Substance Abuse Treatment and Insurance

History of Insurance Coverage and Substance Abuse

While conducting treatment for substance abuse is vital to millions of people worldwide, it can be an expensive prospect and, without insurance, it can certainly be outside the budgets of many. As substance abuse is becoming more common, and alcohol and drug addiction is seen increasingly as a mental disorder, a wider number of insurance agencies have come out with coverage to financially protect those who require these often lengthy and expensive treatment procedures.

In the USA, progress has been steadily made to ensure that insurance plans provide more comprehensive cover for those seeking treatment programs for drug and alcohol abuse. In 1996, the Clinton government implemented the Mental Health Parity Act of 1996 which ensured that mental and physical disorders were both given the same level of coverage. This was the first step towards fairer insurance policies for all even though this new scheme still did not apply to those suffering from drug and alcohol dependency. That would have to wait until 2010 when a new law was brought out covering substance abuse treatment programs as well. Under this recent act, if an insurer provides coverage for those with mental health and substance abuse disorders, they must offer the same benefits and issue the same costs as for those seeking coverage for more traditional physical ailments and diseases.

Types of Addiction Treatment and Insurance Plans

The amount of coverage offered by an insurance agency will vary from contract to contract. One common difference is that the policy will only include expenses incurred in the detoxification stage of the treatment, rather than the lengthier rehabilitation stage. This is because detoxification is generally viewed as a medical treatment while rehabilitation is more psychosocial. Those who are seeking financial help with the substance abuse should make sure that they are covered for both of these stages. This is especially important since rehabilitation is generally a far lengthier process than detoxification and can be more expensive as a result.

There are plenty of other differences commonly found within insurance plans, including:

* Inpatient and outpatient care (day limits and cost limits)
* Yearly and lifetime benefit limitations
* Out-of-pocket copayments and cost sharing

Insurance Problems for Substance Abusers

Of course, there are still certain drawbacks for those suffering from drug and alcohol addiction when it comes to taking out insurance. The first is that rehabilitation centers are not required to accept policies from each and every insurance agency out there. As a result, patients may be limited to visiting specific facilities depending on the terms and conditions of their contract. This may cause difficulties, especially with those locations which are situated far away from the individual seeking treatment or which are too costly to be covered adequately.

The second issue that may emerge is the higher cost that substance abusers may experience. Since those addicted to drugs and/or alcohol are deemed high risk individuals, insurance agencies will typically increase their premiums in order to ensure that they can still make a profit even though there is a higher probability of a claim being made. These additional costs can become a burden, especially for those with middle or low incomes.

Depending on the law in a patient’s particular region, there is also a chance that an insurer may reject a claim made for reasons relating to drug and alcohol abuse. This situation can present itself if an individual physically injures themselves after consuming drugs or alcohol. In this case, the policy’s terms and conditions may allow an insurer to deny a claim and subject the patient to the full extent of their medical charges. To prevent this, some doctors have been known to only take care of a patient’s physical problems without treating them for substance abuse as well. This will then provide that individual with a better chance of making a claim, although it means that they could then miss out on the treatment that they require to properly rid themselves of their addiction.

Finally, taking out an insurance claim can then result in a history of substance abuse which may have effects down the line. For example, if an individual takes out a claim for drug and alcohol treatment, they could then be denied coverage later on if an unrelated accident occurs as well. This all depends on the limitations stipulated in the insurance contract and care must be taken before filing a claim for rehabilitation so that the agency will still provide coverage in case something else happens in the future. These limitations can be based on cost or frequency, both of which are important factors for those seeking treatment for substance abuse.

Despite all of the above issues, it is still more beneficial for someone suffering from drug or alcohol addiction to take out an insurance claim when undergoing detoxification and rehabilitation. The right choices have to be made though, for both treatment facilities and insurers, before a claim can be made comfortably and affordably. This applies to both the coverage offered and the premiums charged, and both should be looked into carefully before an individual suffering from drug or alcohol dependency takes out a particular insurance package.

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