4 Steps to Discovering How Much Your Insurance covers

If you've decided to enter a treatment center, you need to understand what type of addiction coverage your insurance provides. Learn how to find out.

Table of Contents

Understand How Addiction Coverage Works

It helps to understand how alcohol or drug addiction works within the insurance industry. This will help give you an idea of what to expect once you enter a facility and receive treatment. For the most part, addiction coverage is very similar to coverage for other health issues. However, there are some minor differences and things you should know.

All insurance plans within the Health Insurance Marketplace must cover substance abuse services according to HealthCare.gov. If private insurance plans want to be sold in the marketplace, they must cover addiction treatment as well. However, they don’t have to if they aren’t included in the marketplace.

Furthermore, insurance policies that provide addiction coverage do so without applying conditions. For example, they provide coverage for addiction treatment regardless of what drug you’re addicted to and how you became addicted. This means that your provider won’t look at the details of your addiction to determine the amount of coverage you receive. This is determined by your plan.

It’s also important to understand that the majority of states require group health insurers to provide addiction coverage just like they would other illnesses.

Determine What Level of Treatment You Need

The type of addiction coverage you receive from your insurance provider has everything to do with your plan and the type of treatment you require. It’s important you participate in a treatment plan that’s best for your level of addiction.

You also need to consider that your insurance policy may not cover every type of medication needed during your recovery. These medications are typically given to clients who need help detoxing and dealing with severe withdrawal symptoms.

Before you enter a treatment facility, you need to have a meeting with a substance abuse specialist to determine which recovery approach is right for you. Possible treatment plans could include:

  • Inpatient treatment programs
  • Outpatient treatment programs
  • Inpatient detox
  • Substance abuse counseling

If you’re suffering from addiction to opioids or heroin, you may need to take part in a maintenance program. These help individuals who need additional assistance to function without the drug. They typically utilize prescription medications such as Suboxone to help patients overcome their dependence.

Consider your options carefully and come up with a treatment plan.

Consult With Your Insurance Provider

Once you’ve determined what type of rehabilitation you require, you can speak with your insurance provider to determine your level of coverage. You could also check the details of your policy yourself, however, this can be confusing. For a more concrete idea of your addiction coverage, it’s better to call your provider directly.

Remember, your particular plan determines the level of coverage you have. Your provider can tell you how they’ll cover different types of treatment. They can also help you determine what medications they’ll cover if you need prescription assistance during the detox stage of your recovery. Make sure you write all this information down to reference in the future.

You also need to ask about inpatient coverage and ongoing treatment. An inpatient program can last anywhere from 30, 60 to 90 days. You need to know how much of this will be covered. If you’ve opted for outpatient treatment, ask your provider how they handle this. You’ll also need to inquire about ongoing treatment coverage for after you’ve finished your program.

Covering all your bases is important during this step. Make sure you understand your deductible along with all policy conditions so you don’t end up with unexpected bills after your treatment has ended.

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