Behavioral Health Insurance Coverage For Drug Treatment

Substance Abuse Treatment programs can be expensive. Cost can deter many people from seeking out treatment but stop for a minute to consider the cost of substance use. The cost of obtaining your drug of choice adds up quickly over time and so do the impulse decisions that come with drug use. The limited capacity at work or school can severely set your loved ones back, often including the loss of their job. Combine that with deteriorating physical health, mental health effects, and the loss of valuable relationships and substance use disorders begin to show their true cost.

Finding a Treatment program that can help you or a loved one get back to sobriety can be the most cost-effective decision you will ever make. It doesn’t have to break the bank either if you can get the bulk of treatment covered by health insurance. Thanks to the Affordable Care Act, most people do have most of the treatment covered by health insurance.

The Importance of the Affordable Care Act (ACA)

The Affordable Care Act, the Mental Health Parity, and the Addiction Equity Act have made behavioral healthcare a mandatory part of all healthcare policies. With all but the most bare-bones plans, your insurance must provide mental health and substance use treatment benefits. This means that treatment is more accessible and affordable than ever before. Many people are aware that insurance can help, but dealing with the system is complicated and can feel overwhelming. Let’s break down how health insurance for behavioral health and substance use works and what questions you should be asking your insurance company.

Behavioral Health Insurance Coverage

Start by looking at the back of your insurance card. If there is a number listed for mental health, that is a good indicator that you may be in luck. Call that number and ask a lot of questions. Start by confirming that you have mental health and substance use coverage. Then go through the following:

• Do I have out of network coverage?
• What are my in-network/out-of-network deductibles?
• When does my deductible reset? (generally, plans are on a calendar year basis)
• Which providers (treatment programs) are in my network?

The insurance companies will try to push you towards in-network providers, but there are some trade-offs that might come with choosing an in-network provider depending on where you live.

Advantages of In-Network

All insurance companies have contracts with certain providers (in this case we are talking about treatment programs). The contract includes agreed upon reimbursement rates for various services and also locks the provider in to set modalities for providing care.

Some insurance policies that offer behavioral health coverage only have in-network options. For those who have out-of-network coverage, there are some things to consider. In-network options are generally cheaper, although there are exceptions here too.

In-network options work great for medical care and are usually the way to go. For behavioral health care, there can be limitations, so it’s good to look at out-of-network options as well. The advantage to going in-network is that it’s usually cheaper for you and the program is vetted by the insurance company beforehand.

Advantages of Out-Of-Network

The benefit to having out-of-network coverage is flexibility. Many insurance policies only offer a limited number of treatment programs in their network in many areas. Oftentimes, the treatment option that best meets your needs is out-of-network.

Why would a good program be out of network with your insurance carrier?

There are several possible reasons why an insurance company hasn’t contracted with a treatment program. One reason is that the insurance tries to negotiate a discounted rate as part of the in-network contract.  Also, insurance companies have been slow to evolve their thinking as it relates to effective drug and alcohol treatment, which can make it difficult for providers who offer comprehensive treatment programs that are above and beyond the basic care insurance companies prefer to cover.

When insurance companies look for providers to contract with, they are looking for programs that have been around for a long time and have lots of certificates and credentials.  They are also looking for the lowest cost providers, which can sometimes translate to more limited service offerings and care.

It is important to remember that just because a treatment program has been around for a long time, doesn’t necessarily mean it is a better program than newer options. A good therapist or clinical director doesn’t want to be limited to a narrow scope of practice. They want to be able to use their broad experience to tailor programming to meet their client’s needs, which may involve more comprehensive care than what the insurance company is willing to commit to in their contract.

Other reasons why a treatment provider may not be in-network is because it might be a newer program or because the provider is not able to prove the efficacy of their treatment program. Sometimes it is just a matter of time, but other times it can be an indicator of low-quality treatment. It is always important to take the time to find a high-quality treatment program.

Limited In-Network Coverage for Drug Rehab

You may find that there are insufficient in-network options and that the ones that are in-network don’t meet the needs of you or your loved one. Before you start digging into your retirement fund to pay for your loved one’s rehab, there is another option to consider.

Single Case Agreements

If the provider you would like to go with is not in-network with your insurance carrier, and you don’t have out of network coverage, you can try to negotiate a Single Case Agreement. The insurance company will make a decision based on “medical necessity” and clinical specialty and compare that to their existing network in your area.  Work with the treatment program to set this up and expect it to take some time. Single Case Agreements can take anywhere from 1-2 days to 1-2 weeks to get approved, but can make all the difference and allow you to access care as if they were an in-network provider!

Resources for Getting Drug Treatment Covered by Your Insurance Carrier

Below are direct links to the behavioral health divisions of major insurance providers. You may have behavioral health benefits of which you weren’t aware. Log in using your insurance card to familiarize yourself with the benefits available to you. Insurance companies are recognizing the importance of preventive care, so you may be able to get coverage for some much-needed self-care.

United Healthcare/Optum Behavioral Health – Optum usually manages Behavioral Health Insurance for United.

Cigna Behavioral Health

Kaiser Permanente Behavioral Health – This links specifically to support in Colorado.

Anthem Blue Cross Blue Shield Behavioral Health

Humana Behavioral Health

Aetna Behavioral Health

Need Help Sorting Out Behavioral Health Insurance?

Do you still feel overwhelmed or unsure? The last thing that should happen is that you lose steam and fall into old patterns because you can’t find a place that works with your insurance carrier.  At Sandstone Care, we believe in everyone’s ability to change and want to support people who are ready to change as well. Give us a call and we will help you find the best option for your treatment and financial situation. Our Admissions Team is well versed in the world of behavioral health insurance and will help you find which treatment providers take your insurance. If our program isn’t the right one for you, we will find one that fits your needs.