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Insurance Using It to Pay for Treatment

Addictions harm our bodies. The needles we use push bacteria beneath our skin, while the drinks we down stress and burn the liver. When a hit goes wrong, we don’t hesitate to visit the doctor to get better, and we use our insurance to pay for treatment.

What if that same insurance plan could help you to kick the habit for good? 

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The Surgeon General says one of the best ways to stop a rising tide of addiction is to ensure that more people have health insurance. If you’re already enrolled, the hard work is complete. Now, you should use your plan to help pay for the care you need.

insurance concept

What’s Covered By Insurance?

A visit to a doctor, a therapist, or a treatment facility could cost you hundreds or even thousands of dollars. Health insurance plans buffer the financial impact. The premiums you or your employer pay buy you coverage for some types of health problems.

Essential benefits are those that all health plans must cover. Mental health care and drug abuse treatment are among them. That means plans should include:

Years ago, health plans could deny claims for care for mental health or substance abuse problems. If you checked into a center anyway and got care, you’d be stuck with a bill at the end. Now, they must cover your treatment.

But there are plenty of loopholes involved, and some of them could cost you a lot of money.

  • Length of stay: Addictions can be persistent, and overcoming them can mean staying engaged with treatment for months. For some people, leaving an inpatient program means entering a world of hazards and relapse risks. If they walk out too soon, they are sure to relapse. A couple interviewed by National Public Radio claims this happened to their son. He was discharged due to insurance policy rules, and he overdosed soon after.
  • Network: Insurance companies create connections with treatment providers. Together, they agree to lower costs. Some plans won’t pay for care that’s delivered through someone who isn’t part of your network.
  • Premiums: You must pay for your policy, or it’s canceled. Addictions can be chaotic, and it’s easy to neglect payments. If you miss just one, your company could nullify protections.
  • Copayments and coinsurance: Cost sharing is part of some plans. Your insurance company pays some, and you pay the rest. If you work with an expensive provider, your bill could be large.
  • Prior authorization: Notification before you spend your benefits is part of some plans. If you don’t ask for permission before you enroll, your entire claim could be denied.

Don’t let this list discourage you. Using your plan does involve jumping through a few hoops, but the results could be very worthwhile.

insurance concept

How Does Your Plan Work?

To encourage you to dig into your policy and use your coverage for care, we researched a few plans that are popular in Florida. Each works a little differently, but all of them could help you to pay for addiction treatment.

Florida Blue: This company is an active participant in conversations about opioid addictions in the United States. The company points out that 64,000 people died of opioid overdoses in 2016, and that many of these people were young. The company wants to help. They are:

  • Removing a popular opioid from their list of preferred drugs.
  • Identifying and managing doctors who prescribe too many opioids.
  • Monitoring members with opioid prescriptions.
  • Requiring paperwork before opioid refills.

Given this stance, it’s reasonable to assume that the company also offers generous benefits for addiction care. However, there are dozens of different types of plans for people in Florida to choose from, and each works a little differently. We can’t make a blanket statement about all of these plans, but we can safely say the company offers coverage for addiction treatment.

Aetna: This company offers a wealth of online information about addictions and recovery. Members of the program can find out how addictions develop, how they are treated, and how insurance coverage can help.

Typically, the company says, people with addictions should speak with primary care physicians (PCPs) as a first step. That’s likely due to the types of insurance Aetna sells. They use their PCPs as gatekeepers for care, and those doctors write referrals for advanced services. This keeps costs low. If you speak with your PCP and you get a referral to treatment, it can ensure your treatment is covered.

But again, Aetna offers many different plans, and each has its own coverage levels and limits and prices. You’ll need to read the fine print to determine how much you’ll be asked to pay.

Cigna: This company offers information about three types of addiction treatment:

  • Inpatient care
  • Outpatient care
  • Intensive outpatient treatment 

The company suggests that doctors can help their patients determine which type of treatment is best. It’s possible that you’ll need to get approval from your doctor to jump up to the highest (and most expensive) level of care, and that also helps to keep costs low.

Cigna offers many insurance packages in Florida, including some made for low-income families. Each comes with separate rules and regulations to follow.

Humana: This is arguably the largest insurance company in Florida, as it provides insurance plans for individuals, companies, and the state government. Most people in Florida either have Humana insurance or know someone who has coverage through Humana.

Since the company is so large and their plans are so different depending on the payment source, generalizations are difficult. But people with PPO plans may have an advantage. This type of coverage lets you move outside of a restricted network, so you can use whatever provider you want as long as you pay a little more.

Humana is big enough that it might have contracts with everyone you want to visit, but if you have a PPO plan, you can extend your reach yet further.

friends helping each other

How Should You Start?

Insurance coverage can be confusing, especially because it’s personalized. Your plan may work differently than one owned by someone close to you. That’s why contacting the company is always the best idea.

Your insurance plan has operators who can look over your policy, tell you what’s covered, and explain whom you can use to get care. A quick phone call can give you all the data you need to get started.

If you feel too ill to make that call, some addiction treatment program staffers can do it for you. They can connect with the insurance company directly and explain your situation and your needs. That can help you get care too.

No matter what route you take, be sure to explore your benefits before you agree to pay for care on your own. You’ve purchased your insurance. Put it to work for your recovery.

Check Insurance

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