Insurance Coverage

Facts About Insurance Coverage

It’s true that inpatient treatment can be costly – living in a rehabilitation center full time for days, weeks, or months can be a large expense in relation to outpatient care – but insurance coverage can alleviate all or most of these costs for those who qualify with rehab insurance.

For patients facing health concerns, it’s not unusual to be anxious about the costs associated with care. In the United States, healthcare costs have risen to an unsustainable level, putting critical services outside the reach of many Americans. In 2015, spending rose 5.8% over the past year to reach a total of $3.2 trillion, or $9,990 per person. As such, many non-fatal conditions, or perceived non-fatal conditions, fall by the wayside as families on a budget allocate their income elsewhere.

Protections for Those Seeking Rehabilitation

Over the last several decades, the United States government has afforded patients in need of mental health treatment and long-term healthcare resources several protections pertaining to both job security and access to care.

The Family and Medical Leave Act of 1993, colloquially known as FMLA, is a federal program that requires employers who meet certain standards to provide access to unpaid leave to address personal or family medical issues. For example, things like pregnancy and childbirth, cancer care, adoption, drug and alcohol rehabilitation, and chronic illness treatments qualify under FMLA. While FMLA leave is generally unpaid, this option provides a way for employees to seek treatment without putting their jobs at risk. FMLA covers one 12-week period every 12 months and only applies to employees at qualifying companies who have been employed for at least one year.

In addition to FMLA, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 put further groundwork in place to protect those struggling with addiction. Under MHPAEA, dollar limits on mental health benefits cannot be less than any limits associated with medical and surgical benefits for those with group health plans. This extends to co-pays, treatment limits, and any other components of coverage as they apply to standard medical care. Challenges in parity should be reported and can be done so here through the American Society of Addiction Medicine.

Insurance Coverage for Rehab

Under current law, the Affordable Care Act, also known as Obamacare, guarantees certain coverage requirements, including mental health care. As insurance providers are not allowed to discriminate against those with pre-existing conditions and are bound by legal coverage minimums, insurance in the U.S. currently is required to cover at least some facet of care related to addiction and substance abuse. This has allowed many to obtain insurance coverage for rehab. Currently, the Republicans in Congress are attempting to make changes to the structure of Obamacare, which may mean limiting or overturning coverage for pre-existing conditions and mental health issues in the future. However, no definitive changes are upcoming as of 2017.

More limited plans may not apply to all options and all facilities, but most employer-sponsored healthcare programs and higher tier ACA plans do include basic coverage for most standard services. Under the ACA, all plans, regardless of source, must include:

  • Behavioral health treatment, like psychotherapy and counseling
  • Mental and behavioral health inpatient rehabilitation
  • Substance use disorder treatment

Covering the Costs of Care

As with doctors and hospitals, insurance acceptance often varies on a case by case basis. While most facilities make every effort to accept common area plans, not all insurance policies can be used at all treatment centers.

PPO, or Preferred Provider Organization, plans are more likely to offer flexibility in treatment facility choice. HMO, or Health Maintenance Organization, plans may limit care to one selected center. Cigna HMOs, for example, do not generally cover inpatient rehabilitation but offer options for other forms of care, like outpatient programs. Before pursuing a particular treatment avenue, take time to contact your provider and ask for the specifics. With proof of enrollment, customer service representatives can walk you through your options and explain the ins and outs of your unique plan.

It is important to understand that treatment programs want to see patients succeed. With an overall goal to treat addiction and reduce substance abuse in the community, many are willing to work on behalf of patients to ensure the highest level of coverage.

Insurance coverage for rehab varies from facility to facility, but verifying eligibility is often a streamlined process. Most accredited rehabilitation centers will offer free, confidential insurance verification to help you understand the coverage provided by your insurance company and the out of pocket expenses you may face. While legitimate programs will work with your insurance company on your behalf, it may to your benefit to reach out on your own.

At Lumiere Healing Center, we accept rehab insurance coverage from most major national and local carriers, including:

  • ValueOptions
  • BlueCross BlueShield
  • Cigna
  • Humana
  • Anthem BlueCross
  • Medical Mutual

Find the Right Care for You

If you or someone you love is struggling with an addiction to drugs or alcohol, help is here. We can check to see if you have rehab insurance coverage.

Please contact Lumiere Healing Centers at 513-909-2225 to learn more about our rehab insurance programs and options. Free insurance verification are available to help you best create an affordable path forward.