Health Insurance for Medical Alcohol Rehab

Health Insurance for Medical Alcohol Rehab

Drinking too much and losing control over drinking behaviors may seem to be common and normal. This is especially the case in a society where alcohol is legal and drinking is deeply embedded in culture. But it may be the case that drinking behaviors have turned into abuse or addiction, which are problems that can negatively impact a person’s life and the lives of those around them in many ways.

Alcohol abuse and addiction is a problem to take seriously. It is considered a medical condition that requires treatment, which is often covered by medical insurance plans. Treatment, such as medical detox and medical alcohol rehab, and assistance covering the cost of that treatment is available for people who find that alcohol addiction has been taking over their lives.

Does Alcohol Addiction and Abuse Require Treatment?

Alcohol abuse and addiction are not just simple problems a person has to deal with on their own. Instead, they are part of an official medical diagnosis called alcohol use disorder, which is a specific type of substance use disorder. This means that the problem is considered an official medical condition that requires treatment and management.

This is a chronic debilitating condition that continues to progress without intervention. People often think they can handle the problem on their own, but it’s part of the nature of addiction that one finds it difficult if not impossible to stop using the substance, in this case alcohol. Professional treatment can provide the support and guidance to break that cycle.

Alcohol use disorder has certain criteria that help professionals diagnose it. This is a summary of the signs and symptoms of this medical condition:

  • Experiencing withdrawal symptoms when trying to stop using alcohol
  • Feeling strong cravings to drink alcohol
  • Needing to drink more alcohol to feel the same effect, which is called tolerance
  • Feeling unable or unwilling to stop drinking
  • Failing to meet obligations of school, work or loved ones
  • Stopping activities, hobbies or social encounters one used to enjoy
  • Continuing to use alcohol despite knowing it’s causing problems in one’s life
  • Focusing a lot of one’s time and attention on getting and using alcohol
  • Putting oneself into risky situations because of one’s alcohol use

A medical professional would assess a person for these criteria and potentially diagnose the person with alcohol use disorder based on meeting a certain number of the criteria. Then, the professional would decide whether the person had a mild, moderate or severe case of alcohol use disorder, which would help determine the treatment.

There are different types of treatment, and the best plan is one that’s customized to fit the person’s needs and goals. One may need to start with a medical detox program to help the person stop drinking safely and get through any withdrawal symptoms, and then transition into an inpatient or outpatient medical alcohol rehab program. Rehab generally includes therapy and other services to help the person overcome the thoughts and behaviors of addiction and learn to live differently. After that, many people transition into aftercare services to help them continue with recovery and avoid relapse. A professional diagnosis, a customized treatment plan created by a professional and health insurance may all inform the treatment a person participates in.

Insurance Coverage for Addiction Treatment

Many people avoid addiction treatment because of the cost of care, but it’s important to know that a health insurance plan may help cover some or all of the cost of treatment. Today, most health insurance plans are compliant with the Affordable Care Act (ACA). To be compliant, they have to offer minimum essential coverage, meaning that they provide coverage for certain health benefits considered essential. One of these 10 categories is mental health and substance abuse treatment. So if someone has an ACA-compliant plan, it will cover treatment for alcohol addiction or abuse to some extent.

One should double check whether one’s plan is ACA-compliant and therefore covers addiction treatment. It’s likely that it does. If so, check on the amount and type of coverage a specific plan provides, because these vary from plan to plan. One can find this information on the plan’s summary of benefits and coverage (SBC) documents or by contacting the health insurance company.

A plan will often cover inpatient or outpatient treatment. It may also cover office visits with a substance abuse professional, such as a counselor. It will provide coverage for providers, such as professionals or facilities, that are in the plan’s network. It may also cover providers outside the network, but plans tend to cover more of the cost of treatment that’s in-network. One can generally find providers in one’s network by searching on the insurance company’s website or by contacting the insurance company. A person can also check with a specific provider to see if they take an insurance plan.

Plans vary in how much coverage they provide, so check on the substance treatment coverage of the plan. There may be a copay for visits, which is common with outpatient care or office visits. In this case, the person would pay the designated fee, such as $50 for the visit. There may instead be a coinsurance percentage, which is common with inpatient care. In this case, the person would pay a percentage of the total cost, such as a 30 percent coinsurance, which means the person is responsible for 30 percent while the insurance company pays the other 70 percent. One may be required to pay the plan’s deductible before these benefits kick in, and sometimes there are additional expenses such as an admission fee for inpatient care that’s separate from the coinsurance amount.

