Why Health Insurance Only Pays for Certain Medical Detox

Have you ever wondered why medical insurance plans only cover medical detoxification for certain types of drug & alcohol withdrawal services?

Health insurance policies that pay for detox often limit reimbursement for certain types of substances. When there is a medical necessity, there is a high likelihood of payment. Substances such as alcohol, benzodiazepines, and opiates are often covered due to the destruction withdrawal can wreck on the body, up to and including seizures, coma and death. Alcohol is the most dangerous substance to detox from and is therefore the most highly covered by insurance companies. Other drugs such as marijuana, cocaine and methamphetamine have more of a psychological withdrawal and won’t lead to catastrophic outcomes if an individual chooses to stop using abruptly. That doesn’t mean these individuals do not need to be separated from their drug of choice to start the recovery process.

The Mental Health Parity and Addiction Equity Act requires insurance companies to handle mental health and substance abuse claims in the same manner they would any other medical or surgical condition. This law does not require insurance plans to have mental health or substance abuse coverage but if they do have that coverage, it has to have a similar cost as any other treatment.

The Affordable Care Act (Obamacare) builds on the mental health parity law and expands coverage for mental health and substance abuse disorders. It requires most health insurance plans to provide treatment coverage.

As every health insurance plan is different, the best way to determine your coverage is to contact your provider directly. Some questions to ask include:
• Will my insurance pay for detox, rehab and/or aftercare?
• Will insurance pay for any prescription medications?
• What will my co-pay be?
• What will my deductible be?
• How long of a detox or treatment program will my insurance cover?
• Do you use provider networks? What are my limitations?

Some insurance plans don’t offer mental health or substance abuse coverage. If this is the case, you can speak with your employer as they may offer coverage even if not required by law. They may even be willing to help incur the cost, especially if you are indispensable to your organization. You may contact detox centers directly and inquire about payment plans. You can also ask directly about scholarship programs.

detox – THE FIRST STEP to Recovery

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