You may be wondering: is drug rehab covered by insurance? Here are tips to understanding payment options for treatment – especially if you need to act fast.
Family members, clients, and even seasoned professionals get overwhelmed by navigating the payment options for substance abuse treatment services. Is drug rehab covered by insurance? Should you pay privately, or should you use your insurance? If you do use insurance, will that affect ongoing medical coverage or future employment? What will insurance cover for drug rehab? Will my insurance cover a detox from drugs and alcohol or an IOP program?
Is Drug Rehab Covered By Insurance, and Should You Use It?
The questions about the right thing to do are virtually endless…
A family member recently asked us to verify their insurance benefits for a loved one to enroll in a drug rehab. But without understanding how insurance works for drug treatment programs the information we provide after verifying is of little help. So to learn what it all means, we’ve provided 3 simple tips to helping people understand the insurance verification process.
Use cash and enroll now or use insurance and prepare for some serious red tape.
No matter what, using cash is the easiest way to access substance abuse services. It’s also the most private, and most unlikely way to ever have an issue about having received substance abuse treatment in the future. Cash offers total privacy and total control. These are two elements that whenever possible, you shouldn’t overlook.
Insurance benefits are laden with red tape. When you’re in crisis, the process can be unwaveringly slow. So if you need to place someone immediately private payment is almost always the way to go. Before an insurance company will authorize any form of treatment you have to give them a lot of information first. Then they will verify what form of coverage you have (if any). After that they will probably request some additional information. Then, if you’re lucky, they will authorize a set number of days. They will then request more information about why further treatment is medically necessary.
Then they will verify your coverage and…See a pattern emerging?
So no question about it, if you can afford to pay for treatment privately, it’s the best option. Most PPO insurance plans offer In Network and Out of Network options. They will usually provide more coverage if you stay In Network then if you choose to go Out of Network. A lot of times the drug rehab you want to attend will be a non-preferred provider (Out of Network) and this means if go that route you will be responsible for more of the costs.
Out of Network treatment and the little known SUPERBILL
When you want to go to a specific Out of Network drug treatment program you can choose to get a Superbill. This means that at the end of treatment you will get a reimbursement check instead of the facility. With a Superbill, you pay the entire cost of treatment upfront and then receive reimbursement directly from the insurance company. This is generally a better financial decision. The sad fact is that you can go to any program you want if you have an insurance plan that offers Out of Network coverage. The insurance companies really, really, REALLY discourage you from going this route. That’s quite simply because it ends up costing them more money.
Not All Insurance Covered Drug Rehabs Offer The Same Thing
Out of Pocket Maximums
After asking is rehab covered by insurance, you’ll have to determine what is actually covered. In addition to having an In Network and Out of Network option on most PPO plans, there will also be an Out of Pocket Maximum. This means that once you reach a predetermined amount in patient payment responsibilities, the insurance will cover at 100% going forward. To determine what your Out of Pocket Maximum is on your PPO plan simply call the 800 number on the back of your insurance card and ask them what your Out of Pocket Maximum is for Substance Abuse treatment.
An unfortunate aspect of the Out of Pocket Maximum is that is often doesn’t include your deductible. In other words, the deductible on your PPO insurance might be $2500.00 per person on the plan, with a Family Aggregate of $10,000.00. In this scenario, if you went In Network, you would more than likely be responsible for the 20% (at least) for the duration of the whole treatment episode. Remember to ask them if your Out of Pocket Maximum includes your deductible. When the insurance company says they will cover 60% of substance abuse treatment you will have out of pocket expenses (often not including your deductible) up to, but not exceeding, a set dollar amount. So if your out of pocket maximum is $10,000.00 you will have to pay 40% up to $10,000.00. After that the insurance company will cover 100% of authorized services.
Mental Health Insurance Covers Drug Rehab And Alcohol Treatment
How Mental Health Benefits Can Help Offset Costs
Remember, insurance companies break up benefits into several categories. The two that are most relevant are the Behavior Health and Mental Health benefits. When you go to a co-occurring disorders treatment facility, or dual diagnosis program, you can effectively bill for any behavioral and mental health issues that you presently have. This can be very helpful with both Out of Network coverage and when Superbilling.
The breakdown for mental health coverage in terms of In and Out of Network benefits, deductibles, and out of pocket maximums is very much the same as their behavioral health counterparts. However, it’s important to specify the coverage type your seeking when calling your insurance company to verify benefits information.
Call to Learn More about Insurance Covered Drug Rehab And Alcohol Treatment Options in Los Angeles
Is rehab covered by insurance? More specifically, is drug rehab covered by insurance? The reality is that the landscapes in the private-pay sector and the insurance-based arena are very complex in the greater Los Angeles area. It can be very helpful to have the support and guidance of an expert who can assist you in determining which program options will be the best fit for your situation, and we can assist in verifying insurance benefits. If you would like more information about both private pay and insurance-based substance abuse treatment options in Los Angeles, call 866-256-0051 to speak with a counselor today.