People with broken bones, deep infections or failing organs might not hesitate to reach out to their insurance companies for payment help. They know that the companies provide products that are designed to help clients stay alive, and the help insurance companies provide allows them to fight back and regain the health that was once at risk. People with addictions, however, might resist the idea of utilizing their insurance, as they may feel that their ailments are caused by weakness and poor choices, not medical necessity. It’s not an opinion that many insurance companies share. In fact, many insurance providers know that leaving an addiction in place causes even more problems, and higher costs, when compared to addiction therapies. As a result, families that reach out to their providers may find that they have a willing partner in the fight against addiction, and they may be able to get the help they’ll need while maintaining the family budget.

By the Numbers

In 2011, about 15 percent of Americans didn’t have health insurance, according to NPR. Changes in legislation that make health insurance mandatory may make this number drop in the years to come, although it’s possible that many people will pay for their insurance coverage out of their own pockets, rather than allowing their employers to pay for coverage. Part-time work, freelance work or a lack of steady employment could all leave people without insurance, but they can find carriers willing to help them through new federal or state-run programs.

Not all insurance programs are created equal, however, and the coverage can vary widely from plan to plan. For example, some plans offer a full suite of mental health benefits that match the benefits provided for physical ailments. There are some programs, however, that provide reduced benefits for mental health care. According to the American Psychological Association, legislation was designed to create parity between the two types of programs, but these rule changes don’t apply to insurance plans with 50 employees or fewer. Some states have their own laws about this, but others don’t.

Since addiction care utilizes a blending of physical and mental health techniques, these subtle distinctions are important. Understanding the language of the plan can help families know what costs will be handled by the insurance company, and what fees they’ll be expected to handle on their own.

Asking Good Questions

Addiction treatment facilities often accept insurance payments. For example, in 2011, of the facilities responding to the National Survey of Substance Abuse Treatment Services:

• 64 percent accepted private health insurance
• 57 percent accepted Medicaid payments
• 39 percent utilized state-financed health insurance
• 33 percent allowed Medicare payments
• 33 percent accepted federal military insurance

Many of these programs hire case managers who are adept at talking with insurance companies and explaining benefits to people who are confused. Families can also make their own calls and talk with insurance company representatives about the treatments they believe are coming. Issues regarding setting are especially important to address. Some insurance companies have contracts with specific treatment providers, and they won’t pay for care that takes place in other facilities. Other insurance companies will only pay for outpatient care, not inpatient care. It’s important to deal with these issues at the outset.

While insurance plans will often cover much of the cost of care, families might be expected to chip as well. A daily copayment or a per-visit copayment might be required, for example, or the family might be asked to pay for any treatments exceeding a specific limit that the insurance company places on care. Insurance companies might agree to put these costs in writing in a formal estimate, and that might be an excellent tool families can use as they plan.

Utilizing insurance like this isn’t designed to be painful, and insurance company representatives are rarely harsh or discouraging to families who call. Again, addictions can be costly if they’re left untreated, so insurance programs want to get the problem handled now. It’s best for the clients in their care, and it’s best for the company’s bottom line as well.

At Axis, we’ve dealt with many different insurance companies through the years, and while we know it can be stressful for families to coordinate this care, we also know that payment help can be vital for some people. We’re happy to help in any way we can. Please call us to find out more.