The majority of people with substance abuse issues do not receive the treatment they need. One of the biggest barriers to treatment is cost. They could not afford it, or they did not have the right insurance coverage.
In 2017 alone, about 30 percent of the one million people who believed they needed addiction treatment did not receive any due to cost or lack of insurance, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Put another way, about one in three had no health insurance or were unable to afford the cost of treatment.
However, cost should never get in the way of you receiving a vital service that can ultimately be life-saving.
At Harmony Hills, we help you understand your insurance coverage options. We also walk you through a comprehensive overview of your insurance benefits to make treatment accessible and stress-free in terms of cost.
In the section below, we have assembled the most frequently asked questions that people have about health insurance and available treatment options. If you would like to speak with an intake specialist now, you can contact us online or by phone.
There are more than 14,500 specialized drug treatment facilities in the United States. Many of these provide behavioral therapy, counseling, medication, case management, and other services for people in need of substance abuse treatment, according to the National Institute on Drug Abuse (NIDA). These centers deliver treatment in an inpatient, outpatient, or residential setting.
What’s more, most standard health insurance plans will provide coverage for some form of addiction treatment. However, not all plans are created equal. It is critical that you understand the range of services covered under your insurance.
For instance, you will want to find out whether the desired treatment facility is “in-network,” which means the center is covered because it has a contract with your insurance company. Also, if a facility is in-network, the amount of coverage provided by your insurer will be determined by factors like whether the facility is public or private and in-state or out-of-state.
Those factors mentioned above can be verified through your doctor, insurer, or your desired treatment center.
At Harmony Hills, we aim to make the insurance verification process as easy and seamless as possible. We accept most major insurance providers, including:
If your insurance carrier is not listed above, we encourage you to contact us. One of our intake coordinators can discuss full and partial private-pay options. We can also work with you to devise a reasonable financial plan.
One concern that you and other clients may have is whether treatment for a specific substance abuse issue is covered by their insurance. As long as your health plan lists addiction treatment as a covered benefit, care will be provided regardless of the substance. It is always a good idea to be sure what your specific insurance covers.
Health plans will cover a variety of substance abuse issues under the addiction treatment umbrella. However, that does not mean they will offer the same kind of blanket coverage for every treatment level and service available.
Thus, it is critical to find out what types of substance abuse services are covered under your insurance. Depending on your plan, the following services may or may not be covered:
Inpatient or residential care that provides temporary housing to patients requiring treatment is more expensive than outpatient care, which allows people to live at home. Therefore, it is very likely that your insurance carrier will provide coverage for outpatient rather than inpatient care.
Severe addictions, especially those involving alcohol, opioids, and polysubstance abuse (where two or more substances are being abused simultaneously), require comprehensive, inpatient care.
What’s more, your insurance carrier may not cover aftercare because it deems it a non-essential service, even though it’s a crucial component in relapse prevention and long-term recovery.
What matters most is selecting the kind of treatment that gives you the best opportunity to realize lasting recovery.
If your insurance provider does not cover treatments or services that you and/or your doctor deem necessary, or they decide not to cover them completely, you should call us at Harmony Hills so we can work on a payment arrangement to get you the life-saving care you need.
Another factor that insurance carriers consider is treatment duration. Depending on the level of your plan, your insurance carrier may cover the entire length of your treatment. However, there are plans that will only cover a certain amount of days. This can be an obstacle if your substance addiction requires a longer residential or detox process.
Another determining factor is whether the treatment facility is public or private. Private facilities tend to be more expensive than public ones. Thus, a stay at a private facility may cause you to hit your maximum coverage limit faster than if you sought treatment at a public center.
What you should know is that when it comes to addiction treatment what ultimately matters are the quality of services, available treatment plans, level of credentialed staff, reputation, and the facility’s track record of success.
NIDA has published its “Principles of Effective Treatment,” which can provide a valuable yardstick in determining the quality of an addiction treatment center. Those principles include the following:
Addiction treatment is a dynamic and responsive process that should adhere to your needs. The treatment process typically starts with medical detox, where the substance is removed from your body, and withdrawal symptoms are treated. Depending on the nature and severity of your substance abuse, you could enter into inpatient or outpatient treatment. You will have access to therapies through your program, depending on your specific needs.
Treatment will entail participation in individual and group therapy, along with some form of behavioral therapy like CBT or DBT.
If you require treatment for a mental health issue like depression, anxiety, or schizophrenia, you can get referred to specialists who can address those conditions. Depending on your needs, the cost of treatment can vary.
Addiction treatment is a healthcare procedure, so it follows that it would carry a similar cost. In essence, substance addiction can be expensive. The question remains whether it is actually worth it. When you take into consideration the costs associated with an addiction when left untreated, then the return on investment is totally worth it. Drug addiction impacts employment and often leads to imprisonment, which are both costly outcomes. Another thing to consider is how active addiction can spur disease and/or exacerbate an existing medical condition, which leads to increased costs for medical care.
When you enter into and remain in treatment, chances are you will make occupational and social gains. For instance, treatment can reduce criminal activity and limit exposure to the criminal justice system. A stay in treatment can also result in improved job prospects, social, and psychological functioning.
There are tangible benefits that occur with treatment. As NIDA points out, every dollar invested in treatment yields a four to seven dollar return with the reduction of crime-related legal costs.
Absolutely. Most private insurance carriers offer coverage for addiction recovery services. The amount of coverage you are entitled to will depend on factors such as treatment needs, level of insurance coverage, and the particular rehab facility you plan on attending.
For example, if your substance abuse problem involves marijuana, you may not get covered for medical detox because the standard form of the drug is not known to generate severe withdrawal symptoms.
To best determine what level of coverage you can get for treatment, it is best to talk with your intake coordinator and insurance representative.
Many addiction treatment facilities, like Harmony Hills, will accept most forms of private health insurance. There are some insurance plans that these centers will not accept. The best way to get an answer to this question is by contacting your preferred treatment center.
There are some treatment centers that accept Medicaid. However, there are a lot of centers that do not. Federally-backed insurance plans tend to come with prohibitive administrative costs and red tape for healthcare providers. These factors can deter treatment centers from accepting Medicaid patients. Because of the procedural and administrative hurdles associated with Medicaid, the insurance payouts often take a long time and tend to be smaller in comparison to standard insurance.
To treatment centers, these realities make Medicaid more trouble than it’s worth. Again, there are treatment centers that accept Medicaid. You can speak with an intake coordinator or Medicaid benefits representative to find out which facilities accept it.
National Institute on Drug Abuse. (n.d.). Is drug addiction treatment worth its cost? from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost
National Institute on Drug Abuse. (n.d.). Treatment Approaches for Drug Addiction. from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
National Institute on Drug Abuse. (n.d.). 8: Medical detoxification. from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification
National Institute on Drug Abuse. (n.d.). Drug Addiction Treatment in the United States. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states
ScienceDirect. (n.d.). Long Term Residential Care. from https://www.sciencedirect.com/topics/medicine-and-dentistry/long-term-residential-care
Substance Abuse and Mental Health Services Administration. (2018). (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53) [PDF File]. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. from https://www. samhsa.gov/data/