The arrival of the changing foliage means that addiction treatment advocates will be pushing recovery into the forefront of social awareness by means of both education and celebration. Why? For 29 years, September has been designated as Recovery Month. Recovery deserves celebration more than anything we can think of at the Process Recovery Center, but it’s also important to acknowledge how inaccessible it can appear to multitudes of help seekers – whether they are active individuals or family members. Addiction treatment is daunting enough if you don’t have a thorough understanding of the biological, psychological, and social factors that drive substance use disorder, but when you toss in insurance coverage as a consideration, the situation can look downright insurmountable. In fact, insurance coverage for addiction treatment is arguably the most stressful part of the help seeking process.
As we’ve said before, stress is a primary precipitator of relapse. Moreover, families who are struggling with the pain of an active loved one don’t need the added strain of navigating insurance coverage for addiction treatment. At the Process, we pride ourselves on alleviating stress and helping individuals and families alike figure out the next step. While we can’t singlehandedly make the health insurance world less alien in nature, we can arm you with the necessary questions to negotiate insurance coverage for addiction treatment. We’ve compiled a reference list for you to utilize when you’re ready to contact your insurance company on behalf of yourself or a loved one:
- Do you provide insurance coverage for addiction treatment?
- If so, what levels of care do you cover? Do you cover residential, partial hospitalization programming (PHP), intensive outpatient (IOP), or outpatient (OP)? Do you cover detox?
- How much insurance coverage for addiction treatment do you provide? What is my out-of-pocket maximum expense?
- Is specific coverage needed for addiction treatment?
- Do you cover medications like Vivitrol or Narcan?
- What will my co-pay or deductible look like?
- How do you determine which level of care is medically necessary?
- Where do I find a list of network providers? Can you refer me to treatment providers in my area?
- What are some of your other member services?
The Thousand Pound Telephone
You may be wondering, “Why should I have to contact my insurance company and ask these questions about insurance coverage for addiction treatment? Why can’t they list the answers on their website? Why is this so unbearably difficult?” We understand. Unfortunately, these types of questions cannot always be addressed on a Frequently Asked Questions forum. Let’s face it, insurance companies are not the most inviting institutions on the face of the planet, but it’s important not to throw the baby out with the bathwater. In other words, the institution may provoke confusion, but the people who work within it are often eager to help. In terms of the question of cost, we can empathize with both sides of the issue. For instance, when people visit our website or social media, one of the most common questions is, “how much does this cost?” While we’d like to be able to provide a general answer that applies to everyone, we can’t. Your treatment plan will be as unique as your insurance coverage. Just as a treatment plan caters to your lifestyle and individual needs, insurance coverage for addiction treatment depends on things like your plan, your employer, and whether or not you are covered in the public or private sector. While it would be incontestably easier if these details added up to a non-issue, the reality is that our healthcare system will be operating along these lines for the foreseeable future. The good news is that technology is evolving in a way that is simplifying the process. Many insurance companies have already implemented online cost estimators and other convenient features.
The wheels of change turn slowly… but don’t despair. If you’re feeling overwhelmed, our best advice is to print out the aforementioned list, pick up the phone, and ask for help. There is no shame in asking for assistance; we all need a hand sometimes. It doesn’t matter whether we are demystifying health insurance or trying to make sense of this crazy thing called life – we are all in this together. Almost everyone reads insurance related literature with the same deer-in-the-headlights expression – and none of us were born with an instruction manual for the human experience. Sometimes we need to ask, “What the heck does this mean?” Asking for help doesn’t denote weakness; it is a sign of strength.
A huge part of what makes recovery successful is human connection. The process is so much easier when you connect with another human being. If you can’t relate to the first person with whom you speak, keep trying until you find the right person for you. We guarantee he or she is out there, compassionately waiting to interpret your insurance coverage and usher you onto the next step. In active substance use, the telephone can feel like it weighs a thousand pounds. If that’s the case, perhaps a family member, friend, or case-manager can walk you through the process. One insurance company – Tufts Health Plan – even has a Substance Use Disorder (SUD) Navigator. This specialty navigation program provides SUD focused case management for members.
What If I Don’t Have Insurance Coverage for Addiction Treatment?
Engaging in a discussion on insurance coverage requires that the dark underbelly of healthcare be taken into account. The harsh fact is that some people do not have insurance coverage for addiction treatment or, alternately, have a type of coverage that isn’t universally accepted. Again, don’t despair; we still encourage you to pick up the phone. Some treatment centers offer cash payment plans and/or scholarships. Again, these scholarships and cash payment plans will vary based on the level of care you require – and you must call. If you never ask the question, the answer will always be “no”. On an equally hopeful note, there are programs which exist solely to serve populations who might otherwise experience difficulty accessing care.
A good starting point is the Substance Abuse and Mental Health Service Administration’s free and confidential national helpline. The helpline is a “24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations”. To utilize this service, please call 1-800-662-HELP (4357).
You can also reference the New Hampshire Alcohol and Drug Treatment Locator. This website allows you to choose the type of service, the population (youth, pregnant women, veterans, homeless etc.), and type of insurance. Once you select your criteria, the website displays results which correspond with your needs. Local recovery centers – such as Revive Recovery in Nashua, New Hampshire – may also be able to facilitate support. In addition, Nashua and Manchester offer “Safe Stations”. Anyone can walk into a city fire station and get connected to treatment.
Another helpful New Hampshire resource is the S.T.A.R.S. Program, which provides scholarships for individuals looking to transition into sober living after completing detox and 28 days of treatment. A solid aftercare plan can make or break early recovery. The S.T.A.R.S program helps to bridge the gaps in the aftercare process.
If you’re a resident of Massachusetts, you might find it helpful to know that the state government presides over a Bureau of Substance Addiction Services. The Massachusetts BSAS is responsible for providing access to treatment for the uninsured…among other crucial duties. You can find a complete list of service descriptions – as well as the populations they serve – by visiting Mass.gov.
If you have any questions about our programming – to include insurance eligibility, payment plans, or additional resources – you can submit a query or request a call-back by filling out our online contact form.
Autumn Khavari is the Process Recovery Center’s in-house writer. She received an education in Substance Use Counseling from Beal College in Bangor, Maine.