It can be challenging to find out if your insurance provider can cover your fentanyl rehab treatment, even more so than the choice to go for rehab at first. After all, the cost of rehab treatment is often a deterrent to seeking those services. In most cases, part or the entire cost of addiction treatment will be covered by private insurance since substance abuse disorders are categorized as medical conditions.
With all the different insurance plans and treatment types, how will you know if your insurance provider will cover your fentanyl rehab treatment? You can take several steps before enrolling in treatment to ensure your coverage pays for your rehab treatment. If it doesn’t, you will be able to find out how much you’ll pay out-of-pocket eventually.
Most people don’t know if their insurance will cover fentanyl rehab costs. Even though most insurance companies will cover all or part of the treatment prices, several factors will determine the answer. Fortunately, the Affordable Care Act expanded insurance coverage to include substance use services, and most providers now offer some type of care.
One of the most significant factors influencing insurance coverage is whether you select an out-of-network or in-network treatment facility. Private insurance companies typically work with specific providers so that policyholders can receive care from within their care network. On the other hand, out-of-network care might be more expensive and not covered at all.
Private Insurance Coverage for Fentanyl Rehab Treatment
People who are not eligible for public insurance or prefer more personalized coverage can opt for private insurance. Group insurance is a type of private insurance typically provided by an organization or employer. When people in a group pool their money, it allows insurance companies to offer more coverage for emergencies and routine health checkups, with each individual paying lower monthly amounts.
The Affordable Care Act (ACA) has made private insurance obtained without the assistance of an organization or employer more popular over the last few years. Since a person may not have the advantage of pooling together money within a group, the monthly premium rates tend to be higher than employer-provided insurance. These coverage plans are bought via the ACA marketplace or the state-run website.
Private insurance providers are required to offer coverage for substance abuse and mental health services since the ACA made behavioral health treatment an essential benefit. The level of coverage provided will differ based on the plan you pick. Most of the time plans with increased monthly premiums will cover a larger share of the rehab treatment costs.
Fentanyl Rehab Services Covered by Insurance
When seeking fentanyl rehab services, you’ll probably be concerned about the cost of treatment and whether insurance will help cover it. In most circumstances, your health insurance provider will provide some level of coverage for your treatment. Since the ACA mandated that behavioral and mental health care are essential services, insurance companies are supposed to cover substance abuse treatment services, which include fentanyl rehab. Rehab services frequently covered by insurance companies include the following:
- Prescription medication: This is in cases where medication-assisted treatment is required for the patient. Medicines like Methadone and Suboxone can be covered.
- Outpatient rehab: Outpatient services enable a patient to go to a rehab center several times weekly or for a few hours before returning home.
- Residential or inpatient rehab: With this type of treatment, the patient stays at the rehab facility throughout the program.
Some insurance plans will cover 100% of the rehab and detox treatment costs once the person meets their deductibles. Other insurance companies require insured members to pay co-payments for every service charged to the provider by the facility. Sometimes out-of-network rehab centers may cost more for insured members.
The detox process will differ based on the substance use disorder being treated. The cost amounts covered by insurance will also vary depending on the person’s specific plan and selected process. For example, a non-medical detox can be less expensive than one conducted in a hospital-based detox center.
The out-of-pocket maximum, co-payment fees, annual deductible amount, and the fraction of costs covered might vary significantly based on the type of insurance and the coverage plan one has.
Even though insurance providers might have to provide coverage for fentanyl rehab, they don’t really have to cover inpatient treatment. In cases where outpatient care is unsuccessful, inpatient rehab might be considered medically necessary, whereby a provider determines that a medical professional would treat the patient after prudent clinical judgment.
Rehab Services Not Covered by Insurance
Some types of treatment can be beneficial to most people in attaining and sustaining long-term recovery from a substance abuse disorder. However, these services might not be covered by insurance, and they include the following:
- Multiple rehab center visits: Usually, health insurance plans restrict the number of rehab stays they approve within a year.
- Treatment methods that are not medically approved: Most insurance plans will only offer coverage for empirically-proven treatment methods. For this reason, many rehab centers covered by insurance providers offer alternative therapies and evidence-based treatment methods.
- Sober-living facilities: Although many people benefit from staying in a sober-living home after fentanyl rehab, health insurance usually does not cover this type of care.
Another thing to consider is insurance providers usually restrict the rehab centers they offer coverage to for clients within their care network. Based on the insurance plan, this could mean the provider does not provide coverage for rehab facilities outside their network. It could also mean the out-of-pocket maximum and the deductible are higher, while insurance covers a smaller percentage of the treatment cost.
In conclusion, having health insurance dramatically increases the chances of people seeking substance abuse treatment services. Make sure you ask your insurance provider and the rehab facility about your coverage plan to determine whether your fentanyl rehab treatment will be covered before enrollment in a program.