Deciding to attend rehab, detox or any other form of addiction treatment is a wonderful move and a step in the right direction toward a lifetime of sobriety. Unfortunately, many patients want to begin receiving treatment right away, but are concerned about their health insurance coverage. Some addiction treatment clinics and facilities won’t accept specific policies or plans, and there are a range of different reasons for that. Take a closer look at why a facility might not accept your health insurance coverage.
They Only Accept Cash Payments
Some facilities, particularly those that are boutique clinics with high-end amenities, only accept cash payments. This can be acceptable for the very wealthiest of patients, but most individuals have trouble gathering the necessary money to pay for treatment and care in cash. Thankfully, this is a rarity for most drug and alcohol rehab centers today. Many of the top facilities, like Beaches Recovery, readily accept health insurance plans from major providers, making it easier for patients who need help to get it regardless of financial situation.
The Facility is Out of Network
Most health insurance plans require patients to stay within a network of healthcare providers when seeking treatment, whether that treatment is for a broken arm or addiction therapy. When this happens, an insurance company can opt only to pay for treatment when it is provided through a designated, in-network provider.
If a facility is aware that they aren’t in the designated network of a patient, they may decline health insurance coverage. This isn’t meant to be punishment, but it just a way to alert the prospective patient about the coverage options. If patients want to keep costs low, then they may move on to a different treatment facility that is within their health insurance provider’s network.
Just because a facility is out of network, it doesn’t mean it is off the table entirely for patients interested in addiction treatment. Sometimes, a treatment program is out of network, but the individual policy allows for some wiggle room. For instance, patients can pay for treatment out of pocket, but be reimbursed by their health insurance providers after program completion.
Patients Don’t Qualify as Having an Addiction
In order for health insurance to cover the cost of addiction treatment, patients need to qualify as being addicted to a dangerous substance, whether that is prescription medication, illegal drugs or alcohol. There are several ways for patients to verify this information, but it often has to be arranged through a primary care physician, who can then confirm and recommend addiction treatment.
Another option is an admission evaluation upon arrival at a detox or rehab facility. If for any reason a patient doesn’t appear to have an addiction, then they might be denied coverage.
The Facility Doesn’t Work With Your Health Insurance Provider
In some cases, addiction treatment facilities simply don’t have a working relationship with specific health insurance providers. This may be more true of smaller insurance companies, and less common when it comes to major, nationwide insurance providers.
The Insurance Plan Doesn’t Cover Certain Levels of Care
In 2011, the Substance Abuse and Mental Health Services Administration reported that approximately 2.6 million Americans received some kind of addiction treatment. It is important to realize, however, that there are multiple kinds of treatment and care available. Some insurance plans allow for outpatient treatment, but not inpatient. Some will cover 30 days of partial hospitalization programs, but won’t work with facilities offering sober living.
Unfortunately, there are some facilities that can’t or won’t accept certain types of health insurance coverage. The good news is that Beaches Recovery in Jacksonville, Florida, accepts a wide range of plans, and delivers exceptional care for patients.
We partner with national providers, including: