Health Insurance and Addiction Treatment in the United States

HOW TO RECEIVE AFFORD TREATMENT

Currently, over 300 million people live in America. Approximately 270 million of them are over age twelve. Nearly 10% of these people abuse substances. The results from the most recent National Survey on Drug Use and Health offer proof: 17.6 million suffer from alcohol disorders, and 25 million abuse illicit drugs. These are just the people who actually said ‘yes’ to the survey question.

Worse yet, one American citizen dies from drugs and/or alcohol every 8 minutes.

Perhaps even worse than these numbers is the fact that only 10% of addicts ever receive any type of treatment. Dr. Vivek Murthy, former surgeon general under Obama, issued the first ever surgeon general’s report on drug and alcohol use. In the report, Dr. Murthy called for a shift in how America perceives drug/alcohol addiction. He wants us to realize addiction is a disease, not a product of laziness or low willpower.

He also wants us to realize how much America’s substance problem costs. “At a time when we are resource-constrained already, we cannot afford, for humanitarian reasons or financial reasons, to not address addiction in America,” said Dr. Murthy to USA Today (linked above). “Every dollar invested in viable treatment options for substance use disorders saves $4 in health care costs and $7 in criminal justice costs.”

Why Only 10 Percent?

So why aren’t more substance addicts in treatment? There are two reasons. One is that healthcare professionals simply do not screen for substance addictions often enough, or at all. The other reason is very simple, and very unfortunate.

Treatment costs way too much.

Health insurance has never really been ‘affordable’ in this country, at least generally speaking. Therefore, many Americans go without it. Surely a portion of addicts have no health insurance. Besides, treatment centers often still cost too much, even for the insured. While we cannot fund your stay at a facility, and although we are not financial advisors or insurance experts, we indeed are experts in helping people achieve sobriety.

There are over 15,000 drug/alcohol rehabilitation facilities in the US. What follows is a guide to getting you into one, with insurance, in the process of shopping for insurance, or even without insurance. There is no order – it’s just a list of suggestions. Skip to whichever step(s) apply to you. We simply do not want anything to stand in the way of your achieving a sober lifestyle.

Naturally, more options become available when you have health insurance, but insurance-free rehab centers do exist. If health insurance is absolutely not a possibility for you, skip to #4 below.

  1. Contact your Insurance Company

If you do have health insurance and you’re seeking addiction treatment, start by getting a hold of your insurance company. (If you have coverage through an employer, contact your HR department prior to the actual provider). With so many different companies and policies, the only way to find out if you’re covered for treatment is to call. Plus, learning about your policy is always a good thing!

At least four major health insurance carriers cover some or all of the costs of substance abuse treatment under most of their policies: Aetna, Blue Cross Blue Shield, Cigna, and United Healthcare. Please be aware that often, regardless of provider, the carrier is required to cover some of the costs.

Aside from asking if treatment is covered, be sure to ask the following questions:

  • Does my policy cover the entire cost of treatment?
  • Is there a list of treatment facilities I have to select from?
  • Are there any limitations regarding treatment?
  • How long does my policy cover treatment for?

If it turns out your health insurance provider does not cover treatment, maybe it’s time to shop around. After all, your health is going to decline as your addiction worsens. There may be no better reason to switch insurance companies. According to an HBO documentary on addiction, “43% of Americans who are unable to get addiction treatment cite cost or insurance barriers as their obstacle…”

  1. Shop Insurance Companies

First off, if you know your current provider is supposed to cover the costs of substance abuse treatment, but they are refusing, take action. It is your right to be covered if you know for a fact your provider is obligated to do so. Most states actually have laws requiring providers to cover addiction treatment. That being said, it is a fact that some companies do not cover the costs. So, it’s time to shop.

If you find an insurance company you like, wait on switching. First, compile a list of companies you like, call them all back, and ask the four questions listed above. Many policies cover the costs for only 30 days, and others only up to a certain dollar amount. Frankly, if you’re looking for a health insurance plan that covers most or all of the costs of substance abuse treatment, look no further than the healthcare marketplace.

  1. Go to the Marketplace

When Obama passed the Affordable Care Act, he intended to make healthcare available to as many Americans as possible. Soon nicknamed Obamacare, his act included one very important part that all substance addicts should be aware of:

All marketplace health insurance plans cover substance abuse treatment!

In a major government effort to help those unable to afford the insurance necessary to be treated for addiction, we now have the marketplace. In addition to substance abuse treatment, marketplace plans must cover the following:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventative and wellness services, including chronic disease management
  • Pediatric services

On top of that, marketplace insurance plans cannot deny you coverage or charge you additional money if you have a pre-existing condition. This includes addiction. Also, there are no annual or lifetime dollar limits for marketplace plans, including benefits for addiction treatment. For those who have a continuing problem or require long-term care, this is a financial savior.

All marketplace plans must provide “parity” protections between substance abuse benefits and medical benefits. This means that limits applied to substance abuse services cannot be more restrictive than those applied for medical services. This is another wallet-pleaser.

The types of limits covered include: financial (co-pays, deductibles, co-insurance, out-of-pocket), care management, (authorization requirements, long-term assistance), and treatment (number of visits, length of stay).

You might be reading all of this, thinking to yourself how great it would be if you could just afford it still. After all, as much as the government has helped lately, none of this is necessarily affordable.

The middle class income range currently tops out at $70,000 per year. That’s not always a lot to work with in today’s economy. Heck, forget about whatever cost for treatment is leftover after insurance. Many still can’t afford insurance.

Wouldn’t it be wonderful if treatment were available without insurance? Wouldn’t be even more amazing if that treatment were free?

You may be in luck.

  1. Treatment without Insurance

If you suffer from a diagnosable substance abuse addiction, yet have little to no income, plus no health insurance, don’t give up. There is help available. As long as you are a legal US resident, state-funded help is most likely available. (You must also be an official resident of whichever state you reside in).

American Addiction Centers offers a tool for finding a free rehab near you. Just note, as per the site: “Depending on the state, there may be other requirements before the individual can be accepted into the treatment program. Once this information is established, if the state deems that the client cannot pay, they may provide free treatment on various levels through specific types of clinics or treatment centers.”

SAMHSA, the Substance Abuse and Mental Health Services Administration, also offers an online tool for locating treatment without insurance. If you do not have access to the Internet, the phone number for SAMHSA’s helpline is 1-800-662-HELP (4357).

In Conclusion (It’s all about money)

Every year, substance addiction costs our nation $700 BILLION. This includes the costs related to healthcare, crime, and lost productivity. Tobacco leads the pack, costing 42% of that total. Alcohol and illicit drugs make up the rest. Every dollar the government spends on treatment options for substance abuse saves $4 in healthcare costs, and $7 in crime-related costs.

You better believe our government would rather spend one dollar than seven!

Having treatment covered under marketplace plans saves Uncle Sam a great deal of money. Plus, it’s becoming easier and easier (and more affordable) for addicts to receive the proper care they need and deserve. Only one out of every ten substance abusers is receiving treatment. No excuse exists now for those other nine of ten.