Using Insurance Coverage for Drug Addiction

Parents who find themselves facing the nightmare of a young adult child who is addicted to drugs will likely do anything to help them.  But when the reality of the potential costs involved with treatment becomes known, many loving parents simply don’t have access to that kind of money.  Due to the perceived financial burden of treatment, they may not get help for their son or daughter, unaware of recent significant changes in health insurance coverage.

In the past, health plans didn’t offer much in the way of insurance coverage for drug addiction, and children aged out of the parent’s plans at age 21.  Thankfully, several positive changes over the past several years have modified the health insurance landscape offering new hope for young people needing treatment.

Insurance Coverage for Drug Addiction

With the passage of the 2010 Affordable Care Act, most individual, and all Marketplace plans now offer coverage for substance use disorder and behavioral and mental health disorders.  Benefits for these services do vary according to the state in which the policy is issued, and the type and breadth of the insurance coverage selected, so it is crucial to select the health plan carefully.  Additionally, young adults are now covered by their parent’s plans until they reach the age of 26.

These important changes followed on the heels of the passage of the Mental Health Parity and Addiction Equity Act in 2008.  This law stipulates that there can no longer be higher copays charged for doctor visits related to mental health and addiction services.  According to the Substance Abuse and Mental Health Services Administration (SAMHSA):

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 require health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care.

Between these two new laws, insurance coverage for drug addiction now offers benefits for a much larger percentage of the costs related to addiction treatment than in the past.

What Specifically Does Insurance Cover for Addiction Treatment?

Each plan offered by the various insurance companies will have varying rates of coverage for treatment services.  Generally, most policies will provide coverage for assessment and diagnosis, detoxification, outpatient care, and partial coverage for inpatient or residential treatment programs.  There is no differentiation between the different substances in terms of coverage, so whether it is a marijuana addiction or a heroin addiction—or anything in between—treatment will be offered.

The complexity of insurance policies makes it a challenge for parents of young adults to decipher exactly what is covered on their plan.  Insurance coverage for drug addiction is usually detailed in the plan’s list of benefits.  A list of treatment providers, including primary care physicians, detox facilities, outpatient treatment facilities, and inpatient programs, will be available on the insurer’s website.

Regardless, it is worth the time and effort to call the member services for your plan and ask specific questions, such as:

• Ask about copays and deductibles
• Ask what specific level of care is covered for treatment, such as assessment, detoxification, outpatient, residential, partial hospitalization, etc.
• Ask what your maximum out of pocket expense is
• Ask what percentage of coverage is offered for out of network providers

Another option is to have the rehab admissions specialist do an insurance review of your benefits for you.  They often have the tools and experience to flex the benefits, making the insurance coverage for drug rehab work for you.

Phoenix Rising Provides Outpatient Life Skills for Young Adults

Everyone deserves a chance to renew their life and start over.  Helping individuals start fresh following treatment for substance abuse is what Phoenix Rising is all about.   Located in Ladera Ranch, California, this Intensive Outpatient Program (IOP) combines evidence-based treatment modalities and A.A. programming, with an emphasis on attachment perspective (addiction as a pseudo-attachment).

Post Script from Victoria

I didn’t know what pseudo-attachment meant. I found some scholarly articles on the subject, but the best description came from the Phoenix Rising website:

What is Pseudo Attachment? Well, Pseudo means false or fake. A false attachment would be, in the case of dealing with addiction, a drug or other substance used to replace an attachment the addict had with something or someone else in the past. Now that they have reverted to this addiction as an attachment instead of what was lost, this is now called a Pseudo Attachment or “false attachment” because it is not really the thing that the person wants to be attached to, but is a false misrepresentation of whatever they were attached to. This can be as common as losing a loved one in death, a marriage or relationship breakup, or worse yet one might be going from substance to yet a worse substance to fill the void.