Addiction is a wide-reaching disease, affecting the young and old, rich and poor. It touches lives indiscriminately across regional boards and ethnicities. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2014, more than 20 million American adults qualified as having a substance use disorder, which includes substance abuse, dependence, and addiction. Of those, only 2.5 million actually received treatment, which is a little over 12 percent.
With so many people struggling, why do so few get treatment?
There are a variety of barriers that stand between you and getting the drug and alcohol addiction treatment that you need.
Some don’t want to admit they have a problem. Others are embarrassed to admit that they need help and are deterred by the stigma that still surrounds both addiction and mental health. Many don’t know where to start when it comes to finding the treatment that is best for them.
However, one of the biggest barriers to treatment is the cost. The healthcare field can be costly and the notion of seeking the best quality of care can be financially daunting. However, addiction is a disease that will slowly start to invade different parts of your life. Drug dependence is difficult to keep up and requires time and money. Before long, funding your addiction will take up a significant portion of your finances. The physical and psychological effects will begin to take their toll. Your performance at work or school may start to suffer. It may become harder to get through a whole work day without using.
Active addiction may start to become the most expensive thing you’ve ever had to pay for and it can ruin your career and livelihood. The cost should never be a barrier to treatment and sobriety is worth every penny it takes to get there. That being said, you aren’t without financial options. Many high-quality addiction treatment centers accept several insurance options.
But which centers accept your insurance? To answer that question, there are a few important things you need to know.
With insurance companies providing coverage for a variety of mental health and addiction treatment services, many treatment centers accept most private insurance options. A treatment center will look for ways to work with insurance companies to get you the most comprehensive coverage possible. However, not all insurance options are accepted. Some providers have very low payouts and come with a lot of red tape and paperwork. One notorious example is Medicaid.
Medicaid is a government health insurance option that is very affordable for people who can’t spare the price of more expensive private insurance premiums. Medicaid insures more than 70 million Americans but many of them struggle to find doctors and treatment all across the medical industry. Why? Because Medicaid is infamous for low payouts and prohibitively complicated paperwork.
Medicaid typically pays out very small amounts, leaving the patient and healthcare professionals with the majority of the bill. And anyone who has experienced medical procedures will know how expensive that can be. In the addiction treatment world, top quality treatment centers that provide evidence-based therapies look for insurance companies that help clients afford the best care for their needs.
In 2013, provisions in the Affordable Care Act attempted to get more doctors to accept federal insurance by increasing reimbursement fees. It improved marginally for about a year but returned to the low payout standards when the program ended. The paperwork and red tape with Medicaid providers are also a barrier for health care and addiction treatment providers.
Paperwork required by Medicaid and other federal insurance options is time-consuming and complicated. When it is accepted, it takes up significant time for doctors, medical professionals, and medical office workers, so much so that it isn’t cost-effective to accept at most facilities.
There are federally provided addiction treatment options and as the opioid epidemic becomes a pressing political issue, some are seeking to make those options more robust.
However, most top-quality private treatment centers don’t accept Medicaid, even though they accept many private insurance options.
When an insurance company is considering an addiction treatment center, they look at a number of factors. First, they look for centers that are already in their network. This network refers to a prescreened list of treatment programs that the company already knows and covers. In-network providers are usually easier to qualify for coverage.
However, insurance companies will also cover out-of-network treatment centers if they meet certain qualifications. First, the company will look at the type of treatment that’s offered at the facility. There are a wide variety of therapy options but some are more effective than others. With the addiction epidemic growing, more and more therapy options have developed and some of them haven’t been supported by much research.
Certain alternative therapy options can be of tremendous help to some people but they aren’t proven to be effective on any significant scale. Treatments that have gone through scientific and clinical testing and have proven to be effective are called evidence-based practices (EBP). EBPs can also have set standards that allow them to be effectively used in a variety of treatment settings. Insurance companies prefer to cover treatment centers that offer a foundation of evidence-based therapy options.
