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A survey conducted in 2014 found that the most common reason for people who avoided substance abuse treatment was affordability. In fact, an estimated 39 percent of people with a substance use disorder avoided seeking treatment at southern California rehab facilities for this reason. Does MHN insurance cover rehab? Many people are unaware that health insurance can help with many of the costs associated with substance abuse treatment. Learning more about MHN insurance for rehab and how to use your insurance can help you or a loved one see that treatment is financially possible.
How the Affordable Care Act Enforces Insurance Companies to Cover Rehab
Does MHN insurance cover rehab? Part of the Affordable Care Act ensures that all MHN insurance for rehab plans that are a part of the market provide coverage for substance abuse as it falls under mental health. This includes all of the plans that are available on the Health Insurance Exchange and Medicaid plans.
The exact type of plan that you choose, and your state determine exactly what is covered and how much coverage you are given. However, in most states, you are able to enter a rehab facility for either a manageable copay or no out-of-pocket cost at all.
The insurance companies see all forms of substance abuse as the same when it comes to coverage. This means that one addiction is not covered more or less than another. All of the plans available via the ACA Marketplace will not discriminate based on:
How Insurance Can Reduce the Costs Associated with Treatment
Medical insurance today offers a very broad range of care for substance abuse disorders. In most states, coverage is provided for the following:
In addition to the ACA, another law was passed in 2008 and it is referred to the Mental Health Parity Law. Under this law, substance abuse treatment is included. The law makes it a requirement for insurance companies to provide at least equal coverage for both medical/surgical and mental health/substance abuse treatment. For example, your insurance company cannot charge you $50 for mental health or substance abuse treatment copays if your copay for medical and surgical treatments is only $25. Your mental health or substance abuse treatment copays must be $25 or under.
Most insurance plans have some form of coinsurance in addition to copays. If your coinsurance is 20 percent, you are responsible for 20 percent of the costs. For example, if the cost of treatment is $1,000 and you have 20 percent coinsurance, you will pay $200 and your insurance will cover the other $800. This essentially reduces your out-of-pocket costs by 80 percent, or whatever your coinsurance percentage is.
How Insurance Covers Medications at the PHP Level of Care
Partial hospitalization program (PHP) refers to a type of outpatient treatment. Many insurance plans will cover biologicals and medications that are considered not safe to self-administer. They must have FDA approval and cannot fall under the umbrella of an investigational protocol.
The associated costs often depend on your coinsurance percentage. For example, if a medication is $100 and your coinsurance is 30 percent, you are responsible for $30 and your insurance company will cover the remaining $70.
How Insurance Covers Various Forms of Individual and Group Therapy
In general, therapy is covered when it is deemed medically necessary. For this to happen, you have to be officially diagnosed with a mental health disorder and substance abuse disorders fall under this umbrella. The level of coverage that you receive varies based on the state that you are in. However, all of the ACA Marketplace insurance plans must provide coverage for psychotherapy and counseling.
The level of coverage will be listed in your insurance policy. It is important to look at the paperwork that you received when you initiated the policy as this will provide the coverage details. If you cannot find this information, you can call your insurer and ask about the therapies they cover and how much coverage you get for each of them. This will allow you to assess the expected out-of-pocket costs that you could incur.
Insurance Companies Only Work with the Best Accredited Facilities
An accredited facility offers care that is tailored specifically to your needs. Accredited facilities also tend to be in-network with most major insurance carriers. When a facility is in the insurance company’s network, you are able to get the full level of coverage that your insurance policy provides. When the facility is out of network, there may be little to no coverage from your insurance company.
It is best to stick with facilities that have the proper accreditation. Not only will your insurance likely provide better coverage, but the treatment will be tailored and multifaceted, ensuring a higher level of care.
Many insurance plans do not cover experimental care and services. It is also common for them to avoid providing coverage for natural and alternative treatments since these often do not have any scientific backing for efficacy and safety.
When a facility is using evidence-based treatment, they are using what science shows to be safe and effective. They are treatments that will fall within the parameters of what most insurance companies will cover. Common examples of evidence-based treatment for substance abuse disorders include:
Now you know the answer to “does MHN insurance cover rehab?” Insurance can make the costs of southern California rehab far less daunting. Mission Harbor is here to help you see how much your insurance can help so that you can get the treatment that you need to get on the road to recovery.
The facilities at Mission Harbor are staffed with trained experts to best assist patients with their mental health issues. We are capable of dealing with any and all cases with a licensed staff, equipment, and approved techniques. Our mission is to help those who want to help themselves, and we support your decision in seeking help.
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