As of 2014, the Affordable Care Act requires most health insurance plans to provide some coverage for addiction treatment services. These services are now considered “essential health benefits,” so health insurance offered through the health insurance marketplace must offer mental health and addiction services. These plans are required to cover behavioral interventions, inpatient services, and substance use disorder treatment.
How to Cover Treatment Using Health Insurance
You will need to follow certain steps in order to have your health insurance pay for your treatment:
Step 1: Gather your insurance information.
Begin by gathering all the available information on your insurance plan. You will need to know your provider and have your identification number available. You may need to provide the insurance company with your full name, date of birth, the name of the primary insured individual, and your social security number. Your insurance card should provide your ID number, as well as a phone number you can call to find out more about your coverage.
Step 2: Call the treatment center.
You will need to ensure that the treatment center where you are receiving your rehabilitation accepts your health insurance, and provide them with your coverage information. Call the treatment center or provider to give them the necessary information. Provide your name, date of birth, insurance provider information, and ID number. The treatment center will verify your insurance coverage and determine if you are responsible for a portion of your bill.
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Step 3: Complete the insurance verification process.
Your treatment provider will be able to determine how much of your care is covered by your insurance. The amount your insurance pays will depend on your insurance provider and your specific plan. Some plans may only cover outpatient services, or will only pay for a certain number of days of inpatient treatment.
The treatment center will call your insurance provider to find out which services your insurance covers. You can also find this information yourself by calling the phone number on your insurance card.
Step 4: Determine out-of-pocket expenses.
You will probably have some out-of-pocket expenses for your addiction treatment. Most insurance plans include a deductible, or an amount you need to pay before your insurance will cover the cost of your treatment. You may also have a copay or coinsurance, which is the percentage of your treatment expenses you are responsible for. Rehab can seem costly; however, the benefits to your future and quality of life far outweigh the monetary costs.
To determine your out-of-pocket expenses, call your insurance provider and find out which services they cover, as well as your deductible. Get specifics on copay or coinsurance amounts you are responsible for.
Step 5: File a claim, or have your treatment provider file a claim.
In order for your insurance provider to pay for your treatment, they need to receive a claim. Most treatment providers will file the claim for you. Some providers may require that you file the claim yourself.
To file a claim, you will first need an itemized bill from your doctor. This bill will list every treatment, procedure, and medication you have received, along with the cost, and an insurance code. This code is what insurance companies use to determine what kind of procedure you received, and whether or not your insurance plan covers that procedure.
In addition to the itemized bill, you will need to fill out a claim form. Your insurance provider will supply you with this form. Make copies of the form and the bill before mailing, emailing, or faxing them to your insurance company. You may also want to call the company to make sure there’s nothing else you need to send in order for your claim to be processed.
Step 6: Follow up with your insurance provider.
Stay in contact with your insurance provider once you have filed a claim. Call to make sure they received your paperwork. Ideally, your insurance company will process the claim and pay your treatment provider. If there is a problem with your claim, it will be denied, and your insurance company will not pay for the services you received. This can happen if the service is not covered by your insurance. It is best to call your insurance provider before receiving any services to make sure everything is covered by your plan.
Step 7: Come up with a plan to pay out-of-pocket expenses.
It is likely that you will have to pay at least a portion of the cost for rehab. Your treatment provider will give you a bill for your out-of-pocket costs. Some treatment centers offer payment on a sliding scale, meaning the cost of treatment is based on your income level; though most private treatment facilities just offer straightforward pricing. Many do, however, offer payment plans, so you can receive care now and pay for it slowly over time.
Talk to your treatment provider about payment options. It is likely they can help you come up with a plan to cover your portion of the expenses.