Insurance companies will also look at the treatment center’s track record. Have they had a series of blunders, have they been penalized for unsafe practices, or are they virtually unknown? Insurers will look for a treatment center that is established, has a track record of safe and effective practices, and offer results-oriented treatment.
What your insurance company will cover will vary based on the state you live in, the coverage that you have, and the insurance company that you have. Your insurance company may provide coverage for your complete stay at a treatment center or they may pay for parts of your addiction treatment. Generally, you will need coverage for medical detox and then addiction treatment.
Medical detox is the process of healing from chemical dependency. When you’ve used a drug for a long time, your brain will become used to the presence of the foreign chemicals. When you stop using, you may go through painful withdrawal symptoms. Some withdrawal symptoms are uncomfortable and can lead to relapse, like opioid withdrawals. Others can be medically dangerous and even life-threatening without treatment, like benzodiazepines. Medical detox is 23 hours of medically managed service to keep you safe and comfortable.
Most insurers will cover medical detox if you have serious co-occurring medical conditions or if you are being treated for drugs with dangerous withdrawal symptoms like alcohol and benzodiazepines. However, some may not cover detox for withdrawal symptoms that are not known to be life-threatening, even if they are extremely uncomfortable like opioids. Still, your treatment center may be able to work with your insurance company to get you the coverage you need.
Today, most private insurers offer at least some coverage for addiction treatment. To find out how much coverage you will get with your specific insurance plan, call your insurer or an addiction specialist to help walk you through your coverage options.
Your length of stay in addiction treatment will depend on several factors. But, as with other aspects of addiction treatment, it primarily depends on your personal needs. You may want to get into addiction treatment and get back to normal life as soon as possible but treatment takes time to be effective. It’s important to separate from your lifestyle of addiction, identify triggers and high-risk situations, develop positive coping skills, and formulate a relapse prevention strategy.
That process takes time.
Addiction affects your limbic system, which is closely tied to reward and learning. Rewriting the way you perceive addiction and cope with stress without using is a complex process.
Insurance companies will also want you to get through treatment as quickly as possible to mitigate payouts. However, studies show that treatment needs to last long enough for it to be effective. According to the National Institute on Drug Abuse (NIDA), the most effective treatment duration lasts about 90 days. If your treatment is too short, it may lead to relapse, even if you seemed to do well through the process.
Though insurance companies want to limit the time they pay for, they also want the treatment they pay for to be effective. Still, people progress through addiction treatment at different rates. Your therapists and clinicians will work with your insurance company to cover treatment as long as you need it.
Insurance coverage may be difficult to navigate on your own, especially if you’ve never really sought professional health care or addiction treatment before. Navigating your options can be complicated and getting the best payouts for the best treatment may require some back and forth with your provider. However, you don’t have to navigate your insurance options for addiction treatment on your own.
Addiction specialists at Delphi Behavioral Health Group are committed to making the process of financing treatment as simple as possible. Call today at 844-899-5777 and to find out if your insurance provider is accepted into our network of facilities. Learn more about the treatment options that are available to you and covered by your insurance company. Addiction is difficult to overcome on your own and it can affect multiple areas of your life. Don’t let cost stop you from a life free from active addiction. Learn more today.
McGovern, M. P., & Carroll, K. M. (2003, December). Evidence-based practices for substance use disorders. Retrieved from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678283/
National Institute on Drug Abuse. (2018, January). How long does drug addiction treatment usually last? Retrieved from from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment
Renter, E. (2015, May). You've Got Medicaid – Why Can't You See the Doctor? Retrieved from from https://health.usnews.com/health-news/health-insurance/articles/2015/05/26/youve-got-medicaid-why-cant-you-see-the-doctor
SAMHSA. (n.d.). Trends in Substance Use Disorders Among Adults Aged 18 or Older. Retrieved from from https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html