The Truth About Rehab Reimbursement
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The Truth About Rehab Reimbursement


People often make it sound so easy when they say they went to rehab—as if it’s something you need then, it just happens. Discussions about someone agreeing or deciding to go to drug and alcohol rehab can sometimes not even include the discussion of insurance. But the reality is that recent changes to healthcare policies have made finding a rehab that fits your needs and your budget potentially a lot trickier than you might have thought.

Let’s start off with a reality check: when it comes to anything medical, the one-percenters win every time. The level of care someone has access to has, in the US, always been about money—a depressing and terrifying thought for most of us. But if you are thinking about checking yourself into rehab and happen to be a one-percenter or anything close to one in financial means (are you single? I make a mean lemon loaf), then feel free to call up any one of the luxury rehabs and they will make sure to find space for you. It’s not that high-end rehabs (or any rehabs for that matter) only care about money—even if it might appear that way; it’s that regardless of how much they would love to help addicts of lower income who want to get sober, they have a business to run and most insurance policies don’t cover adequate care.

So if you have come to the realization that you have a problem with drugs and/or alcohol and feel like—as many do—you would be best served entering a residential rehab program, then congratulations! This is a huge step toward your recovery. Now, probably feeling a little nervous and scared, it’s time for you to figure out where to go. Unless you are familiar with treatment centers or have a friend or loved one who went through rehab and can recommend one, chances are you are going to start with some Internet research. Luckily, our site is one of the few resources with a comprehensive list of residential facilities complete with detailed reviews so you can do your rehab shopping all in one place (ps, click here to check how much your insurance will cover). You are welcome.

Once you have chosen a few places you are interested in, you can check your insurance coverage here. It’s important to know what you are working with before you start making calls and setting up appointments. But with the way healthcare policies are these days, even a benefits check may not tell you the whole story of what level of treatment you will be entitled to.

Michael Bloom, Owner of Pasadena Recovery Center, says he will give a price quote over the phone but he can’t guarantee it will be accurate. “What your healthcare policy actually covers in terms of drug and alcohol treatment can be deceiving,” he says. “It might say you have coverage but when it comes down to the wire, it may turn out they only cover a couple of weeks—or in some cases, a couple of days. So even if you are technically covered for treatment, many policies aren’t willing to pick up the bill for even a minimum run of adequate treatment. It often ends up making us look like the bad guy and I don’t like to have any adversity with my clients.”

But rehab owners like Bloom aren’t comfortable with the treatment limitations of many insurance plans these days. When you have someone under your care who needs more than a week or two of respite from outside lives which were structured around their addiction, it doesn’t feel right to kick them out because their insurance refuses to pay.

“We try to do the right thing,” Bloom says, adding, “If a client’s insurance stops paying on a Friday, we will give them the weekend gratis to make any necessary arrangements and use Monday as a transition day. But you don’t see insurance companies giving someone who needs it a few extra days just because it’s the right thing to do.”

The (sort of) good news is that under the Mental Health Parity and Addiction Equity Act (MHPAEA), if your insurance plan covers both mental health and substance abuse disorder benefits as well as medical and surgical benefits, then they are required to provide the same benefits for both—meaning your deductible for surgical procedures is required to be the same as the deductible for your addiction treatment. The bad news is, depending on your policy, this could be as high as $25,000 depending on the plan you chose or that your employer offers.

In the wake of many people paying exorbitant heath care premiums for so many years—and with more self-employed people paying their own coverage—the reduced rates of Obamacare are a welcome relief. But many of us who opted to take the tax cut and reduce our monthly bill justified that we rarely go to the doctor and it would be fine. We didn’t take the time to notice or care that we chose a policy that barely covers anything we might need in case of an emergency—and drug and alcohol addiction treatment is certainly not a health care expense anyone plans for.

“I hope it continues to get better as things get worked out,” Bloom says. “More people have insurance now, which is great, but they are paying the premiums and would like to be able to get the benefits of care they need.”

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About Author

Danielle Stewart is a Los Angeles-based writer and recovering comedian. She has written for Showtime, E!, and MTV, as well as print publications such as Us Weekly and Life & Style Magazine. She returned to school and is currently working her way towards a master’s degree in Marriage and Family Therapy. She loves coffee, Law & Order SVU, and her emotional support dog, Benson.