Paying for Treatment Step by Step
What follows are the major ways to finance addiction rehab, from paying out of your own pocket to seeking public funding. At the outset, take notes from conversations with rehab personnel or insurance companies, write down names of people you talk to, be sure to get things in writing, and have a support person in on conversations when possible.
SCENARIO 1: PAYING FOR ALL OR PART OF TREATMENT OUT OF YOUR OWN FUNDS
SCENARIO 2: USING COMMERCIAL INSURANCE
Determine your policy’s substance use disorder coverage benefits and limitations, looking into the following:
— Residential versus outpatient treatment
— Detoxification
— Group counseling
— Individual counseling
— Treatment duration
— Medications prescribed during treatment
— Extended care or sober housing after primary care treatment
— Ancillary services, including laboratory tests and visits to the program’s psychologist, psychiatrist, and other personnel (e.g., dietitians, fitness professionals, and massage therapists)
— Coverage for treatment of underlying medical conditions (such as high blood pressure) if the rehab treats people for those
SCENARIO 3: USING PUBLIC ASSISTANCE
Excerpt From: Anne M. Fletcher. “Inside Rehab.”
SCENARIO 1: PAYING FOR ALL OR PART OF TREATMENT OUT OF YOUR OWN FUNDS
- Find out about sliding fee scales and how you might qualify for one.
- Get an itemized list of all fees and services up front and “for the full length of time of your treatment. (While you’re in treatment, Elizabeth F. advised that it’s wise to stop by the billing office once a week to ask about your balance and to find out about elective aspects of treatment that you may choose to forgo.)
- Determine the refund policy. If you pay any up-front costs, ask if you’ll be reimbursed for unused treatment if you leave early. Ideally, you should only be charged for services used and reimbursed for unused services if you paid in advance and leave treatment prematurely. However, money may be taken out for administrative charges. (One place told me they officially have a “no refund” policy but that, unofficially, they settle reimbursement requests case by case and typically use any remaining money as credit toward future treatment.)
- Some rehabs will arrange for loans to pay for treatment. Be certain to understand the exact terms of the loan.
SCENARIO 2: USING COMMERCIAL INSURANCE
Determine your policy’s substance use disorder coverage benefits and limitations, looking into the following:
— Residential versus outpatient treatment
— Detoxification
— Group counseling
— Individual counseling
— Treatment duration
— Medications prescribed during treatment
— Extended care or sober housing after primary care treatment
— Ancillary services, including laboratory tests and visits to the program’s psychologist, psychiatrist, and other personnel (e.g., dietitians, fitness professionals, and massage therapists)
— Coverage for treatment of underlying medical conditions (such as high blood pressure) if the rehab treats people for those
- Find out which treatment programs accept your insurance. The Web sites of some programs may mention specific carriers they work with, particularly if they are preferred providers for national insurance companies. Check your benefits to see if you have in-network and out-of-network rehab benefits, which cover different programs to varying extents, depending on the insurance company’s agreements with facilities.
- Find out about any up-front referrals, authorizations, or precertifications required by your policy to attend a program. Get copies of any related correspondence.
- See if the program you want to attend has a financial assistance specialist who can help determine your insurance coverage. However, you may want to follow up with the insurance company yourself if you’re not satisfied with the information you receive. (Sadie A. found that “insurance ‘specialists’ at the treatment facilities usually do not understand the insurance enough to know how much it’s going to cost you.")
- Even if you have insurance coverage, some facilities don’t handle insurance billing, requiring direct payment from you and leaving it up to you to seek reimbursement from the insurer. Find out if such programs will help you with any related paperwork and/or appeals.
SCENARIO 3: USING PUBLIC ASSISTANCE
- If you’re eligible for Medicare or Medicaid, it’s recommended that you contact your specific Medicare or Medicaid contractor and/or your county or state public assistance agency to discuss your benefits. Then determine which treatment programs accept your coverage and its limitations. (See previous section.)
- For help in determining which programs are publicly funded, consult the Directory of Single State Agencies (SSA) for Substance Abuse Services found at http://www.samhsa.gov/Grants/ssadirectory.pdf. Each state has an SSA that oversees treatment centers, counselors, and use of alcohol treatment and prevention funds. (It may take some exploring to find the right page.)
- Another useful resource is the Substance Abuse Treatment Facility Locator operated by the SAMHSA at http://findtreatment.samhsa.gov/. The entry for each program lists the type of funding it accepts. You can also call SAMHSA’ s twenty-four-hour treatment referral service at (800) 662-HELP (4357), which connects to a state-by-state information service.
Excerpt From: Anne M. Fletcher. “Inside Rehab.”