June 5, 2015

Getting Sober Using Health Insurance

In the market today, with so many private pay treatment centers sprouting up all over the country, health insurance has almost become a non-factor.  Almost.  There are still many treatment centers that understand the necessity of accepting health insurance benefits as a source of payment for rehabilitation.

The way health insurance companies overcomplicate and make difficult the utilization of their benefits is almost criminal.  However, there are billing specialists and a few treatment centers that understand that process and are able to use it to the clients’ advantage.  Health insurance premiums are so costly that all their beneficiaries should be able to rely upon them to cover the cost of life saving treatment from drug addiction, alcohol dependency and mental health disorders.  While many treatment centers don’t have direct contracts with various insurance companies, individuals can still utilize out of network benefits to help mitigate the out of pocket expense that substance abuse treatment can be.

It is imperative, when selecting a substance abuse or mental health treatment center that clients’ connect directly with the admission personnel to discuss the potential for utilizing health insurance as a means of payment.  Most health insurance policies allow for out of network benefit utilization.  This means that even if the health insurance carrier does not have a direct contract with the treatment center, the invoices can be submitted and the insurance company will repay a percentage of the cost of the program.  If you’re looking at a treatment program that costs twenty to thirty thousand dollars for the month, and the allowable out of network repayment is at 60%, even though your insurance carrier doesn’t have a contract with the treatment center, you can recover twelve to eighteen thousand dollars.  This is a large savings compared to having to pay entirely the cost of treatment.

It seems complicated, and that’s because the insurance carriers make it this way to prevent people from pursuing the recovery of these funds.  Additionally, if the treatment center does have a direct contract with a specific insurance carrier, the out of pocket cost can be significantly lower.  For example, if a treatment program has a contract that states they will cover 80% of the cost of treatment, and your plan has a two thousand dollar annual out of pocket maximum, the cost of treatment will be only two thousand dollars, even if the program states a twenty thousand dollar cost per month.  Again, it seems complicated, and the best way to get sober using health insurance is to consult with an admissions professional and discuss in detail the policies and contracts that specific treatment center has with various health insurance providers.

Many people choose a program based solely on the contracts with health insurance providers in order to limit the financial out of pocket cost of treatment.  The more people utilize their benefits, the more treatment centers will understand the necessity of contracting with health insurance carriers.  People pay for health insurance for a reason, to be able to rely on coverage in times of crisis.  What is more critical than getting treatment for a drug addiction or mental health disorder?

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