Drug Insurance Basics

When it comes to drug insurance, most people are aware that their policies will pick up the tab for at least part of the pills they get at the pharmacy. But when those pharmacy visits develop into an addiction, or when a person develops an addiction to drugs that might never be seen on the pharmacy shelves, the insurance coverage issue can become slightly more complicated. In general, it’s best for people to address their insurance questions to their human resources managers or their insurance companies. But, this article may help to clear up some confusion about how most insurance plans deal with questions regarding rehab.

A Mental Health Issue

In the past, addictions were considered a matter of habit and personal preference, meaning that people who had addictions were encouraged to simply change their minds about their drugs of abuse, and then they’d be magically healed. Now, experts know that addictions begin with chemical changes in the brain, and treatments are necessary in order to help people to heal. Since addictions are chemical disorders, on par with other mental disorders, health plans sometimes include coverage for rehab at the same levels they would use for treatment of other mental health disorders.

In 2014, the Affordable Care Act mandated that insurance plans provided in individual and small group markets provide this kind of coverage. But even now, according to the National Conference of State Legislatures, 49 states and the District of Columbia require employers to provide mental health coverage in group plans.

Parsing Plan Information

While insurance companies might be required to provide clients with some type of coverage, they might not be required to cover all of the costs people might incur in treatment. For example, drug rehab programs might provide patients with:

Some plans provide coverage for all of these steps, while other plans only provide coverage for some types of services, and they may exclude other types of care from the policies they provide. These plans might also require clients to make copayments for the treatments they receive, and these payments can add up to a significant amount of money.

In order to control costs, some insurance plans create a group of preferred providers who have agreed to charge a specific amount of money for the care they provide. If clients use these providers, their care is covered. If clients choose to use another provider, that care might not be covered, or clients might be asked to pick up a larger share of the tab.

Working With Insurance

People with addictions may cite worries about costs when they’re asked why they don’t enter treatment programs. According to a study in the Journal of Community Psychology, these practical considerations are also of prime importance to people who have mental disorders, and these worries can keep people from getting the care they’ll need in order to recover. It’s a shame that this is the case, however, as many treatment facilities are ready and willing to work with insurance companies in order to ensure that people get the care they need. Experts at these facilities can work with insurance companies to ensure that the care will be covered, and these experts can explain the financial obligations to the family in detail, so everyone will know what the treatment will cost and when the bill will be due.

Understanding insurance issues is never easy, but by asking questions early in the process, families can ensure that they understand their coverage options. This can help them to pull together just the right kind of program to help the person they love.