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Detoxification is a biological necessary first step in the drug abuse recovery process. For this reason, there is obvious concern about whether insurance will pay for detox and to what extent. Before approaching an insurance company about coverage, some preparation and information gathering can be helpful. Understanding the basics of detox programs and what services are offered can illuminate the process of paying for it with insurance partially or completely, depending on the health insurance plan.
There are different types of detox options available in different settings, such as:
When considering which option to pursue, it is critical to understand that abruptly quitting drugs can precipitate severe withdrawal symptoms. For this reason, it is nearly never advisable to undergo a “cold turkey” detox without supervision. Medical detox or medicated detox is a much safer option.
During medical detox, whether inpatient or outpatient, a team of addiction specialists will oversee the patient’s natural detoxification process. To make the process comfortable, the attending doctor may provide mild prescription drugs, such as muscle relaxers for cramps. In addition, staff may provide over-the-counter medications. The detoxing person may also receive psychological therapy. Nutritious meals will be provided. Overall, medical detox provides a person with a healthy detox environment while providing added assurance of physical and psychological safety.
Medicated detox is available depending on the drugs of abuse at issue. At present, medicated detox is typically limited to individuals who are recovering from abuse of opioids (e.g., heroin or prescription narcotic pain relievers such as oxycodone), benzodiazepines, and/or alcohol. Medicated detox features medication-based substitution therapies (i.e., FDA-approved addiction treatment medications). For example, a person who has been abusing heroin can be put on buprenorphine. In this way, the person does not go into full withdrawal but is transitioned to, and stabilized on, a safer drug. This method helps to stop or manage withdrawal symptoms, including reducing or stopping drug cravings. Over time, a person may be weaned off the substitution medication and achieve full detoxification.
The above description of detox programs provides insight into the many billables involved.Various factors drive the cost of a detox program:
A person seeking detox, or a loved one who is organizing the person’s admission to a detox program, will initially go through a process of piecing everything together. First, the rehab center will make a recommendation as to the type of detox that is needed to address the person’s specific needs. Once the person knows what program type and services are needed, the next step is to learn what services the health insurance company will cover.
A drug rehab center can help a patient and/or concerned loved one to navigate a health insurance plan’s coverage terms. At the outset, it is always advisable to have a copy of the summary plan description (SPD). This document sets forth the insurance company’s coverage terms. Of course, those terms remain open to interpretation, but the SPD provides insight into what services may and may not be covered.
It is helpful to understand that rehab centers and insurance companies are extremely familiar with the billing side of the recovery process. For instance, the rehab center will know the specific medical codes that are ascribed to different detox services, and the insurance company will know whether they are covered. That said, it’s not simply a black and white process of coverage versus non-coverage of services. Additional issues can arise, such as the insurance company limiting the number of certain treatments or days of treatment.
Once a person is admitted to a detox program and the process is underway, it is helpful to pay close attention to any correspondence from the insurance company.Correspondence like an “Explanation of Benefits” will show important details in writing, such as:
Using insurance to pay for ongoing medical services, in general, is a learning process. Staying in touch with the insurance company can help to avoid any surprises and signal what’s ahead (e.g., a limit, such as number of treatments, being reached). It is also important to understand that insurance companies, in the event of a dispute, provide an appeals process. The hope is that there will not be any need for a dispute resolution, but it’s good to know that one is available.
Understandably, a person seeking detox services will question whether insurance will cover it. It’s an obvious question that might not have so obvious an answer. As discussed, the best practice is to reach out to the insurance company directly or through the selected detox center/drug rehab facility. It’s usually part of a rehab center’s responsibilities to be in contact with insurance companies. For instance, before a client is admitted to a detox program, the rehab center will typically contact the insurance company for precertification. After admission, the rehab center may need to continually contact the insurance company for a utilization review, so the insurance company knows the insured member continues to meet the requirements for drug treatment coverage.
The member care contact information for a health insurance company can be found on the insurance card.Contact information for popular insurance companies is outlined below:
At present, the Affordable Care Act (ACA, also known as Obamacare) remains in effect in America. It is helpful to know that the ACA has specifically designated drug abuse treatment services as an essential health benefit, and as such, all ACA plans must provide some level of coverage. This rule does notapply to all health insurance plans in America but it does apply to all ACA plans, whether they are employment-based, private, or public (e.g., state Medicaid programs).
Paying for detox and other recovery treatments is understandably a concern but it should never be a barrier to getting help. Insurance companies may not advertise their coverage of drug treatment services, so it’s critical for those in need to seek out this information. The addiction treatment industry is layered with caring professionals who want to provide exemplary help at every turn. When a person’s goal is recovery, the assistance to get through it – including assistance working with insurance companies – is available.