The American Medical Association recognizes alcohol use disorder (alcoholism) and substance use disorder (drug addiction) as disease. They are not moral failings, and sobriety is not a simple step that can be solved with a quick fix. If these life-threatening conditions are diseases, then effective, evidence-supported treatment is not a luxury that should be available only to the wealthy.
Out of recognition of this, U.S. law requires that all insurance companies provide coverage for substance abuse treatment, to the same degree it would cover any other medical condition. Having insurance can dramatically decrease the out-of-pocket costs for inpatient rehab and other treatments necessary to recover from addiction. The compassionate and well-trained staff of the Gooden Center are committed to doing everything they can to give access to its services, and will work with you to help get insurance coverage you need.
Assessment: For insurance to cover a rehab expense, a professional health-care-provider must determine that it is “medically necessary.” That means that it must play an essential role in your care and recovery. Your counselors, doctors, and therapist will communicate with insurance companies to cover programs that are beneficial to you. In order to determine that the program will meet the criterion of “medically necessary,” your first step should be to receive a Professional Assessment.
As part of the assessment process, a physician or addiction specialist will meet with you to learn about your condition. They will perform tests on your health and ask about your drug or alcohol use, to see if it meets standards of problematic use or addiction. This assessment should be totally covered by insurance. If the health care professional decides that you meet a diagnosis of substance dependence, it can start the process of receiving treatment for your recovery.
What is Covered: Insurance policies may vary in details behind what is covered. To get specific details behind your particular policy, you should contact both the insurance company’s member services, and the rehab center to get specific information on coverage and costs for you. The Gooden Center has an online form you can use to have an admissions specialist contact you within a few hours.
In general, rehabs.com reports that most insurance will cover the following: Detox, or the medical process of allowing the intoxicants to leave your system- full coverage for basic detox, which may not apply for rapid detox. Inpatient residential treatment, or the time spent living in the rehab center undergoing intensive recovery – partial coverage. Things deemed necessary for the process, such as enrollment in the program and a bed will be covered, but certain extras that are a part of “luxury rehab” might not be. Outpatient treatment, or therapeutic and medical treatment that allows you to continue to live and work in your normal environment – mostly covered.
Applying for Insurance: The Affordable Care Act makes it easier than ever to apply for health insurance that will cover your rehab, and also forbids insurance companies from rejecting your application because of the “pre-existing condition” of your chemical dependency. The online Healthcare Marketplace (for the state of California) or Healthcare.gov (for other states) can walk you through the process of finding and selecting an insurance plan that is right for you. These plans will offer you a great deal of help with paying for inpatient or outpatient rehab, as well as the treatment that will be necessary for aftercare. The open enrollment period is from November 1 to January 31 for a year, during which time you can apply for coverage that will carry through for the year.