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Insurance Coverage For Drug Treatment

Most people who are seeking a drug rehab center and are fortunate enough to have health insurance want to know if it will by for the treatment. While there isn’t really a simple answer to this, there are some basic guidelines here that can help you understand the process a bit more and how it can factor into which facility you choose.

One of the first things to know is whether or not your particular policy, whether a group plan through your employer or an individual policy, has substance abuse and mental health benefits. You can look this up in the explanation manual provided by your insurance carrier each year, check it out on their website or just give them a call.

A law that recently passed called the Mental Health Parity and Addiction Equity Act ordered that group health insurance providers (of 50 or more enrolees) must include equal benefits for mental health and addiction treatment as they did for medical conditions. This does not mean that all policies were ordered to pay for rehabs, just that certain plans must provide equal coverage for behavioral health. This means that if there was a yearly maximum benefit of $50,000 for hospitalization, then there should be the same amount for drug rehabilitation.

If a policy has substance abuse and mental health benefits, a typical scenario may be that it pays for up to 10 days of detox at $1,000 per day, 30 days or residential rehabilitation at $500 per day, and 90 days of outpatient care at $100 per day. This is just a hypothetical situation though. There is really no limit to the variations of coverage. Just like with other healthcare coverage, there are typically co-pays and deductibles as well.

If you find out you do have coverage, the next thing is to see what kind of network benefits are available. Some policies will pay no matter where you go, others my pay different percentages for in-network and out-of-network benefits (PPO) while others still are limited to only a few providers and have no other coverage (HMO).

Sometimes rehabs will bill the insurance carriers directly and receive the assignment of benefits to be paid directly by them. Other times they may help provide billing information and your coverage is used as reimbursement to you after paying for the cost of services yourself. In this case, the insurance company will send the checks back to you rather than to the facility.

If you have any questions about your policy you should know that you can always call them to get an explanation of your benefits and ask questions. Just remember, insurance companies are in business to make money, meaning they are supposed to take in more than they pay out, so dealing with them can be very difficult and even take multiple claims in order for them to finally pay. If you are able to find a facility that will help bill your isurance as a form of payment or to help you get reimbursement, they should have the exprience to hopefully get the maximum amount of your benefits.

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