Does insurance cover the cost of substance use disorder treatment? In many cases, people are surprised to learn that their insurance plan provides coverage when they decide to seek treatment.
Many insurance plans cover some or all of the cost of treatment programs, although coverage varies on factors including the state you reside in, your insurance company and the specifics of your policy. Understanding the way your insurance plan impacts the cost of treatment can help you plan for a healthier future.
Will My Health Insurance Plan Cover the Cost of My Treatment?
A substance use disorder is a medical disorder, so most insurance companies cover at least some of the costs of treatment under the mental health portion of their policy.
Whether a rehab center is in-network is a big factor in determining coverage. Insurance companies have care providers and treatment facilities that are part of their network. If someone receives their care in-network, they are likely to have more coverage.
In-network insurance companies for Orlando Recovery Center include:
- BCBS/Florida Blue
- Orlando Health Network
- Healthcare Solutions Group
- Mines and Associates
- First Health
- First Choice
- Medical Mutual
- ClaimBridge Administrators
- Preferred Medical
- America’s Choice Provider Network
When someone requires treatment for a substance use disorder, they will often need a referral or pre-approval from their insurance company. Receiving an official diagnosis of a substance use disorder may be used by the insurer to determine how much coverage a policyholder would receive for services ranging from detox to inpatient and outpatient treatment.
With many insurance policies, coverage is available for the basics of treatment, including residential treatment, but amenities or added services that are available at the rehab center may need to be covered out-of-pocket.
Aspects like deductibles and out-of-pocket maximums play a role in how much coverage is available for addiction treatment as well.
The Affordable Care Act and Substance Use Disorders
Two significant pieces of legislation expanded the provision of coverage for mental health treatment and substance abuse treatment. The first was the Mental Health Parity and Addiction Equity Act. More recently, the Affordable Care Act further expanded coverage for the treatment of mental health and substance use disorders.
All plans offered through state insurance exchanges must cover behavioral health treatment and substance use disorder treatment. Marketplace plans can’t deny coverage or charge someone more because of any pre-existing conditions, including a mental health disorder or a substance use disorder.
The Affordable Care Act defines parity protections between substance abuse treatment and other benefits. If limits apply to mental health and treatment for substance abuse, they can’t be more restrictive than limits on any medical or surgical services. Limits included within the definition of parity protections are financial limits, treatment limits and care management.
The specific level of benefits and coverage someone has depends on their plan and the state they live in.
If your insurance doesn’t cover some or all of the costs of addiction treatment, options are available. Non-insurance options include personal financing or setting up a payment plan with the treatment center. Many treatment programs will work with self-pay patients to help them receive treatment in a way that’s manageable for them financially.
Contact Orlando Recovery Center
At Orlando Recovery Center, we know that receiving quality care for a substance use disorder is essential to living a healthy life. Our admissions team can speak with you about your insurance and help you determine what your policy covers. The admissions coordinators can contact your insurance company on your behalf and create a list of covered services. They can also work with you to ensure you understand possible out-of-pocket costs.
Contact Orlando Recovery Center today to learn more about treatment or payment options.