Health Insurance and Addiction Treatment

A common concern for individuals struggling with alcohol or drug addiction is health insurance and the cost of treatment. Unfortunately, many who need treatment will not seek it because of a lack of knowledge about cost and insurance coverage. What Types of Health Insurance Can You Access in Florida?

  • HMO
  • Health Insurance Policy
  • Self-Insured Plan
  • Publicly Funded Plans for Addiction Treatment

Health Maintenance Organization (HMO)

The laws of the state of Florida regulate this category of healthcare coverage which is available either as a group or individual plan. For patients to benefit from this type of insurance, they must have a primary care doctor that provides basic care and gives a referral to specialists when needed. HMOs, do not pay for service outside the network, except in cases of emergency. For Non-emergency care, patients must live in the coverage area of HMO services.

How Much Treatment Will Insurance Cover?

Every plan offers a different level of coverage for specific doctors, clinics, pharmacies, drugs, and even particular services.

The coverage requirements and limitations depend on the type of policy a patient has and there may be limitations concerning the kind of care covered by the plan. For instance, insurance companies may pay for medical detox and the medications needed during this process, but they might partially cover the subsequent rehab therapies.

Even policies purchased from the Covered Florida Marketplace may be subjected to certain limitations. It is highly recommended to check the fine print of the insurance plan before enrolling in an addiction treatment program to find out how much out of pocket is the responsibility of the patient and how much the insurance covers.

How Do I Verify What My Insurance Will Cover?

Finding out about insurance coverage is quite a task that experience in this area will be helpful. If you are not familiar with the insurance industry and find reading the insurance contract’s fine prints challenging, communicate directly with the insurance company regarding the services need either by phone or email.

However, by far the best option available is to contact a reputable addiction treatment facility and ask for the verification of benefits. Let the people in the verification department of the treatment facility who talk to the various insurance companies on a daily bases argue on your behalf to get the maximum possible coverage. It is beneficial to you to have a utilization review specialist (fancy word for the person who is in charge of figuring out how your insurance policy applies to your current medical needs) get involved at the earliest possible. It requires knowledge of the required services to ask the insurance company for exact benefits applicable to your treatment needs.

Which Rehab Facilities Accept Health Insurance?

Almost all addiction treatment facilities, whether private or public, do accept insurance for the treatment covered by the patient’s plan.

Individuals without insurance coverage or with limited insurance coverage for alcohol or drug (AOD) treatment have the option of paying out of pocket or getting treatment through publicly funded addiction treatment programs.

Most addiction treatment facilities work with patients on the out of pocket or the portion of the treatment cost that is not covered by the insurance. It always helps to ask if the facility you have in mind offers that kind of financial help.

How Do I Get Addiction Treatment in Florida without Insurance or using an Insurance Policy with low Coverage?

There are several options, as listed below, exist for individuals who need alcohol and other drug treatment services and have no insurance or have low insurance coverage.

  • Centers that offer financial help based on the income of the patient. These centers provide individualized care by asking for payment for only what the patients can afford
  • State-funded programs, although patients have to meet certain requirements to be admitted (specifically low income)
  • Non-Government Organizations (NGOs) that specialize in drug and alcohol rehabilitation that direct individuals seeking treatment to treatment facilities or clinics that admit patients without insurance or without the means to pay medical bills.
  • Substance Abuse and Mental Health Services Administration (SAMHSA) offers grants to low-income individuals, helping them fund their alcohol or drug treatment.

ObamaCare and Mental Health Treatment Policies

ObamaCare (officially known as the Affordable Care Act or ACA) allows states to expand Medicaid to increase coverage for low-income people under 65, covering many who had not been eligible for coverage before.

The U.S. Department of Health & Human Services offers comprehensive information about programs and services available through ACA.

What Are The State-Funded Resource Available to Those Without Health Insurance?

There are low-cost or cost-free options funded by the state for substance addiction treatment available to low-income individuals who need addiction treatment.

Directory of Single State Agencies (SSA) for Substance Abuse Services has a list of contacts for each state’s agency dealing with substance abuse issues. There is information about free clinics, state-funded treatment programs, and other services related to addiction treatment. Additionally, the SAMHSA website contains information regarding such centers and allows individuals to search for treatment in different states.

The state of Florida also has various facilities where an individual struggling with addiction can find treatment for free or find an affordable program. These public facilities offer patients with counseling, 12 step groups, and even medical detoxification. Florida residents seeking treatment in a private inpatient facility can have access to affordable healthcare through Medicare or Covered Florida Marketplace.

State-funded facilities provide care to patients with no insurance or with low-income as well as court-mandated cases. Due to the demand for these types of facilities generally, there is a waiting list which makes admission to take up to several weeks or months.

Below are some additional options that either provide free or low-cost help to struggling addicts:

Vocational Rehab – These facilities offer work to those who are clean and in recovery. They get funding from the treatment industry, Religious groups or various private businesses. For instance, the Salvation Army is one of those organizations that provide help in terms of Vocational Rehab and gets funding as donations from the public.

Rehab Centers Funded by Donations – These facilities receive funding from individual and NGO organizations. They often work as an extension of a certain business.

Although various options exist, it’s important to note that not all these facilities offer the same level of treatment and expertise of care. The type of substance abuse, the condition of the individual seeking treatment, as well as any co-occurring mental health conditions influence the type of rehabilitation that an individual needs which must be matched with the care providing facility.

Most state-funded programs take in patients and help with their rehabilitation but may be short of medical personnel and other resources that usually creates the circumstances for long waiting time. That is why the care sometimes is rationed and offered to those with an acute need or in a critical time of their treatment, such as those with past overdose history and existing high risk of overdose or those who need treatment for withdrawal symptoms and limit the assistance for therapeutic treatment which is much needed after detox.

Overcoming Your Addiction

While federal laws have been pushing for mental health and addiction conditions to be included in health insurance plans, the fact remains that many insurance providers can impose their own set of rules when it comes to coverage.

Many rehab clinics can offer proper guidance to patients and help determine if their insurance covers their treatment. In those cases that the treatment is not covered by insurance, many reputable rehab facilities offer payment plans and other financial help to make treatment available to a wider group of people.

Related Articles:

What is SAMHSA?

Family and Medical Leave Act (FMLA)

Choosing Where to Go for Rehab – Part I

Choosing Where to Go for Rehab – Part II