Health Insurance: Addiction & Mental Health Treatment in the United States

There is no denying the fact that drug addiction is a complex disorder that affects millions of people throughout the United States. However, paying for treatment is often times as challenging as dealing with the actual addiction.

Over 15,000 Treatment Facilities

According to DrugAbuse.gov, there are nearly 15,000 drug addiction treatment facilities in the US that provide some level of counseling, therapy, and/or case management.

While many people are glad to learn that there are people who can help, the problem of how to pay for treatment rears its head time and time again.

Fortunately, since drug addiction is a major public health concern in the United States, a large portion of treatment is funded by federal, state, and local governments.

In this case, if treatment is paid for in full or partially through funding, the concern over payment is not nearly as big a burden.

Additionally, it is important to note that many private and employer sponsored health insurance plans also provide coverage for addiction treatment as well as any direct health consequences.

It’s a Simple Problem

The problem with this is simple: since the treatment is being paid for by insurance companies, shorter average stays are becoming increasingly more common. Subsequently, the patient is not getting the level of care he or she needs to actually overcome the addiction.

You have Options

According to a recent report by HBO.com, there are many people who struggle to receive insurance coverage for addiction treatment. Here are some of the main points of the piece, pertaining to insurance and addiction treatment:

  • Don’t let your health insurance company turn you away when they are obligated to pay for some or all of your treatment
  • The majority of states have a law requiring insurance plans to cover addiction treatment
  • Be prepared to fight against the insurance company if you purchase your own plan, while also becoming familiar with your employee benefits if you receive coverage through your employer

According to the same article, the economic impact of untreated addiction to the United States check in at more than $325 billion per year. Even more telling is the fact that the cost savings, related to proper treatment, is $7 to $12 saved for every $1 spent.

Despite the fact that you should be able to receive treatment through your health plan, many are facing a dead end.

For more information on how laws work in your state, you don’t have to look any further than The National Alliance for Model State Drug Laws (NAMSDL).

Note: group health insurance plans are required by law to comply with the law in your particular state.

How much will my Insurance Cover?

If you require professional addiction treatment, you should immediately contact your health insurance provider to discuss your plan. Some policies will cover your entire bill, after the deductible has been met, while others will only pay for a portion of the treatment.

When it comes to finding treatment, you should never settle for anything but the best. And it is worth noting again, you cannot afford to let your insurance company push you around.

If you are covered by a policy and addiction treatment is underwritten, you are guaranteed coverage.

These details concerning insurance and addiction treatment will come in handy should you find yourself or a loved one in need of professional assistance.

Coverage for Mental Health and Addiction Services by Insurance Carriers

Insurance Carrier Address Phone Website Addiction Treatment Mental Health Average Premium*
Blue Cross Blue Shield Blue Cross Blue Shield
Washington, D.C.
1310 G Street, N.W.
Washington, DC 20005
1 (888) 630-2583 www.BCBS.com Mostly Covered Mostly Covered $117
United Healthcare Varies Varies www.UHC.com Mostly Covered Covered $68
Aetna Aetna, Inc
151 Farmington Avenue
Hartford, CT 06156
USA
1 (800) 872-3862 www.Aetna.com Covered Covered $94
Humana Humana Inc.
500 West Main Street
Louisville, KY 40202
1 (800) 486-2620 www.Humana.com Covered Covered $90
Cigna Cigna Corporate Headquarters
900 Cottage Grove Road
Bloomfield, CT 06002
1 (800) 997-1654 www.Cigna.com Covered Covered $129
Assurant Health 501 W. Michigan St.
PO Box 3050
Milwaukee, WI
53201-3050
1 (800) 553-7654 www.AssurantHealth.com Covered Mostly Covered $98
WellPoint Health Insurance WellPoint, Inc.
120 Monument Circle
Indianapolis, IN 46204
1 (317) 488-6000 www.WellPoint.com Mostly Covered Mostly Covered $79
Kaiser Permanente Kaiser Foundation Health Plan, Inc.
393 E. Walnut St.
Pasadena, CA 91188-8514
1- (800) 443-0815 www.KaiserPermanente.org Mostly Covered Mostly Covered $87

*Average premium is based on a healthy 28 year old male. Gathered from online quote averages.

Different Levels of Care & Definitions

Level of Care Definition
Inpatient (Rehab) 24/7 medical care with cognitive, behavioral and group therapies.
Inpatient (Detox) 24/7 medical care with intake evaluation, physical and mental exam, detoxificaiton medication protocol and stabilization of withdrawal symptoms.
Residential Rehab Sober living with off site care and specialized therapy for relapse prevention and character development.
Partial Hospitalization (PHP) Day or evening treatment with relapse prevention, group therapy, education and mental health services.
Intensive Outpatient (IOP) Outside residence with intensive therapy throughout the day and group therapy.