How Do I Know if My Insurance Covers Addiction Treatment?

People may avoid substance use disorder (SUD) treatment for several reasons. Sometimes people are afraid of the detoxification process. Others may feel anxious about spending time away from friends, family, and loved ones. Unfortunately, many people may also avoid treatment for financial or insurance reasons. It is unfortunate that financial circumstances may prevent a person from getting help for their SUD. Nevertheless, it is a reality we must acknowledge. 

You can find out if your insurance will cover addiction treatment. Many treatment facilities work with potential clients to help them verify their insurance coverage. These places want to help you get the best help with the least amount of financial worry. Call your insurance provider or potential treatment center today to understand your coverage and options.

What to Know About Insurance

Most people have insurance, but do we really know what it is all about? The concept of insurance is simple, but there always seems to be some complexity or hidden factor we neglect to account for. It may feel like so many hoops to jump through that getting a service covered is hardly worth it.

In a nutshell, insurance helps to make treatment less expensive and protects people from unexpected medical costs. You can use insurance for preventive services. However, you will most likely use it in accidents or emergencies. Take an unexpected trip to the emergency room, for example. An emergency room visit can range from a couple of hundred dollars to thousands. But, of course, there are a lot of factors that impact that price, including: 

  • Where you are in the United States 
  • The medical services your condition or injury requires 
  • Medications needed to treat potential conditions 
  • Surgery costs if an operation is required 
  • The length of time you need to recover in the hospital

Depending on your plan, health insurance will typically cover a percentage of medical costs. For example, a better plan may cover 90% of costs, meaning you would only be responsible for paying 10% of the medical fees. Other plans may ask you to pay a certain amount out of pocket before benefits kick in.

Unfortunately, insurance is not always an exact science. For emergency purposes, you typically find yourself feeling grateful to be insured. You may be particularly thankful when you consider the astronomical prices of most medical services nowadays. What about when it comes to preventative or restorative care, like addiction treatment?

Health Insurance and Addiction

There are various kinds of insurance, but health insurance is our main focus regarding addiction treatment. On average, health insurance typically covers large parts of addiction and mental health treatment.

Factors That Determine Addiction Treatment Coverage

Many factors may impact coverage for SUD treatment, such as: 

  • The behavioral health benefits of a policy 
  • What providers a treatment facility utilizes 
  • The kind of addiction treatment you require 
  • How long you need to be in treatment 
  • The type of program you need

What Treatments Will Insurance Cover?

Depending on where you are in your treatment journey, you may not know what level of treatment you need. However, some of the treatments insurance should cover include: 

  • Inpatient treatment programs 
  • Dual diagnosis treatment for co-occurring mental health conditions 
  • Medication-assisted treatment (MAT) 
  • Outpatient addiction treatment 
  • Post-treatment continued care, including individual therapy sessions and other treatments

Equal Benefits and Additional Options to Consider

Much of the coverage people have rights to today is thanks to the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. According to the Department of Health and Human Services (HHS), this act requires "health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care."

While no system is perfect, regulations like this can put people more at ease regarding their insurance coverage. However, coverage will still depend on your policy and other circumstances. Thankfully, there are other options you can utilize if you have limited financial resources, including: 

  • Medicaid eligibility 
  • Addiction treatment services through your state's health departments 
  • Programs that offer payment assistance or sliding fees — payment assistance and sliding fees may permit cost adjustments to treatment programs based on what you can pay

How to Know if Your Addiction Treatment Will Be Covered

If you have any doubts, the best way to find out if your insurance covers addiction treatment is to call your insurance provider and inquire about their benefits for substance use and mental illness treatment. Before considering a program, contact your insurance company to gather as much information as possible. 

Additionally, facilities like NorthStar Transitions can help you access quality treatment. We work with many insurance companies and are an approved out-of-network provider. Some of the companies we work with in-network include: 

  • Aetna 
  • Anthem Blue Cross and Blue Shield 
  • Cigna 
  • Humana 
  • Kaiser Permanente
  • United Healthcare/Optum 

These are just a few of our in-network companies. You can verify your insurance with us by filling out our insurance verification form.  

Do not let costs and insurance be why you avoid seeking addiction treatment. We can work with you to get you started on your path to sobriety today. 

Insurance should be a simple, straightforward process. Unfortunately, it can get pretty convoluted. Nevertheless, the best way to determine if your insurance will cover addiction treatment is to call your insurance company and ask. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires insurers to provide benefits for mental and substance use treatment. Calling is still vital to learn about the details regarding addiction treatment coverage. Additionally, NorthStar Transitions helps you get the treatment you need by working with a number of insurance companies and verifying your insurance. There are also resources for those with other financial limitations. To seek treatment, call NorthStar at (303) 558-6400 today. 

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