Paying For Treatment
New Life Treatment Center works with most major insurance carriers. We also accept clients funded through CCDTF and self-pay.
Health Insurance When Paying for Drug Rehab
Due to federal and state parity laws and other factors, health insurance coverage for drug rehabilitation varies widely. Your coverage will depend on a number of factors, including whether the Parity Act applies to your plan, what state you live in, and what types of benefits are offered by your plan.
Even when you have coverage, you still need to pay close attention to what that coverage is and how the insurer will manage your case. Clink on the link below to learn more about your specific insurance coverage:
No matter who your insurance coverage is with, there are 10 questions you should ask your plan’s customer service representative to help make sure you get the best, most affordable care.
Ten questions you should ask your plan’s customer service representative
Does my plan provide coverage for treatment of drug abuse: It’s important to understand the federal Parity Act, but most people don’t know whether an employer is a self-funded group plan, or how their state laws handle benefits for substance abuse treatment. Your plan’s customer service representative will be able to tell you exactly what your benefits are. Sometimes benefits for drug rehab are handled by a “managed behavioral health organization (MBHO).” If that’s the case, your insurer should let you know the name of the company and how to contact them. Then you will deal with the MBHO, rather than your insurer.
Ten questions to ask your drug rehab insurance provider
Do I need a referral from my doctor: You’ll want to find this out before drug treatment, since in some cases, benefits can be reduced or denied if you don’t get required referrals. If you got emergency treatment without time for a required referral, call your insurer as soon as possible and explain, and then follow their instructions.
Is my diagnosis covered: Your health insurer will consider whether they believe your condition is “medically necessary.” Some plans may not cover repeat care if you didn’t follow through with your last course of treatment. Other times, they may cover your care, but not to the extent you would like. For instance, they may say that for your diagnosis, only outpatient treatment is covered. In addition, your insurer will consider if there is any reason that your treatment would fall under a general exclusion of the plan. This would be the case if you have coverage through your employer, but your addiction is caused by active service in the military. Another exclusion may apply if your treatment was court-ordered.
What type of plan do I have: Some common plan types include:
Preferred provider organizations (PPO) – With a PPO plan, you can choose a covered provider (as long as they meet the plan’s definition of a covered provider). However, you get a greater benefit if you go to “in-network” providers, rather than “out-of-network” providers.
Managed care plan – With a managed care plan, you must go to an in-network provider to receive coverage.
Consumer-driven health plan – These plans are usually a PPO hybrid, and have very large deductibles (thousands of dollars). Usually once the deductible is met, all covered services are paid at 100 percent.
Is there a difference in coverage between in-network and out-of-network care and if so, what is it: It’s common for plans to pay a higher benefit for in-network care. For example, a plan may pay, say, 100 percent of the covered cost for an in-network provider, but perhaps only 70 percent of the cost of an out-of-network provider. So it’s important to know what you’re getting into if you choose a non-network provider.
Is there a deductible: The deductible is the yearly amount you must pay before the plan will start paying benefits. In some instances, the deductible is waived, like for preventive care or sometimes for inpatient care. Under some plans, any amount applied toward your deductible in the last three months of the calendar year is carried over to help meet your deductible during the next year.
Will there be co-payments: Co-payments are like mini-deductibles. They apply to individual services, like office visits, prescription drugs, and others, and they usually do not apply toward your deductible. It’s important to understand how much your co-payments are and what they apply to. If you will be having outpatient care, you may have to pay a co-payment for each treatment day, and co-payments are usually due on the date of service.
What is my out-of-pocket (coinsurance) limit: If you pay a percentage toward your medical services, like 30 percent after 70 percent coverage or the 20 percent after 80 percent coverage, those amounts you pay go toward your yearly out-of-pocket limit. Once that limit is met, your remaining covered health expenses for the year are paid at 100 percent. If your rehabilitation is covered, your insurer will pay the provider directly, but you will be billed for out-of-pocket expenses.
Are there any restrictions on where I can get help: Besides considering “in-network” providers, your plan will likely only cover certain drug rehab facilities. You’ll want to ensure you find out up front, so that you can choose the most effective, and affordable drug rehab center.
How will my care be reviewed while I’m in treatment and how will any reviews impact my coverage and treatment: If you will be having inpatient or residential treatment, it’s important to know that your care will be monitored, likely by the insurer’s nurse case manager. As you make progress, your insurer will want to be certain that the level of your addiction treatment matches the severity of your condition. And they will decide this based on “concurrent” and other reviews.
“Non-quantitative” Treatment Limitations
Pay attention to how your plan handles what has been called “non-quantitative treatment limitations” (NTQLs). Because remember, if you have coverage, unless your plan is exempt from parity laws, your coverage for drug abuse rehabilitation should be comparable to coverage for medical and surgical care.
NQTLs are plan features that are not expressed numerically (with numbers) but in other ways that can limit your benefits. These come into play with substance abuse treatment because they apply to medical and surgical care. Some NQTLs include:
Medical management that bases decisions about coverage on medical necessity or on the medical appropriateness of your care or based on whether a treatment is experimental or investigative
The list of prescription drugs that your insurer covers
Provider coverage and reimbursement rates
Methods used to decide the “usual and customary amount” or negotiated fee” that is covered for each service provided
The refusal to pay for higher-cost therapies until it can be shown that a lower-cost therapy is not effective
Exclusions based on failure to complete a course of treatment
Since some patients and caregivers have argued that NQTLs have not been used fairly with substance abuse treatment as compared with medical and surgical are, advocates (people who support) parity laws are watching this closely. That’s why it’s important for you to file an appeal to your health insurer if you feel your coverage is not handled fairly in light of parity laws. Research shows that 50 percent of individuals who file appeals are successful.
What to Do If You Don’t have Insurance Coverage When Paying for Drug Rehab