Will Health Insurance Cover IOP For Alcohol Addiction?

The designation of substance abuse as a health issue has achieved two things: it made treatment more accessible by forcing health insurance providers to cover rehab and removed some of the stigma from addiction. It’s no longer viewed as an issue of poor self-control, but a treatable medical condition. It may take some diligence on your part, but inpatient alcohol rehabilitation is an eligible treatment under most insurance.

Know Your Options

Most private and employer-provided health insurance plans cover substance abuse treatment as well as any related health problems. If you’re seeking treatment for alcohol dependence, the first place to start is with your insurance provider. Some plans cover the full cost of treatment, some will cover only portions of your recovery. However, if your policy underwrites substance abuse treatment or rehab, they can’t deny payment. If your particular state mandates that group health insurance covers rehabilitation, your insurer must comply with state law.

Once you know what your policy will cover, you have to find a facility that takes your insurance plan, including Medicaid or Medicare. You should also inquire about whether doctors and therapists at your facility are in your network to avoid additional out-of-pocket expenses. The case manager at your facility will help with insurance claims.

Public Health Insurance

Medicaid and Medicare are public insurance providers. There may be some out-of-pocket expenses, but there’s a government maximum that you can be charged. Under the ACA, they both must cover substance abuse treatment, including inpatient, outpatient, medically supervised treatment, and any related health concerns. However, different states have different eligibility requirements, and rules are constantly changing. In general, Medicaid recipients must meet at least one of the following requirements:

– Over age 65 or under age 19
– Pregnant or the parent of a minor child
– Below a certain income level
– Eligible for or receiving SSI

Medicaid covers:

– Screenings and intervention
– Maintenance and craving-control medications
– Inpatient and long-term residential treatment
– Outpatient care
– Mental health services
– Detox

Medicare is public health insurance for those over the age of 65 and people who have qualifying disabilities. This insurance does cover drug and alcohol treatment, but different parts cover different aspects. Here’s the breakdown:

Medicare Part A – Covers hospital stays, including inpatient treatment. Be aware that there may be a deductible, and there’s a 190-day lifetime cap on payment.

Medicare Part B – Covers up to 80 percent of the cost of outpatient treatment, including professional intervention, therapy, and doctor-prescribed maintenance medications.

Medicare Part C – This is a supplemental private insurance that covers more, but may have higher out-of-pocket expenses.

Medicare Part D – This is prescription coverage, and it will pay for maintenance and craving-control medications to manage withdrawal symptoms.

Be aware that these insurance options must be in place before you seek treatment. You can’t decide to go to treatment, and then buy or apply for insurance after the fact. The only exception is Medicaid.

<h2>Getting Treatment When You Have No Health Insurance</h2>
Financial concerns shouldn’t keep you from seeking treatment. In addition to public funding that’s earmarked for addiction treatment in almost every state, there are options that cost nothing but time. If you’re in an emergency or crisis situation, such as an overdose or you’re having suicidal thoughts, you should call 911. For emergency, non-crisis situations, a local crisis intervention hotline can direct you to help within your community.

Most communities have public substance abuse or mental health centers that charge according to ability to pay. The type of care depends on need, so there will be an intake evaluation and recommendations for placement after an assessment. Larger substance abuse treatment centers sometimes offer scholarships or grants to help cover the cost of treatment. You also have the option of joining a 12-step program or inquiring at local places of worship or non-profit organizations about any treatment or counseling programs they have available.

Learn the Lingo of Insurance Carriers

The last peace of the last piece of the coverage puzzle is to know how insurers and facilities define different types of care. For example, inpatient detox, inpatient rehab, and residential rehab may sound the same, but they provide different types of services. Not all of these options may be covered by your insurance. There is also partial hospitalization (PHP) and Intensive Outpatient treatment (IOP). It’s important to know which of these are offered by the treatment centers you’re considering and which are covered under your insurance.

If you need help in Roswell, Georgia, to overcome alcohol dependence, we’re available 24/7. All you have to do is call 770-299-1677 to get the process started today.