When seeking treatment for a substance use disorder (SUD) one of the first things someone will ask is whether the treatment services are covered by insurance. It is important to address this issue right from the start so you can begin planning for potential out-of-pocket expenses.

In the past, treatment services related to SUD were typically considered out-of-pocket expenses. Thanks to two important pieces of legislation pertaining to health care, the Affordable Care Act of 2010 and the Mental Health Parity Act of 2008, the chances that your insurance provider will pay at least a portion of the costs are now excellent. With each plan being unique, however, it is critical that anyone seeking treatment start by contacting their insurance company to request the details of their particular plan.

Cost of Treatment

Due to the perceived financial burden, many people resist seeking help for an SUD. While true that financial resources and health insurance status are valid concerns when approaching treatment, there are several payment options available.

Treatment costs cover a vast range and will vary based on several variables. These include:

• Level of care. An outpatient program will cost significantly less than a residential treatment program due to housing and meal costs.
• Location. The state in which the treatment program is located can affect the cost, as well as whether the program is located in a resort community.
• Length of stay. The longer the stay, such as 30, 60, or 90+ days, the higher the total cost of treatment will be.
• Amenities. Treatment programs range from bare basics to high-end luxury, based on accommodations (private rooms, gourmet chef) and services offered (massage, equine therapy, acupuncture).
• Patient ratio. Smaller programs will have a higher level of support and therefore tend to cost more.

Insurance companies offer various levels of coverage for SUD treatment services depending on your individual plan, with some premium plans covering most or all of these expenses.

For someone with minimal insurance coverage, there are private pay options that provide manageable monthly payments. Other resources for those seeking addiction treatment with out of network insurance may include family assistance or credit card financing.

How to Use Insurance for Treatment

Most insurance plans now provide coverage for assessment and diagnosis, withdrawal management, outpatient care, and partial coverage for inpatient or residential treatment programs.

The complexity of insurance policies makes it challenging for individuals to decipher exactly what is covered by their plan. Coverage for SUD treatment is usually detailed in the health plan’s list of benefits. A list of in-network treatment providers, including primary care physicians, withdrawal management services, outpatient treatment facilities, and residential programs, are typically available on the insurer’s website.

It is essential, when preparing to enter treatment, to call member services for your insurance provider and ask some specific questions, such as:

• Copays and Deductibles. Asking about these expenses helps you prepare for out-of-pocket costs.
• Level of Care. Ask what specific level of care is covered for treatment, such as assessment, detoxification, outpatient, residential, partial hospitalization, etc.
• Length of Stay. Ask if the plan limits coverage based on the length of stay.
• Maximum Out-of-Pocket Expense. Ask what your maximum out of pocket expense is so you can plan accordingly.
• Cost of Out-of-Network Providers. Find out what percentage of coverage is provided for out-of-network providers if you are considering a center that is not included in their network.

Most treatment centers offer an insurance review, conducted by the admissions team. These professionals can clarify your plan’s benefits and help you determine the best way to utilize your insurance for treatment services.

Ashley Addiction Treatment, formerly Father Martin’s Ashley, is a nationally recognized nonprofit leader in integrated, evidence-based treatment for substance use disorders and is accredited by The Joint Commission. We offer holistic care that encompasses the mind, body and spirit through inpatient and outpatient treatment, provide drug detox, relapse prevention plans, family wellness programs and a variety of other services tailored to each patient’s unique needs. Our driving principle – “everything for recovery” – reinforces our mission to transform and save lives through the science of medicine, the art of therapy and the compassion of spirituality, and is complemented by our philosophy of healing with respect and dignity. For information about our comprehensive programs, please call (866) 313-6307.