There are millions of Americans who struggle with a substance use disorder involving drugs or alcohol. However, as The New York Times reports, only a fraction of addicted people actually get the help they need. The first step on your road to recovery is deciding to get help for a potential substance abuse disorder. But there are a lot of barriers that keep people from ever taking that first step.

In many cases, a person’s willingness to seek treatment is determined by their own readiness to change. They don’t believe they have a problem or they don’t think treatment is necessary to solve their problem. Encouragement from family and friends can help overcome this barrier, but it’s a difficult one to get around.

Stigma is another significant barrier to treatment. Some find it embarrassing to admit they have a substance abuse problem and need treatment. It may seem that your friends drink or use drugs without developing an addiction, although they might be dealing with their own struggles beneath the surface. Overcoming stigma is a challenge, but it’s one that’s incredibly necessary for many people to get the help they need.

One of the biggest barriers to seeking treatment is the monetary cost. Most treatments, medications, and procedures in the healthcare industry are expensive, and high-quality addiction treatment that offers you treatment for as long as you need it can be a financial hurdle as well.

However, addiction is a disease that spreads to different parts of your life, including your career and your ability to maintain employment.

Plus, the statistical likelihood of addiction leading to costly medical and legal issues makes addiction a financial threat, not to mention it’s threat to your health, social life, and family.

The cost of treatment should never be a deterrent to getting the help you need. Luckily, insurance companies have come to recognize substance use disorders as a treatable disease, and most offer partial coverage for drug and alcohol addiction treatment. There are financing options available, and if you’re looking for addiction treatment, there are a few things you should know about the financing options available to you.

What to Know About Substance Abuse Insurance Coverage

Modern medicine has come to understand that addiction is a chronic disease that can be treated with evidence-based therapies. Fortunately, insurance companies have also come to the same conclusion and most offer some coverage for addiction treatment, including medication and detox services, mental health services, substance abuse treatment, and counseling and therapy sessions.

However, your individual policy will determine what exactly is covered and how much your insurance company will pay out. Anything not paid by your insurance company will have to be paid out of pocket or form some other source of financing.

Some of the bigger health insurance providers have established relationships with some treatment centers. If you are seeking treatment at a center that your insurance company considers “in-network,” then it means the insurer and treatment company have an established relationship. It’s usually much easier to get coverage at an in-network facility.

When an insurance company is considering an addiction treatment center to cover, it will look at several factors to determine eligibility, such as:

  • The type of treatments it provides
  • Whether the facility is in state or out of state
  • Whether the facility is privately or publicly funded
  • The center’s track record and reputation

One of the biggest factors insurance providers look for is the efficacy of the treatment options that a center provides. There are two basic categories when it comes to addiction treatment: evidence-based therapies and alternative therapies. Evidence-based therapies are treatment modalities that have been studied extensively and found to be significantly effective.

No treatment option will work 100 percent of the time for 100 percent of people. However, some treatment options have shown to be more effective than others. Evidence-based therapies show the ability to facilitate positive outcomes in treatment, but they also can be applied in various treatment settings. Examples include 12-step programs, cognitive behavioral therapy, and motivational interviewing.

Alternative therapy, on the other hand, includes treatment options that have not been studied or proven to be effective. Examples include equine therapy, yoga, and art therapy. It should be noted that many people report positive outcomes involving alternative therapy, and just because a treatment plan includes one of these options doesn’t mean it’s worthless. However, treatment plans should be grounded in evidence-based options, and alternative therapies should be supplemental. An insurance company is unlikely to cover a program that exclusively or primarily uses alternative therapies.

Public Insurance

If you don’t have insurance, and you’re struggling to find an insurance provider that you qualify for, there are federally funded options available. Under the Affordable Care Act, there are provisions for mental health and addiction treatment that are easier to afford and qualify for than private insurance options.

However, most privately funded addiction treatment programs don’t accept federal insurance options like Medicare or Medicaid.

Federal insurance like Medicare often comes with prohibitively time-consuming red tape and paperwork that private facilities aren’t equipped to handle. Under public insurance, your options will be limited, and you might miss out on some of the highest-quality treatment centers. Plus, private facilities often have a quick turnaround time and can get you into treatment within 24 hours of your initial application.

Government facilities often take weeks or months before you enter treatment, which can be valuable time lost for someone struggling with addiction. Still, government-funded treatment centers are a solid solution, if you don’t have insurance or other financing options.

Private Insurance

It’s much easier to get into a treatment program with private insurance than a federal option. Many treatment centers accept all private insurance providers and have existing relationships with the most notable ones. Treatment centers, such as The Palm Beach Institute, have staff members that can help you navigate your insurance policy to determine exactly how much coverage you have at your disposal.

Private insurance companies vary widely in the amount of coverage they offer for addiction treatment and which therapy options they will cover. For instance, heroin dependence causes extremely uncomfortable withdrawal symptoms that aren’t typically medically dangerous. Some insurance companies will pay for medical detox for heroin withdrawals while others won’t. It’s important to find out what your specific policy will cover when you are looking for addiction treatment. However, most private insurance companies will offer some coverage for addiction treatment at accredited, reputable treatment centers.

How the Palm Beach Institute Can Help

Finding addiction treatment coverage by navigating your financing options can be a challenge, but you don’t have to go through the process alone. Speak to one of the addiction treatment specialists at The Palm Beach Institute to find out if you qualify for treatment with your insurance provider. We also can work with your insurance provider to get you the most coverage possible and calculate any out of pocket expenses.

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