Once you or your loved one decides to get help, the immediate questions you’ll face include where to get treatment and how to pay for it or does my insurance cover drug rehab? The following information can help you understand health insurance coverage for drug rehab and some important laws that impact coverage. Understanding your coverage can help you to get the best care possible and all of the benefits that you are entitled to receive. Our counselors can help you locate a drug rehab that will work with your insurance to help find a quality treatment program accessible and available to your loved one. Call today to learn more about your insurance coverage for drug addiction treatment.
To understand how health insurance works when paying for drug rehab, it’s helpful to first understand federal and state parity laws.
In the past, most health plans have provided more limited coverage for substance abuse (if any) than for other medical conditions. On Oct. 3, 2008, President Bush signed into law the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. (We’ll call it the “Parity” Act for short.) This new federal law became effective for most plans on January 1, 2010.
The Parity Act requires large employer (companies with more than 50 employees) group health plans that offer coverage (benefits) for mental illness and alcohol and drug rehabilitation to provide those benefits in a way that is no more restrictive than coverage for other medical and surgical care. The Parity Act does not require group health plans to cover mental health and substance use treatment. But, when these plans do cover this treatment, they must do so with “parity”— in a way that is equal to the way benefits for medical and surgical care are doled out.
The intent of the law is to recognize (show an understanding of) the close relationship between mental health and overall health, and to make sure that more people get the treatment they need to overcome addiction.
Keep in mind, the Parity Act does not apply to small employers — those with fewer than 51 employees, and it doesn’t apply to individual plans — plans you don’t get through an employer, but go out and buy directly from an insurer yourself. The Parity Act also doesn’t apply to Medicare and Medicaid, but sometimes there are exceptions depending on how these plans are administered (handled).
Many states had already passed similar laws, so most larger employers were already paying benefits for drug and alcohol treatment in less restrictive ways than for medical and surgical care. However, certain employers with “self-insured” medical plans — companies that pay benefits with their own money rather than with the insurer’s money — don’t have to follow most state-mandated laws, but they are required to comply with the Parity Act. Still, a self-funded employer could choose not to cover substance abuse at all, and then it wouldn’t have to comply with either federal or state law. Overall, 96 percent of employers say they provide coverage for substance use treatment (and mental health).
When the plan is bound by both the (federal) Parity Act and a state parity law, the one that provides the greater benefit applies.
Due to federal and state parity laws and other factors, health insurance coverage for drug rehabilitation varies widely. Your coverage will depend on a number of factors, including whether the Parity Act applies to your plan, what state you live in, and what types of benefits are offered by your plan.
Even when you have coverage, you still need to pay close attention to what that coverage is and how the insurer will manage your case. Whether you have Blue Cross and Blue Shield, Aetna, Cigna, United Health Care, Tufts, Kaiser, Humana, Northwest Medicare, Medicaid, or another plan, there are 10 questions you should ask your plan’s customer service representative to help make sure you get the best, most affordable care.
Pay attention to how your plan handles what has been called “nonquantitative treatment limitations” (NTQLs). Because remember, if you have coverage, unless your plan is excempt from parity laws, your coverage for drug abuse rehabilitation should be comparable to coverage for medical and surgical care.
NQTLs are plan features that are not expressed numerically (with numbers) but in other ways that can limit your benefits. These come into play with substance abuse treatment because they apply to medical and surgical care. Some NQTLs include:
Since some patients and caregivers have argued that NQTLs have not been used fairly with substance abuse treatment as compared with medical and surgical are, advocates (people who support) parity laws are watching this closely. That’s why it’s important for you to file an appeal to your health insurer if you feel your coverage is not handled fairly in light of parity laws. Research shows that 50 percent of individuals who file appeals are successful.
People without coverage for substance use treatment can check with their county’s mental health department, the Salvation Army, or Goodwill Programs. You may also be able to negotiate the cost of your care directly with the drug treatment facility.
As part of the Affordable Care Act, drug rehab will be required beginning in 2014 as part of essential benefits. This should help increase benefits for those who don’t have coverage and for those who are “under-covered.”
As you know, DrugRehab.org is here to give you all the information you need concerning treatment facilities that help those who are struggling with addiction get on the path of straight and narrow. In every state, there are multiple options when... Read more