Is Addiction Treatment Covered by Insurance?
One obstacle that keeps us from getting the help we need for substance abuse is our financial capabilities. Even when we want this help, the cost can and does prevent us from getting the quality of addiction treatment care that is needed. The good news is this has been somewhat rectified by recent state and federal mandates. Your health insurance plan now covers some and in some cases all of a person’s detox and rehab costs! At Cirque Lodge, we have one of the finest billing and utilization review departments in the addiction treatment industry. We can help you determine your benefits and provide you or your loved one with the finest rehabilitation care available for an alcohol or substance use disorder.
Though we are not an in-network provider, changes to insurance laws have created an opportunity and coverage for those that struggle with addictions and other behavioral health disorders. These laws have required insurers to provide meaningful benefits at both in and out-of-network facilities. Let us help you with the process by calling 1-800-582-0709.
Explanation of the Parity Law
The Affordable Care Act of 2008 and Mental Health Parity and Addiction Equity Act of 2008 provided a more specific definition of coverages for mood disorders and addiction struggles. Insurance plans that offer both medical and mental health / substance abuse coverage must do so with parity. It specifies that providers offer the same level of insurance coverage for addiction treatments as any other medical/surgical procedures that are covered. In the past, this coverage was either non-existent or restricted to detoxification or outpatient services. The parity act opens up a number of options, and has designated Residential Treatment as an essential health benefit. Previously those seeking this type of care were usually denied coverage or sent to lower and often times inadequate levels of care. Most states have adopted similar parity laws for insurance companies to provide this coverage in their policies. You can learn more about the parity act and your rights at samhsa.gov.
Most employer health plans must offer this parity benefit, but not all. Some restrictions to offering this benefit include:
- Any plan that does not provide specified benefits for mental health disorders or substance use disorders. Parity only applies to policies that do.
- It only applies to employer plans that consist of 51 employees or larger.
- Small business health plans are not required to offer this parity, unless the plan was adopted after the Affordable Care act went into effect. Then it is likely that the plan offers this parity with its health benefits.
- Most individual health plans purchased through the Affordable Care Marketplace offer coverage for substance abuse or mental health services.
- Medicaid and retiree health plans are not required to comply with the parity act
Parity Rules for Substance Use Disorders
The Parity law specifies the financial areas that must be met by health insurance providers. Co-pays, treatment limitations and out-of-pocket expenses must be comparable for substance abuse help as it is for standard medical services. It also specifies rules for health plans when it comes to accessing this treatment.
Some examples of this include:
- Co-pays - If your co-pay for an office visit is a set amount for all medical services, parity requires that the co-pay is the same for substance use or mental health care visits.
- Treatment limits - If there is no specification on treatment limits (how many doctor visits you are allowed in a year). There should also be no limitation on the number of visits for substance or mental health disorders. This can encompass the number of visits or number of days in treatment.
- Authorization - If your health plan does not require prior authorization for medical/surgical procedures. The provider cannot require such authorizations for substance abuse care.
How can I find about my Health Plan Benefits?
You can contact your health plan or you can simply call your provider (Cirque Lodge) and ask for information regarding your benefits. You should be able to obtain a summary of your benefits including information on your coverage for substance use. You have the right to receive any/all information you need and an explanation or your benefits. You can also ask your health plan provider about their requirements for prior authorization for alcohol or drug rehabilitation care, or again Cirque Lodge can usually provide you with that information. Here are some things to help you when contacting your provider:
- Usually the number for customer service is located on your health plan card.
- The employer and group plan information located on your card is helpful to customer service. It will help your representative locate your benefit information more easily.
- An explanation of your benefits may also be available on your healthcare provider's website.
Can Cirque Lodge Assist with Insurance Inquiries?
As mentioned above the answer is yes! We would be more than happy to assist you with determining what insurance coverage you may be qualified for. Our admissions staff can help you verify your benefits and lay out the treatment options available to you. For more information and details on this service, or for additional information on costs and coverage of treatment, we encourage you to contact our admissions department at 1-800-582-0709.