Insurance 101: What you know about Rehab and Insurance

by baladmin | May 9, 2013

Rehab costs money, right? So how can you go about financing the rehab you, or a loved one, needs?
Here is an Insurance 101, of sorts to help you determine if your health insurance plan will cover the substance abuse treatment program of your choosing.
There are 2 initial steps you can take to find out what your insurance benefits cover:
1. Call your insurance company directly.
Usually there is a phone number on the back of your insurance card that takes you to customer service. Find out what your plan covers, what facilities are considered in-network, if that’s a part of your coverage, and what specific treatment services you are eligible to receive.
2. Call one, or a few, of the substance abuse treatment centers that you feel would accurately treat your unique set of needs. Speak with an intake counselor, or the intake coordinator, to find out what insurance companies they accept, and what plans (HMO, PPO) they work under.
Also ask the trained intake professional what services would be recommended for someone in your situation, with your specific circumstances – detoxification, residential inpatient treatment, outpatient treatment, partial hospitalization, or sober living.
Inform the intake counselor of your drug of choice, your length of use, your frequency of use, and your past attempts at sobriety. He or she will have other questions for you as we’ll. Based on that, you can determine what you need to enroll for, and from there, what part of that your insurance plan will cover.
Drug and alcohol rehab and health insurance can be tricky to navigate, but you can find a treatment center that works with your coverage.
In 2008, President Obama passed the Mental Health Parity and Addiction Equity Act, which implemented the requirement of substance abuse treatment for any health insurance plan covering a group 50 or more enrolled members be equivalent to the coverage for medical treatment.

For some “insurance for dummies” help, here are terms that may get thrown around in the insurance process:
Deductible – generally an annual, fixed dollar amount that you have to pay toward medical and mental health costs before anything is covered by your health insurance company.
Example: $1,000 individual deductible, $3,000 family deductible
Copay – a dollar amount you pay when you access medical, mental health services, or prescriptions. You pay this amount to the facility providing the service.
Example: Doctor Visit – $50, Generic Rx – $15
Coinsurance – generally written in percentages, this is the amount of the total bill, after any applicable deductible and copays, that the insurance company is responsible for that are your responsibility.
Example: 80/20 coinsurance means that the insurance carrier pays 80% of remaining costs, and you pay 20%.