Types of Benefits

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Types of Benefits – Using Insurance for Drug Rehab, Alcohol Rehab, Detox, Counseling, Therapy, or Addiction Treatment

Anyone that has insurance who is searching for help for drug addiction or alcoholism should determine what type of benefits you have.  Many of the major insurance companies like Cigna, Aetna, United Healthcare, Humana, and Blue Cross Blue Shield have different levels of care and tiers of treatment that are associated with drug rehab, alcohol rehab, addiction treatment, detox, or counseling. This is in addition to whether or not your plan has in-network benefits and out of network benefits for the various types of addiction treatment.  It is a lot to understand and understanding how insurance benefits work while in the midst of an addiction can be too much to bear.  For some people, the easiest route to get effective addiction treatment may just to be to contact us for free, confidential help by filling out our contact form or by calling our hotline.

Generally speaking, insurance benefits are paid at a higher rate for the levels of care that are associated with a hospital setting such as hospital detoxification. Most insurance companies will pay in excess of $1000 per day for hospital care, detox, or other hospital procedures associated with addiction treatment. However, because the per diem, or per day, rate for hospital care is so high and costly to the insurance company, in most cases the insurance company will only authorize several days to a week and, in rare cases, a couple of weeks before they will no longer honor hospital based claims. Hospital based claims are justified by a well known term in the insurance and medical industry which is called “medical necessity.” Once a person is more stabilized, the insurance company will insist on a lower level of care, which ultimately is less costly for the insurance company.

Lower levels of care for drug rehab, alcohol rehab, detox, counseling, and other types of addiction treatment that insurance companies usually have benefits for are broken down into two categories: Inpatient/Residential and Outpatient. Inpatient/Residential drug and alcohol treatment would be the highest level of care that a person could receive directly below hospital based treatment. Just because Inpatient/Residential drug and alcohol treatment is not necessarily in a hospital setting, that does not necessarily mean that there is not professional involvement from licensed physicians, nurses, counselors, and other professional staff. A person can still receive excellent care and medical scrutiny at an Inpatient/Residential facility. It’s just that the per diem billing rate costs most of the major insurance companies as much as $500-$1000 dollars per day less. Do the math and now you can see why the insurance companies would rather see an individual in residential treatment instead of a hospital setting. Usually, as long as a pretty strong case substantiating the need for Inpatient/Residential treatment is documented (which is done well at most reputable drug and alcohol treatment centers), an insurance company may authorize up to 30 days for this level of treatment.

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Outpatient addiction treatment can generally be broken down into two categories: Intensive Outpatient (IOP) and Individual Therapy. Intensive outpatient drug and alcohol treatment usually entails that a person attend treatment for several hours up to 8 hours per day for either 5 or 7 days a week, thus its name. Most of the major insurance companies are ready and willing to pay for this type of treatment and may authorize up to  60 days or longer for intensive outpatient treatment. The reason for this, again, is that this type of treatment will ultimately cost the insurance companies less. The average per diem rate for intensive outpatient that most of the major insurance companies pay is around $500.

Outpatient individual therapy is usually where an individual goes to meet with a professional, either a psychologist or some type of licensed counselor or therapist, for one on one therapy. These meetings are usually scheduled for one hour at a time. Sometimes the individual and the doctor/counselor agree to meet once a week. Sometimes they will meet a few times a week. Almost always, as long as the claims process is done correctly and the insurance plan has the appropriate benefits, the major insurance companies will recognize and pay this claim. The average rate for one individual therapy session is around $250.

So, this should give you a general understanding of how insurance benefits work for drug rehab, alcohol rehab, detox, counseling, and other types of addiction treatment. But, as you may have realized now, addiction treatment can be big business. It is well within your interests to understand and to try to insist that you or your loved one get the very best help possible, even at the costlier rates when applicable.  However, ultimately the insurance companies will decide what they will authorize and what they will not authorize.  It is still within your rights to have dialogue with your insurance company and to push for the right type of addiction help.

Your number one goal should always be to get yourself or your loved one into the most effective and compatible drug rehab, alcohol rehab, detox, counseling, therapy, or addiction treatment as possible.  We are certainly glad to lend our vast knowledge and expertise to your situation.  Our help is free.  Your personal information is confidential.  Take your next step on the path of recovery and contact us via our contact form or call us right away.

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