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Why Addiction Rehab is covered by most Health Insurance Plans

“Addiction is a sign or symptom of distress. It is the language that tells us about a plight that must be understood.”  Alice Miller. 

Believe it or not, we all have some sort of addiction. The addiction of yours could pertain to smoking, drinking tea, or even being the first in class always. Well, let’s just agree for the moment that all of them aren’t bad. However, some are not only wrong; they are dangerous to everyone around as well. Not to mention you cannot imagine the temptation of the addict because it is not easy to get rid of the addiction. As Mark Twain describes that “it is Easy to leave Smoking, I left it a hundred times” clearly shows that the journey to de-addiction isn’t that easy. 

This arises various questions in one’s mind as a consumer of insurance products. Does health insurance cover rehab? Why is it necessary for insurers to cover addiction rehab in their health insurance products? How does it work? Which expenses are covered? In this article, we’ll try to cover answers to all of these questions. Before that, let us dig into what addiction rehab centers are.

What are the Addiction Rehab Centers? 

Luckily for you today, even if you are an addict all is not lost as you have something known as addiction rehab centers that would help you out. Not only do these addiction rehab centers help you get out of your state, but they help you become a good citizen for the society. A typical rehabilitation centre does it in four distinct phases. These include Intake (creating a customized plan for you) followed by Detoxification of your body from all the drugs. Ultimately you are then hospitalized, and finally, you are given recovery and aftercare which help you come back to the closest to normal.    

Isn’t it life-changing? Let’s take a moment to think. If you feel anything like me, you would ask “Perhaps not”. Because like you, I also think one about the major factor, the affordability. Luckily, we have health insurance companies today who think like us, and who cover addiction rehab in their coverage. 

Health insurance rehab coverage

It doesn’t seem long enough that we as citizens didn’t even realize that there could be possible problems in mental health or substance abuse by an individual. As a society, you and I always thought that these are problems of the sufferer and not for society. Luckily for all of us, 2008 wasn’t just a financial crisis year in the US. After 2008, under the Mental Health Parity and Addiction Equity Act (MHPEA), and continuing through the Affordable Care Act (ACA) in 2010, a lot changed for Addiction Rehab. 

After this, the government-funded, private, and group health insurers were required to provide the same level of treatment for Drug Addiction and Alcoholism as they did for Diabetes. This means that every insurance that was in the marketplace in the US had to cover at least ten diseases for all of us, addiction rehab being one of them. While there is no compulsion in India, we are going on the right track. With the advent of the declining mental health due to COVID 19, the IRDAI has made it mandatory to include mental illnesses in all health insurance coverage.

This is why you don’t need to worry about whether your health insurance covers rehab or not. But you do need to review the terms and conditions very carefully to select the best health insurance plan that protects you from addiction.

How does Health Insurance work for Addiction Rehab?

After establishing how Medical Insurance situations are changing for Mental Health, it’s time we look at how actual insurance works for Addiction Rehab. There are many factors that dictate how and what your insurance will be covering for your expenses at insurance covered rehab facilities. Here are some of the common factors of an insurance policy for Addiction Rehab. 

  1. Its deductible – Yes, this means that you also have to pay a certain proportion of your treatment costs. While plans are different for different policies, typically an insurance company bears anything between 60-80 per cent costs. Something is better than nothing at least. 
  1. Length of Treatment – Unlucky for all of us; there isn’t any industry standard on what length of treatment would be covered. It could be as low as 28 to 30 days, or it could be a longer-term treatment that is deemed medically necessary. 
  1. Stay with the Carrier – As weird as it sounds this is sometimes a condition for getting a medical claim. Some insurance carriers may require you to register their treatment stay with the carrier before starting your actual treatment. If this is bypassed, this can become the basis for you not getting the required medical claim facility. 
  1. Cover only if necessary – Many insurance carriers make sure to check that addiction treatment is a medical necessity before they jump in and pay for your expenses. This can mean that they undertake a full clinical assessment from treatment providers or any other physician to check if this is the case. Only if they see signs of drug or alcohol abuse, Addiction, or dependence, you are getting your treatment covered. 
  1. Do you need detoxification – Often, when there is a case of medical necessity, there is a case for detoxification as well. This Detoxification could be of alcohol, barbiturates, benzodiazepines, or opioids. Since you cannot leave a person alone in a situation of detoxification, it merely implies that your insurance company is covering all your treatment expenses as well.

Even after all these features, I know everything isn’t crystal clear for you. You may want to ask your insurance company several other questions, which will help you get a clearer idea about your specific insurance policy. These could cover questions like: 

  • Do you cover Detox or Medical Detox Programs? 
  • Do you cover Outpatient / Inpatient treatment, and to what extent?
  • Do you cover prescription medications for treatment?
  • Or the most important, do you cover the after-treatment expenses like seeing a psychiatrist regularly and other costs? 
  • Is there a network of insurance covered rehab facilities for your insurance plan?

Some more questions like these would hopefully help you get a clearer idea about your particular insurance plan and how does it cover addiction rehab expenses. 

Why does your Insurance Cover Addiction Rehab Expenses?

We’ve discussed how Addiction Rehab Medical Insurance is a game-changer for all the drug addicts who get a second chance to become a part of the society in a much more affordable manner. Yet, if you think closely, every insurance policy is a two-way street. It cannot be the case that it is helping you, and it is just a formality to be completed by the insurance company. So, let us see what is in there for Insurance Companies? Or, why do Insurance providers ensure that their health insurance covers rehab?

We saw earlier in the article why does health insurance cover rehab. But, there are other reasons, as well. The first is philanthropic. Maybe, it was a time that Insurance Companies had realized the seriousness of the issue at hand. The health concerns have an everlasting impact on life on not just an individual but the society. The same society which gives it its required revenues it had a moral obligation towards them. 

The second reason is more economic. Insurance Companies wish to cover this because they now realize that this condition is treatable. Now, visualize these two situations, and you would realize what I am talking about. Imagine the policies making Insurance Affordable for all on the one hand, and on the other hand, Drug Addiction becoming treatable.

What does it leave the insurance companies with? It leaves a pool of potential customers who are drug addicts and would possibly require coverage when they face serious health problems in the future. The simple Economic way out of it was to cover for their Drug Addiction Rehabilitation Facilities and pay for a lower treatment cost than to pay a potential higher coverage amount for them in the future. This is why the insurers make sure that their health insurance covers rehab.

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