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Insurance Considerations for Addiction Recovery

There are a few important considerations to keep in mind for anyone looking into addiction recovery programs, and insurance coverage is often near the top of this list from a financial perspective. Being able to receive the help one needs for addiction recovery is very important, and many insurance programs allow partial or even full coverage.

At Moonlight Mountain Recovery, we provide caring inpatient and outpatient addiction recovery programs across Boise plus nearby states like Oregon and Washington, plus important services like insurance assistance and more. Here are some general themes to keep in mind when it comes to insurance coverage for addiction recovery programs, plus some important areas to be sure you check in advance if you or a loved one is entering a program while utilizing insurance.

Mental Health Parity and Addiction Equity Act of 2008

One important legal consideration to keep in mind for anyone looking into addiction recovery programs is the Mental Health Parity and Addiction Equity Act of 2008. This act requires that insurance plans provide equal coverage for mental health and substance abuse treatment as they do for medical and surgical care.

This means that insurance plans cannot impose more restrictive financial requirements or treatment limitations on mental health and substance abuse services compared to other medical services. This ensures that individuals seeking addiction recovery programs have equal access to needed care without facing higher costs or more limitations simply because they are seeking treatment for a mental health condition or substance abuse issue.

Types of Insurance Plans

It’s important to understand the different types of insurance plans and how they may cover addiction recovery programs. Some common types of insurance plans include:

  • HMO: Short for Health Maintenance Organization, these plans usually have a more limited network of healthcare providers and require individuals to choose a primary care physician who will coordinate their care. These are the most common types of plans available through employers.
  • PPO: Short for Preferred Provider Organization, these plans typically allow individuals to see providers outside of their network but at a higher cost. These plans are more common for individuals who purchase insurance on the marketplace or through private insurers.
  • HSA: Short for Health Savings Account, these plans allow individuals to put pre-tax money towards a savings account that can be used for medical expenses. HSA plans are often paired with high deductible health insurance plans.
  • Medicare and Medicaid: Government-funded insurance programs for individuals who meet certain eligibility requirements.

It’s important to know what type of insurance plan you have and how it may cover addiction recovery programs. Some plans may have specific limitations or exclusions for mental health and substance abuse treatment, so it’s important to review your plan carefully.

Our next few sections will go over some other key elements to be checking in advance when it comes to insurance coverage for addiction recovery care.

Deductible

One vital question to be asking your insurance company is: “What is my deductible for addiction recovery programs?” The deductible is the amount of money you will need to pay out-of-pocket before your insurance coverage begins. Understanding this amount and how it applies to specific services can help you plan for potential costs.

Some insurance plans may have a separate deductible for mental health and substance abuse treatment, so it’s important to check if this applies to your plan.

Co-Payments

Another important factor to consider is co-payments, which are set amounts that you pay for specific services. These may vary depending on the type of service received or the provider visited. It’s important to know what co-payments your insurance plan requires for addiction recovery programs and how they may differ from other medical services.

In-Network vs Out-of-Network Providers

Many insurance plans have a network of approved providers that offer discounted rates for services. When seeking an addiction recovery program, it’s important to check if the facility is in-network with your insurance plan. If not, you may be responsible for a larger portion of the cost.

It’s also important to note that some insurance plans may not cover out-of-network providers at all, so it’s crucial to verify this information beforehand.

Reimbursement

Another important question to ask your insurance company is if they reimburse for out-of-network providers or services. If a facility or service is not covered by your insurance plan, this information can help you understand what portion of the cost may be reimbursed.

Pre-Authorization Requirements

Some insurance plans may require pre-authorization before receiving addiction recovery care. This means that the insurance company will need to approve the treatment before it is covered. It’s important to check if this applies to your plan and what steps need to be taken in order for pre-authorization to be granted.

As you can see, there are many important considerations to keep in mind when it comes to insurance coverage for addiction recovery programs. It’s crucial to thoroughly review your plan and ask any necessary questions before beginning treatment so that you can fully understand the extent of your coverage and potential costs involved. At Moonlight Mountain Recovery, we are committed to helping our clients navigate the insurance process and ensure they receive the care they need. Contact us today for help with this or any of our addiction recovery programs for patients around Boise, Washington and Oregon.

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