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.
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.
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.