PPO HEALTH INSURANCE FOR DRUG & ALCOHOL REHAB
Currently in the United States, there are close to 50 healthcare insurers who offer major medical plans. In addition, there are numerous self-funded plans and groups. Obtaining insurance and choosing an appropriate plan for your needs can be daunting. In addition, healthcare insurers often have dozens if not hundreds of different plans that are offered beneath their coverage umbrella.
The plan document, or plan contract, is the legally-binding instrument that details the plan’s coverage inclusions and exclusions, and provides information on the plan’s deductibles and copayments for various visits, procedures, and hospitalizations. The plan documents are typically extensive and detailed contracts that can vary state-to-state, and quite often are difficult to interpret to a layperson. Drug and alcohol rehab benefits should be clearly listed in the plan document as well.
Recently, there have been two legal developments that allowed substance abuse and mental health disorders to be truly treated as a medical illness by establishing federal requirements for their coverage.
The first was in 2008, when the federal government passed the Mental Health Parity and Addiction Equity Act (MHPAEA). This act requires all group health plans and group health insurance plans to provide the same coverage for mental health and substance abuse disorders that as they do medical illnesses. This act was later amended to also include individual health plans. Because of this change, many who were previously unable to receive care for inpatient or residential drug and alcohol treatment by utilizing their insurance benefits were now covered.
Prior to this, many healthcare insurers applied stringent coverage limitations or no coverage at all for substance abuse treatment, and sometimes even major psychiatric issues. This has all changed in recent years, to the benefit of those who require professional assistance for their drug and alcohol and dual diagnosis disorders.
Subsequently, the Affordable Care Act (ACA), that was passed and signed into law in 2010 made it easier for everyone to get health insurance. In fact, after the act was passed, there are tax penalties that apply to those who refuse to get coverage. Alternatively, there are tax incentives for those who cannot afford coverage by themselves. This allow many previously uninsured persons and families to get coverage for medical, mental health, and substance abuse disorders.
The ACA also requires that the children of covered persons be allowed to remain on their parents’ policies to a greater age, currently age 26. The ACA eliminated pre-existing limitations, which previously required a person to be insured for a certain amount of time (typically 6 months or a year) before the insurance carrier would pay for coverage for illnesses that were present prior to the coverage being obtained. This greatly increased drug and alcohol rehab access the younger population. Opiate addiction, such as an addiction to oxycontin, heroin and Vicodin, particularly affects the younger population and is currently a healthcare epidemic in the United States.
Society, medical providers, and the government are changing attitudes on the need for treatment for substance abuse and mental health disorders and require that they be classified as medical illnesses. There is a national trend towards substance abuse treatment and rehabilitation, rather than incarceration and/or medical disability.
When evaluating benefits for inpatient or residential drug and alcohol rehab in certain states, such as New Jersey, Pennsylvania, Texas, Rhode Island, Connecticut, New York and Illinois, it is important to know that each of these states have state-specific laws that govern the provision of substance abuse
benefits. All states must meet the federal requirements, but are free to establish other, more restrictive requirements of their own. For example, Pennsylvania’s Act 106, requires that each inpatient detoxification admission allows up to 7 days per stay, and up to four admissions per lifetime. In addition, Pennsylvania’s Act 106 requires that 30 days of residential drug and alcohol rehab be offered per year and up to 90 days lifetime.
Because of the opiate addiction epidemic and the increasing need for inpatient opiate addiction treatment, New Jersey recently passed a new law that limits the prescription of opiates to 5 days, for new patients. But the State of New Jersey took a further step in ensuring that their citizens who are struggling with drug and alcohol addiction can receive appropriate treatment. The state now requires that medical insurance companies cover at least 6 months of drug and alcohol rehab. Since each state is unique, our Addiction Specialists will be happy to provide you with resources that will help you learn more about your insurance coverage.
If you are concerned about losing your job, and hence, your medical coverage, you may be eligible for COBRA, which allows you to continue your current coverage and benefits, regardless of your employment status. Our staff can facilitate this process, should it be required.
Remember each insurance company offers various plans, so your inpatient, residential, and outpatient drug and alcohol rehab coverage is not only dependent upon your insurance carrier, but also upon where you reside, whether your plan is an individual or group plan, or self-funded, and which plan you or your employer selected. The following pages include some information on a brief list of major healthcare insurance carriers. Please click a link to review more about your carrier.
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