Understanding Insurance Covered Treatment

Drug Rehab

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. Should you pay privately, should you use your insurance – and if you do, will that affect ongoing medical coverage or future employment? What will insurance cover for drug rehab?

Insurance Covered Drug Rehab

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. Here are the most important things you should know about insurance plans and paying privately for rehabilitation.

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, shouldn’t be overlooked. 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. 

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 the 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 get reimbursed directly from the insurance company. This is usually better for you financially in the long run if you go to treatment Out of Network. 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

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.

Deductibles

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 deductible is included in your Out of Pocket Maximum. 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 COVERED DRUG REHAB AND ALCOHOL TREATMENT

How Mental Health Benefits Can Help Offset Costs

Remember, insurance benefits are broken up into several categories. The two that are most relevant to you are the Behavior Health (outlined in the previous section) 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.