Will My Insurance Cover Detox?

Medical procedures and medical treatments are expensive.

The cost to get an individual through a withdrawal management program, or detox, is no exception. However, when one considers the alternative, entering a detox program is certainly a wise investment. For instance, The National Institute on Drug Abuse reports that one year of methadone maintenance treatment costs around $4,700, whereas a year of imprisonment costs about $24,000. Thus, in terms of societal costs, treatment is certainly a better option than the other alternatives for substance use disorders.

If one considers the personal problems associated with having a substance use disorder, such as issues with relationships, financial issues, occupational issues, and the other costs to the individual, it is obvious that detox and addiction treatment save more than just money.

Does Insurance Cover Detox?

The specifics of coverage will vary between companies and policies. 

Specifics regarding your coverage can be obtained from your insurance company in light of the policy you hold. In many instances, the treatment facility will be able to assist you in ascertaining your exact coverage level.

Here are some general tips regarding coverage for detox:

  • If possible, have a medical doctor document the need for detox. Getting a medical doctor to document the specific need for the individual to be enrolled in a withdrawal management program can work wonders with insurance companies. Most individuals will find that having a medical doctor put in writing that the person needs to be involved in a withdrawal management program out of medical necessity carries far more weight than a referral from any other individual. Even if you speak to a therapist or other mental health treatment provider about getting into a withdrawal management program, you should attempt to get a medical doctor to initially make the formal referral if possible.
  • Determine the specifics of coverage. The type of coverage that can be applied to detox depends on the company, the specific plan, and even the state that you live in. These variables will affect how much insurance will cover.
  • Be aware that some services are not covered. A large number of health insurance plans will cover a portion of traditional detox programs, except for any type of rapid detox treatment or any type of treatment that is considered to be experimental in nature and does not have solid research evidence to back its effectiveness. Not all plans will cover certain aspects of residential or inpatient treatment programs, and you should discuss this with your customer service representative. Some programs may not cover the cost of substance abuse treatment for minors. Again, check with your customer service representative.
  • An outpatient detox program may be the best option. Most insurance programs will cover outpatient treatment for substance abuse, including outpatient withdrawal management programs, but many programs have specifications on the length of coverage or have copays. Individuals have a far better chance of getting their insurance to cover most of the cost of an outpatient withdrawal management program compared to an inpatient withdrawal management program. This is because many of the services that are provided in inpatient withdrawal management programs, such as preparation of meals, sleeping quarters, etc., are not considerations of an outpatient withdrawal management program.
  • You will probably have to pay something. Even though there is a good chance that your insurance will pay for a good portion of detox, be prepared to pay something. Most insurance plans that cover treatment for addiction or substance abuse have copays that are either calculated as a percentage of the total costs incurred or that can be a fixed rate that is charged regardless of the total costs. Discuss this with your customer service representative.
 As an alternative to contacting your insurance company, contact the particular detox program you are interested in and discuss admission with the intake advisor. Many intake advisors will contact your insurance for you and determine the duration and breath of the coverage you have.

Because pre-existing conditions can no longer be used as an excluding factor for obtaining insurance, any person can shop for health insurance and find insurance plans that suit their needs and are affordable for them at HealthCare.gov. The Affordable Care Act has also tried to ensure that coverage for substance abuse is part of most plans.

Medicaid, Children’s Health Insurance Program (CHIP), and Medicare will cover the cost of many substance abuse treatments for low-income individuals or individuals with disabilities who have limited or no insurance. One can sign up for Medicaid on the Medicaid application website.
Many community health centers will begin treatment while one is actively signing up for public assistance or Medicaid, so an individual can get into treatment while the Medicaid application is being processed.

If costs are still a factor, you might be able to find a low-cost detox program through the Substance Abuse and Mental Health Services Administration’s treatment locator tool. You might also want to contact your state’s mental health agency and ask for recommendations regarding affordable detox programs in your area.

Using COBRA Insurance to Pay for Detox

Have you recently experienced a job loss? You may be receiving insurance through COBRA and unsure what is covered.

Here’s what you need to know about COBRA:

  • COBRA is not a type of insurance but rather an Act (specifically, the Consolidated Omnibus Budget Rehabilitation Act) that allows you to continue receiving the same insurance you had through your employer after you’re separated from the company.
  • Your insurance will cost more. When you continue your benefits through COBRA, you’ll pay the total premium that you used to share with your employer, plus a small administrative fee (2%).
  • Your coverage won’t change. The same coverage you had while you were working will apply, unless your employer changes the benefits (at which point yours will change too) or ends coverage (yours would also end).
  • There’s a time limit. The time you can receive continued insurance benefits from a previous employer through COBRA ranges from 18 months to 36 months.

In 2010, the Affordable Care Act made mental health and substance abuse treatments essential benefits. This means that marketplace plans must cover them. In addition, the Mental Health Parity and Addiction Equity Act of 2008 gave equal importance to mental health and substance abuse treatment as to other medical treatments, making it illegal to impose less favorable benefit limitations for them. If you had group coverage through your employer, because of these laws, you likely have coverage for behavioral healthcare. You may need to pay for this coverage at a higher premium now, but the coverage can allow you to access lifesaving addiction treatment.

If you’re not sure what your policy covers in terms of addiction treatment, you can call us now to get help at . You can also call the number on the back of your insurance card to learn more about your benefits.

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