coverage

Government policies like Medicaid or Medicare are one type of coverage that provide less fortunate, low income families insurance options affordable for them. These policies, such as Molina and a variety of other names based on state, require you to get help at certain medical facilities and from doctors that are in the policy’s network of providers. So, very rarely are mental health and decent drug and alcohol treatment centers covered under these policies. You will, however, be covered—with all your medical services paid for—if you admit your child into a hospital for detox or go to a more institutionalized government type of rehab program.

When it comes to private health insurance, a cheaper option is usually an HMO plan. These plans usually require you to go to doctors and programs that are in a network with that insurance provider. This is beneficial in that it allows for a lower insurance cost, but in times of need, 90% of the higher quality and more effective programs require out-of-network benefits which an HMO plan does not cover. An HMO plan will require you to reach out to the insurance company to look through their list of certified providers and make a choice based upon those registered in the network. Only about 10% of the nation’s treatment centers and only 5% of the nation’s private laboratories and doctors in the substance-abuse field will accept an HMO policy or be listed in the network.

The hybrid model is an EPO policy. This is the next step up from HMO. The EPO policy will require that the majority of services come from within the policy’s network of providers but will also have the option for several services to be paid on an out-of-network basis.

The premier insurance plans are the PPOs. These plans allow you to have out-of-network benefits and choose who you use for your services, not restricting you to a specific network of physicians, treatment centers, and providers. On these policies you can literally get $50k worth of treatment a month to ensure that your loved one’s taken care of in the best possible way at the best possible programs in the field.

With a PPO, what you always want to look into is the amount of mental health coverage allotted on your policy. Some may only approve of a minimal number of treatment days, while other policies may approve a much higher number of treatment days, which are needed to achieve a stronger foothold in sobriety. The pricing difference between these policies may vary from $100 a month to several hundred dollars a month, but at the end of the day, just know it’s better than receiving a bill for $50,000 a month.

There is also Obamacare and the healthcare network, which can be extremely difficult to navigate in order to actually see what policy you’re getting. Something with a $6000 deductible is not a very beneficial policy, because that costs $6000 out of pocket before you can actually start having the insurance cover the expenses.

So, never go with the cheapest insurance and find a PPO policy if possible. Look into the silver plan, as those are usually the ones that provide the best bang for your buck, so to say.

Find a local agent who specializes in personal insurance and health care, and explain to them what your needs will be. You cannot be denied coverage for a pre-existing mental health or substance abuse condition, so please tell the agent that someone in your family suffers from such a condition and that you need the coverage in order to get them help. Ask the agent to suggest the best possible policy you can get in order to do that.

I see it all day down here. It’s not fun having to sit in an institution or government-run facility trying to get sober when you could be amongst peers and people who do not discriminate or judge. A policy that allows you a proper facility just makes life a whole hell of a lot easier.

I, myself, I went through a government agency for my insurance, and I went to a county-run rehab. I got scholarships through many programs, but in retrospect, I see what my other options could’ve been, and I wish my mom had been able to get me on her insurance.

Insurance is not only for the rehab portion of treatment, but also the continuing level of care to repair some of the damage done to your body by the drug and substance abuse, to maintain sobriety, and to maintain your health after rehab. It’s a good idea to spend the extra money to have good insurance instead of being stuck with huge bills and/or insufficient treatment and care.