Also, there may be stipulations to care. For example, a person may need to get a diagnosis of alcohol use disorder from a professional before treatment would be covered, and one may need to get pre-authorization from the insurance company in advance before it would cover the treatment.

Overall, each person needs to check to see the specific coverage of a particular plan.

How to Determine if Your Insurance Covers Care

Even if someone is covered by a health insurance plan, not everyone can rely on the plan to fully cover the cost of care. If one is underinsured with a plan that doesn’t meet minimum essential coverage, the plan may not cover addiction treatment at all. Otherwise, insurance plans may cover certain types of treatment and certain providers. When a provider is covered, the plan may cover the entire cost or a portion of it.

It’s important to understand more about what a plan will cover before trying to enter treatment. Try to learn more about a plan through methods such as looking through its summary of benefits and coverage, using online tools and/or calling the insurance carrier.

  • Summary of Benefits and Coverage (SBC): A summary of benefits and coverage specific to a plan generally shows whether one needs to pay the cost of a deductible before the care is covered and the portion of the care that would be covered. It may list a copay or coinsurance amount one would be responsible for. Also, it may specify types of care, such as inpatient and outpatient coverage, and the coverage for in-network and out-of-network care.
  • Health Insurance Website: Online tools can often help someone see which providers are in the plan’s network and play with cost calculators to get a better idea of coverage.
  • Phone Calls: Each person could also call the company to get more personalized assistance.

Also, a person can call a treatment facility directly to enquire whether it accepts the type of insurance one carries. In many cases, a facility has staff members who can assist by verifying insurance coverage. Call Discovery Point Retreat for assistance with insurance verification.

Alternatives to Health Insurance for Covering the Cost of Treatment

In some cases, a person may need alternatives to health insurance to help pay for alcohol addiction treatment. This could happen for different reasons, such as:

  • A health insurance plan will not cover the cost of treatment. Maybe the plan does not cover this service, or perhaps the treatment or facility falls outside of the coverage of the plan. (Keep in mind that all plans that meet the Affordable Care Act (ACA) minimum essential coverage standards will cover at least some portion of addiction treatment.)
  • One is not covered by health insurance.
  • The health insurance plan covers a portion of the cost of care, leaving the person responsible for paying the rest. One may need to pay an insurance deductible, copays, coinsurance or other costs.

What options are available to someone who needs to pay some or all of the cost of medical alcohol rehab treatment?

Self-Pay: There is the option to self-pay, which means one would pay the facility directly out of pocket. Some people are able to use savings to do so, while others may get the help of loved ones. Nonetheless, many people don’t find it possible to self-pay the entire cost at once. In this case, other options are available.

Financing: One could inquire with the treatment facility about financing options. Financing could help someone pay off the cost of treatment in reasonable payments over time.

Scholarships: To help people cover the cost of treatment, many facilities offer scholarships. Some are also offered by third-party foundations, such as the charity 10,000 Beds. Scholarships tend to cover necessary care, rather than luxury options, in both inpatient and outpatient facilities. Some scholarships may cover the cost of the full stay while others may provide a boost to help with some of the cost. One could inquire directly with facilities or research third-party scholarships. Generally, one would need to apply for a scholarship, be committed to recovering and follow certain criteria.

If alcohol addiction treatment seems out of reach, consider whether health insurance could help with the cost. Nonetheless, keep in mind that cost isn’t everything, as a quality treatment program will give a better chance at a successful long-term recovery. It’s important to find treatment that is evidence-based, run by qualified professionals and that can be personalized to fit a person’s individual needs. Also, one type of treatment, such as detox or residential treatment, within the full continuum of care may be the right first step for someone over another. Health insurance can provide a helper in finding the right program and making it more attainable for one’s treatment and recovery.

Discovery Point Retreat, which has locations in Waxahachie, Dallas and Ennis, Texas, provides a range of treatment options that are covered in-network by Cigna or Aetna. This facility also accepts out-of-network insurance plans.