What does insurance cover in addiction treatment?
Insurance coverage for addiction can vary dramatically. Some companies cover all costs associated with recovery, while others ask members to pick up some of the cost of care. Some require people to use a specific set of providers, while others have no such restrictions. Some limit the care people can get, depending on their prior attempts at sobriety.
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More and more insurance companies are jumping in line to offer substance abuse treatment coverage to the 22.7 million who need it.
Depending on the insurance company and individual policies, specific treatment options may be covered or partially covered, or the entire stint in rehab could come at little cost to the individual in need of care. Treatment coverage often varies depending on the type of addiction being treated as well as other variables, such as prior attempts at rehabilitation.
Coverage for Heroin Detox
In 2012, the National Institute on Drug Abuse reports 467,000 people were abusing or dependent on heroin. The deadly drug has been responsible for many fatalities; CNN notes 8,260 deaths related to the drug in 2013.
The standard form of treatment for heroin detox is a long-term plan that involves slowly weaning the individual off the drug. Oftentimes, replacement medications, like buprenorphine or methadone, are used as part of this slow weaning process; however, each individual should be assessed on a case-by-case basis to determine the best form of detox.
When the Affordable Care Act was signed into effect in 2010, change came with it. Insurance companies offering policies under the government healthcare reform structure are required to cover substance abuse treatment options. Brief interventions and long-term are covered, as well as clinical evaluations, medications to deter cravings, counseling, drug and alcohol screening tests, and medications used to treat addictions directly. The specific amount of coverage will depend on the individual’s particular plan.
While some facilities offer rapid detox as an effective method for facilitating withdrawal from opiates, studies and organizations that oversee addiction treatment practices don’t support or endorse these practices. Likewise, no insurance plans currently cover this type of treatment. AETNA Insurance confirms the lack of coverage for rapid detox under their plans since it is not proven to be effective. Without coverage, the cost of this type of treatment has been reported to be as high as $15,000, according to Fox News.
Cocaine Addiction TreatmentCocaine is still popular with many people who abuse illicit drugs. The Substance Abuse and Mental Health Services Administration notes 7 percent of people admitted for treatment in 2012 cited cocaine as their primary drug of abuse.
The treatment process for cocaine addiction involves a combination of detox and continued care. There is no medication designed specifically to treat cocaine withdrawal.
Discomfort associated with the detox process can be alleviated through other medications, however, such as modafinil and vigabatrin. In a trial using tiagabine to reduce levels of cocaine abuse, there was a 33 percent increase in the number of individuals with cocaine-free urine samples at follow-up, while there was a 14 percent decrease among those in the control group, per a study in the journal Psychiatry. Disulfiram has shown the most promise in treating cocaine dependency, NIDA reports. Again, any medications used during detox are determined on a case-by-case basis.
Cocaine addiction treatment may be covered by insurance, depending on the individual’s specific plan.
Oftentimes, inpatient care is only covered if it is deemed medically necessary; this is most often the case if the individual has had prior outpatient rehab care that was not successful.
Most often, insurance companies will require that the annual deductible on the policy be met before paying out on any covered services. Treatment coverage is generally more widespread for individuals who opt for treatment at in-network provider facilities. If an out-of-network facility is chosen, some of the rehab costs may be covered, but the individual will generally be responsible for a greater portion of the total cost of treatment.
Determining coverage for medical detox and treatment for an addiction to cocaine can be tricky, but most treatment centers have professionals that help clients navigate the insurance coverage process, U.S. News reports.
Coverage for Methamphetamine Addiction Treatment
In 2012, around 7 percent of people who sought treatment for an addiction did so for methamphetamines or amphetamines, and of that group, 93 percent sought treatment for methamphetamines specifically, SAMHSA reports.
Medical professionals determine the use of medications on an individual basis. All these medications are generally covered by most insurance plans, but some may require copayments.
Other ConsiderationsAddictions to heroin, cocaine, and meth warrant continued care following medical detox. In fact, a quality facility will begin other interventions, like therapy and support group participation, while detox is in process. There is no need to wait for the detox period to be completed to start treating the psychological and emotional issues that have been contributing to the development of the addiction.
The risk of relapse is significantly lower for individuals who seek treatment within a month of detoxing. The Partnership for Drug-Free Kids notes that in those cases, people who relapse will take 40 percent longer to do so. This demonstrates that detox, in and of itself, does not constitute rehab.
On top of treating individuals for abuse of cocaine, meth, and heroin, mental health issues may warrant care, too.
Around 29 percent of people living with a mental health disorder also struggle with drug or alcohol abuse, Psych Central states.
The Mental Health Parity and Addiction Equality Act of 2008 also helped improve treatment in this realm when the ACA went into effect. Treatment for mental illness is included in the latter as an essential health benefit for which all insurance companies that offer plans under the government program must provide coverage. As such, medications for treatment of mental health disorders, and therapy used to treat both mental illness and substance abuse, are covered, too.