How Does Insurance Work For Substance Use Treatment?
One of the biggest obstacles to finding substance use treatment in the United States is insurance. For the 70% of Americans who have commercial or private insurance, finding a program that works with your policy can be tricky. Hopefully, this article can help answer some of your questions regarding what programs insurance carriers will typically cover and how much it might cost to pay out of pocket.
First off, when you contact a treatment program, they will do an intake assessment. The goal here is to gather pertinent details about your substance use, treatment experience and insurance information. From here, treatment programs will run a VOB (verification of benefits). This will tell them about your policy. They’ll look for your out of pocket max (OOP), co-insurance, how much is your deductible, how much of it has been met, etc…
From here, you’ll receive a call back from someone within the treatment program to inform you of the projected costs. But here’s the gist. Your deductible is the financial dollar amount you have to pay for services before insurance will pay the provider. If you have co-insurance, you’ll be responsible for paying a percentage amount for the costs of services until your OOP max is reached. Additionally, if you’ve met your OOP max, treatment shouldn’t cost you a thing. Most treatment centers will collect your deductible and sometimes co-insurance before billing the insurance companies directly.
Another important side note is about Anthem. This is really the only insurance that still practices something called “paid to member.” This means, on an out of network basis, they send payment for services directly to you and you need to give these checks to the treatment center.
What’s The Cost of Treatment?
To help alleviate some of your financial concerns, I’ve included a comprehensive breakdown for what types of services are covered by insurance and the average cash rate for each option. Keep in mind, if you have insurance and a decent policy, some of the out of pocket expenses below might not be relevant to your circumstances. If you have any questions about what each of these programs will provide, I encourage you to read this article.
The first treatment option is for detox programs. Most insurance carriers cover detox programs but the average out of pocket cost is between $250 – $500 per day. This can vary greatly depending on the treatment facility you attend. Secondly, there’s residential treatment which is also covered by most insurance and costs roughly $1,000 – $2,000 per day. The next type of treatment is sober living. To my knowledge, no insurance company will cover sober living programs and they tend to cost between $800 – $10,000+ per month. The reason for this huge difference in pricing is the quality of services provided vary greatly.
The next step down in treatment care is Day Treatment (PHP) and Intensive Outpatient Programming (IOP). Both options are almost always covered by insurance providers. The out of pocket costs for PHP are usually between $5,000 – $15,000 per month and IOP costs between $3,000 – $10,000 per month. Following IOP, the next level of care is Outpatient (OP) and usually costs less than $5,000 per month and is covered by most major insurances.
How To Move Forward
At Orion Treatment Consulting, we know how stressful and difficult it can be to find the right treatment facility to meet your needs. That’s why we offer placement services to help ease the burden of options. Our team has connections with hundreds of treatment programs around the country that range from pure cash rates, too commercial, private and government insurance programs. We also have connections to low cost options for people who are struggling financially.
If you or your loved one is struggling to find an appropriate addiction facility that meets your needs, contact us today to see how we can help!