Health Insurance and Addiction Coverage

The way that drug and alcohol treatment works has changed dramatically over the past five to ten years. In the past people who went away to inpatient treatment would sometimes stay for 6 months to a year, with short-term stays coming in around 3 months. But with the changes in health insurance, mostly due to the Affordable Care Act, a number of treatment centers gauging insurance companies for drug tests, and other treatment centers abusing certain Market Place policies, treatment has changed. Now most people are lucky if they get 30 days authorized by their insurance company. The cost of addiction to the American economy and workplace is significant it goes so far as to affect specific job industries at a higher rate than others.

For all of the good that the Affordable Care Act has done, and I will address the good, there has been a startling trend over the past few years which has seen a dramatic rise in insurance costs and what seems like less coverage for the cost. Insurance companies seem to want to push outpatient treatment more and more on their clients and with little to no recourse in order to fight this, many addicts and alcoholics are left having to deal with inadequate levels of care. Levels of care that any logical person would see were not sufficient to help an addict or alcoholic of the hopeless variety achieve recovery.

 

As with most things that have to do with addiction, the relationship between insurance companies and addicts and alcoholics is a complicated one. On the one hand, inpatient treatment is exceedingly expensive and many addicts and alcoholics do not get sober upon their first treatment stay. This leaves insurance companies paying hundreds of thousands of dollars for the treatment that they deem to not be working. On the other hand, many people are incapable of achieving sobriety without attending treatment and so it is oftentimes a medical necessity for them to go.

Now if you take this back and forth and add in the fact that there have been numerous treatment centers over the past couple of years, which have abused the system by either billing for services that did not exist or for finding billing loopholes which allowed them to milk the insurance companies for inordinate amounts of money and you can see why the amount of treatment that a person receives today differs greatly from what a person received ten years ago.

The way that the Affordable Care Act plays a role in all of this is that by making insurance mandatory, the Affordable Care Act essentially took any sort of competition out of the once free market and gave insurers the ability to continuous raise their rates while dropping the amount of coverage offered. There are some experts who will argue against this fact, but there is overwhelming evidence to the contrary and most scholars believe that the ACA did, in fact, raise insurance premiums across the board. The cost of private insurance, not through the Marketplace, and group employer insurance has skyrocketed and between 2013 and 2015 “the average individual market medical costs increased by 69%.”

For a minute, though, let’s press pause and turn our attention to the positives that the Affordable Care Act has brought to addicts and alcoholics. First, they made it mandatory for health insurers to offer drug addiction treatment to their clients. Although what circumstance this actually happens is debatable and there are a number of loopholes in the wording of this mandate that make it possible for insurers to continue to deny coverage. Nonetheless, under the law insurers do have to offer this coverage and because of this thousands and thousands of addicts and alcoholics who would not have received treatment otherwise have found their ways into treatment programs throughout the country.

The Affordable Care Act has also helped to reduce insurance deductibles for those that are eligible through the Marketplace. Not many people are aware of this, but when you enter a drug treatment facility, if you have an outstanding deductible that has not been met, you are responsible for paying that amount to the treatment center. This is not just a suggestion, but it is actually against the law for a treatment center to not ask for the deductible or at the very least set up a payment plan for it.

With the Affordable Care Act, those who are eligible for the government subsidy will not have deductibles as high as people who have private insurance and so they are able to attend treatment more easily than they could have in the past. This, unfortunately, has been abused by many treatment centers, when they figured out that there were certain plans that had extremely low deductibles and paid very well and so they would actually buy uninsured clients these plans so that they could get paid for their treatment stay.

Which brings up another point, if you are planning on attending a treatment center and you do not have insurance and that treatment center offers to buy you insurance through the Marketplace, run as fast as you can away from that place. While it may seem like they are just trying to help you, it is incredibly illegal and there are numerous treatment centers throughout the country that engage in this type of behavior that also have other illegal activities going on inside that are not conducive to your recovery.

To sum all of this up, the way that insurance companies treat drug addiction in this country is still pretty terrible. This is not entirely their fault or entirely the fault of the Affordable Care Act, but is a combination of those two things and individuals within the treatment industry that has abused the system. It’s not all bad news though and if you are in need of treatment and you do not have insurance then the Affordable Care Act will definitely benefit you. Signing up for insurance through the Marketplace is very simple and depending on how much money you make a year the plans can be rather affordable. Since open enroll has already started, if you do not have insurance yet, go and check it out and start 2017 off right by getting yourself some health coverage.

Rose Lockinger is a passionate member of the recovery community. A rebel who found her cause, she uses blogging and social media to raise the awareness about the disease of addiction. She has visited all over North and South America. Single mom to two beautiful children she has learned parenting is without a doubt the most rewarding job in the world. Currently the Outreach Director at Stodzy Internet Marketing.

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