Getting help for your substance use and mental health disorders means you’ll need to think about the cost of treatment. You may be wondering, “Can I even afford this?”
The thought of going to treatment is a life-changing decision; your life depends on it. Money is the last thing you should worry about, so we’re doing what we can to make it easier for you to have treatment costs and funding to treat your substance use disorder in place.
Under the law, insurance companies must provide coverage for substance use disorder treatment. The passing of the Affordable Care Act in 2010 provides more Americans access to addiction treatment. But, the type and length of coverage for treatment will vary depending on the plan.
Above all, the act prohibits insurance companies from denying coverage for mental disorders. As a result, insurance companies must cover the cost of preventative services. These services include behavioral health and depression screenings. Simultaneously, they can’t put an annual or lifetime coverage limit on substance use disorder (SUD) therapies.
When coming to Sana Lake Behavioral Wellness for treatment, you can focus on your healing and wellness first. We’ll help make the path easier for approaching your insurance company for treatment finances.
We provide a professional and confidential review of your insurance information, making sure everything is in order, and taking care of the payment verification process. Your attention can go where it needs: on your recovery. We’ll look after the rest.
Even though insurers have to cover SUD treatment, they don’t all cover the same services. However, at Sana Lake BWC, we offer many of the standard programs insurers cover, including:
Whether someone is suffering from heroin addiction or an addiction to alcohol, insurers have to cover all addictions. However, a member’s coverage depends on their plan.
It’s vital to pay attention to what substances a center treats. For instance, the treatment approach is different for meth than it is for alcohol. The difference is particularly true for detox programs. The reason being, the withdrawal process is different between substances.
For the most part, insurers cover traditional therapies. However, many don’t cover some holistic therapies. For example, massage and acupuncture are not typically covered. These therapies are a luxury, so insurers likely won’t cover them. But, some companies do.
Measuring your recovery outcomes means you’ll be able to negotiate better rates with insurance companies. We utilize the One Step App in your personalized treatment plan, which will allow us to privately track and measure your recovery outcomes for better insurance reimbursements.
Click the links below to find out more information on these commonly used insurance providers and find answers to common questions:
Previously, health insurance was a luxury only the wealthy could afford. Because it was so expensive, many on tight budgets couldn’t afford it. So treatment cost leads to only treating life-threatening issues. However, SUD treatment was too expensive, even to consider.
But with the passing of the Affordable Care Act, all of that changed. Now, more Americans have insurance coverage than ever before. In fact, in 2018, the U.S. Census Bureau states that only 8.5% of people did not have insurance.
Furthermore, 91.5% of Americans had coverage for health problems. Coverage for mental health and SUD are usually included in plans. However, most plans contain limits and stipulations to receiving treatment.
The two most common insurance plans are HMO and PPO. Each one may, however, have different coverage for SUD treatment. The following explains the difference between HMO and PPO plans.
HMO plans allow members to choose an in-network primary care doctor. This doctor will see the member for most of their medical needs. Seeing the same doctor helps in treatment because they know the whole health history.
Generally, to see an out-of-network doctor or a specialist, members need a referral from the. HMO plans have little to no deductible and typically cost less than PPO plans. The pros of HMOs include low monthly premiums for otherwise healthy members.
PPO plans allow members to choose a primary care doctor, even if they’re out-of-network. However, PPOs have higher deductibles than HMO plans. One pro of PPOs is the ability to see specialists without a referral.
As part of the Affordable Care Act, insurers must also provide mental health coverage. In fact, coverage must be the same as for physical health care. For instance, if a member sees a doctor about a foot problem for $20, then a visit for depression should also cost $20.
The act doesn’t specify what mental health issues insurers must cover. However, the rules are similar to SUD treatment. So if a treatment center also treats mental health issues, then typically insurance covers the services. Furthermore, insurers don’t specify what mental illnesses they cover, so they cover all mental illnesses (AMI).
Medication-assisted treatment (MAT) is part of the treatment and aftercare of some addictions. MAT helps members who can’t function without drugs. Because some substances cause severe brain changes, long-term medication use can help correct the changes.
MAT helps members achieve recovery. At the same time, continuing MAT can prevent recurrence of use. For instance, MAT for opioid use disorder includes methadone or Buprenorphine. These medicines stop withdrawal, minimize cravings, and to avoid recurrence of use. Above all, MAT lets members focus on recovery and positive life changes.
Even though MAT helps in the chronic treatment, it can be very costly. For this reason, it’s vital to know if and what insurers cover. But, the good news is, most insurance companies cover some or all of MAT.
The National Alliance of Advocates for Buprenorphine Treatment finds insurers typically cover MAT for heroin and other opiates. But, the Alliance doesn’t say how many companies offer this coverage or what copays might be. Although they are confident, most insurers believe MAT is helpful.
On the other hand, Medicare and Medicaid plans don’t always cover MAT. But, if it’s deemed necessary for lasting recovery, they will cover treatment costs. Unfortunately, even if doctors think MAT will help, insurers can still deny coverage.
The two opposing views on coverage prove not all insurers are on the same page with MAT. Furthermore, it shows the importance of contacting them directly to understand coverage. If not, the out-of-pocket expenses can be overwhelming.
Like with physical health issues, insurance coverage for mental health and addiction disorders varies. In Missouri, though, the state passed a law requiring all minus HMOs’ policies to cover these services. But, with all policies, there are exceptions to coverage.
Typically, bronze plans have low monthly premiums but high deductibles. In contrast, platinum plans have high premiums and low deductibles. At the same time, silver and gold plans vary in premiums and deductibles.
Members with bronze plans will pay the most out-of-pocket for chronic care of SUD and mental health treatment. Likewise, insurers may require members to attend in-network treatment centers. However, some bronze plans may allow out-of-network treatment.
Lastly, some policies require a copay for services. But once deductibles and copays are met, insurance coverage typically pays the rest. For this reason, knowing the coverage for MAT and mental health disorders is vital.
The benefits of health insurance are meant to make healthcare affordable and accessible. This benefit is no different for substance use disorder. People with insurance who are battling SUD and AMI should have coverage to help with recovery costs.
Contacting the insurance company is a great way to find out the policy coverage. But, coordinators at the treatment center can also help with insurance questions. They handle all the financial arrangements so members can focus on recovery.
Our amazing trained professionals want to make sure you receive the best care. This care includes getting the most out of your insurance benefits. Recovery services at Sana Lake BWC combine traditional and alternative therapies to treat the mind, body, and spirit from detox programs to aftercare services. Some of our therapies include:
When you are ready to find treatment, the last thing you should worry about is paying for it. But, the high cost of chronic care leaves many worrying about money. However, when a person has insurance, treatment becomes affordable.
Don’t let the confusion about your insurance policy stop you from getting help. Let us verify your insurance while you focus on taking the first step to recovery. Contact us today and learn how affordable chronic care is.