In 2008, a law was passed that changed things in Florida and across the country, as far as insurance coverage for substance abuse and mental health treatment. Substance use disorder (SUD) has always been a serious problem that affects many people and for a long time, Americans paid for insurance that had no coverage for treatment for SUDs.
Finally, the government and insurance companies began to realize that coverage for this disorder is as important as coverage for physical health problems. Going without treatment for a SUD can be crippling and even life-threatening. In 2008, a law was passed that changed things in Florida and across the country.
The MHPAEA of 2008 is a federal law. Its purpose is to prevent group health plans and health insurance companies from putting limits on their SUD or mental health benefits. They are required to provide converge equally to the medical/surgical benefits in the plan. In 2010, it was amended by the Affordable Care Act (ACA) to include individual health insurance coverage.
All plans must cover:
Depending on your state and your health plan, some behavioral health benefits may be modified. And some insurance providers cover all or part of the costs of rehab.
The Affordable Care Act (ACA) provides ways to connect people who want medical insurance with companies who sell it. The ACA includes substance use disorders as one of the ten parts of essential health benefits. Insurance that is sold on the Health Insurance Exchanges or provided by Medicaid is required to include services for SUDs.
Private insurance plans are for individuals and families who seek them independently or through an employer or member association. Typically, private insurance plans will cover some or all the cost of treatment. But, private plans often have higher out of pocket premiums while they offer:
Public health insurance has qualifying measures like age and income.
Medicare is a federal program for individuals 65 and over and some disabilities. Medicaid is a state-run program for low-income people. Every state is required to offer Medicaid services.
Individuals may opt to enroll in a group plan through an employer.
Individuals may choose a private plan through the state or federal marketplace.
The person may choose their own private plan.
If you have health insurance, you may find that you have more coverage than you knew. But remember, not every facility, doctor, or program is approved by every insurance company However, most of the time, health insurance for addiction treatment will cover the following at approved facilities:
Often, medical detox is required to treat substance use disorder. A medical detox means that you will stay in a detox center while the drug or alcohol toxins are cleared from your system. Withdrawal symptoms during this period can be extremely uncomfortable and occasionally life-threatening. Medical supervision is vital during this period.
If you need 24-hour supervision during treatment, a residential or inpatient program will be necessary. This type of program is important for individuals with severe or long-term addiction and a possible mental health disorder.
If your addiction is not severe or long-term and you have a good support system at home, you may choose an outpatient program. Intensive outpatient programs provide more days and hours of treatment than a traditional outpatient program although you will live at home during both.
When a SUD and a mental disorder occur at the same time, it is called a dual diagnosis. In this case, it is necessary for both disorders to be treated at the same time.
Continuing Care or Aftercare
When an individual completes a formal treatment program, it is recommended to continue to attend counseling sessions or 12-step groups. This is an important aid to preventing relapse. Some people who don’t feel confident enough to enter a normal drug-free life will enter a sober living home. There, they are able to go back to work and otherwise ease their way into independence.
Some addictions require long-term medication to maintain sobriety. Medication, such as methadone, helps prevent cravings which can result in a relapse.
Wading into insurance terminology can be stressful. So here are some common terms you should know:
Medical necessity is a standard used by insurance companies to decide whether the treatment recommended by your care provider is:
Insurance companies use this process to decide if the treatment you want is medically necessary and in agreement with” accepted medical practice.” Basically, this means that it has been proven to be effective.
This is another way to say “pre-approval.” This is when you or your healthcare provider must request approval for a treatment, service, or prescription drug before your insurance plan will cover it.
This means that you must try a less expensive drug or service before you can proceed to the more expensive prescription or service.
Often, insurance companies have special relationships with certain care providers. These connections are the difference between “in-network” and “out-of-network.” This will determine the difference between how much your insurance will pay and how much you will have to pay. If you aren’t sure, call the treatment facility or your insurance company.Call us today. 844.684.0795
If you are denied insurance coverage you may appeal the decision. Keep in mind that the equal treatment of SUD, mental health conditions, and other medical conditions under insurance plans is called mental health parity. Most health plans are required to follow state and federal parity laws.
Our admissions specialists will be happy to check your insurance coverage for you and answer all your questions. The Intrepid staff is experienced in dealing with insurance companies and helping clients arrange financing for their treatment. So relax and let us handle it. There are several options you might like to review here:
If you or someone you love is suffering from a SUD, you know how important it is to you on a personal level. So, whether you’re convincing yourself or someone else, here are some more reasons:
Substance abuse is an expensive problem. The National Institute on Drug Abuse (NIDA) reported that substance abuse costs more than $740 billion per year in crime, healthcare costs, and lost productivity. Other than money, addiction coverage keeps people out of ambulances and emergency rooms from overdoses. Similarly, getting people into recovery helps them avoid going to jail and prevents the other health problems that come from substance abuse.
Mental health disorders and substance abuse go hand in hand. Many times people with a mental disorder will use addictive substances to relieve the symptoms of the mental disorder. On the other hand, individuals who are addicted to drugs may develop a mental disorder as a result of their addiction. The Substance Abuse and Mental Health Services Administration (SAMHSA) has stated that 7.9 million adults have both a SUD and a mental health condition.
Sadly, children who are around adults who use drugs frequently are more likely to become involved in some type of substance use themselves. This shows that the effects of drug abuse cross generations and why it’s important to treat a parent’s substance use disorder before it spreads to the children.
We know nobody plans to be an addict. And we know you don’t want that for your life. Now is the time for you to take control and contact us. Just make that first step, and we will help you from there.
Our staff of experienced professionals looks forward to helping you create your own success story. Through personally designed programs and multiple levels of care, you will be supported throughout your recovery journey. Intrepid means “brave,” so be brave and take that first step.