The process of recovery from substance abuse addiction can be stressful not only for the person in recovery as well as the family and support system of the individual in recovery. A common question that is asked regarding detoxification services involves the cost of detox and if insurance will cover the cost of detox services, including medical detoxification and formal treatment. Quality detox treatment can go a long way to ensure the long-term sobriety and recovery of a person struggling with addiction. However, every insurance policy is different in regards to what actually is covered and detox facilities can differ in regards to what insurance they accept for their treatment services.
The Coverage of Detoxification and the Affordable Health Care Act
For those who are contemplating entry into detoxification and formal drug treatment programs, there have been questions whether the expansion of healthcare under the Affordable Healthcare Act (ACA) includes substance abuse treatment and detox services. In the simplest of terms, substance abuse disorders are considered to be as one of the ten essential elements of quality health care. As a result, all health insurance sold on the Healthcare Marketplace must include it in the packages that are offered. Legislation is currently determining to what degree specific services and types of treatment will be fully covered.
What To Look For: Will Insurance Cover My Detox Services?
In order to know if your insurance will cover detoxification services, it is important to understand exactly what is contained in your policy. Understanding the terminology in insurance policies and what is actually covered regarding medical detox services and treatment can be very difficult to understand. When looking at detox services in relation to your medical insurance there are some questions that need to be answered before further decisions can be made. Those initial questions may include the following:
- Does my insurance cover rehab treatment or detox care?—the length of the appropriate treatment plan will be taken into consideration in regards to whether the insurance will cover those treatment options. Another important consideration is whether insurance covers inpatient treatment (where an individual lives at the facility with medical and professional staff on premises at all times) and /or outpatient treatment (where an individual spends certain times of the day at the facility and may attend meetings or other activities). The question if insurance will cover detox services at specialty or luxury rehab services is another point to consider.
- Will I need a referral from my doctor in order to begin detox?—there may be stipulations in insurance policies that may require a referral from a primary physician before insurance will cover detox services. The importance of referral is due to the fact that treatment centers as well as insurance companies are realizing that addictions are often accompanied by other co-occurring physical and/or mental conditions.
- Will I need to pay cash for some of my detox and drug treatment?—in some instances there may be services that may not be covered proper under insurance. For those services that may not be covered, there may have to be upfront payment or co-pays involved.
- What is the maximum amount of treatment my insurance will cover?—the cost of treatment can vary. It is estimated that most quality detox and treatment centers cost $20,000 to $40,000 while more luxury facilities may cost more. The quality of care that is provided along with the services that are provided that are tailored to an individual’s special needs are obvious factors in choosing a detox facility.
- How long will my insurance allow me to remain in detox and treatment? –in many instances, the insurance coverage someone has may only cover a certain amount of time that an individual stays in treatment. Some policies may cover extended stays of 28 days or longer while other policies may only cover much shorter stays.
Would There Be Other Options to Fund Detox if Insurance Isn’t an Option?
In the event that insurance does not cover the detox services that are needed, there may be other options that will allow an individual to attend a detox and treatment facility they need. Those options include private medical insurance, Medicaid, Medicare, loans from family and friends or forms of public funds. Also keep in mind that health insurance is fluid in change and treatment coverage can change due to new healthcare legislation and other changes in mental health policies, administration and services.