Concerns regarding being able to pay for formalized substance abuse treatment are often a hindrance to someone seeking help. They may ask themselves, “Will my health insurance even cover rehab?” Luckily, generally speaking, the answer is yes. Insurance companies are not allowed to deny covering the cost of treatment for addiction or substance use disorders. However, the extent of what they will cover and the type of treatment that they will cover does vary depending on the individual, their specific policy and the company’s overall policies. Each policy can have a different deductible, meaning there may be a certain pre-determined amount the client has to pay before their insurance company starts contributing toward the bill. Additionally, if someone chooses to utilize insurance to pay for rehab, they may be limited to the in-network providers with which their insurance company has relationships. This often limits options and does not always accommodate private or high-end rehabs.
Beacon Health Options is unique. Not only does it cover addiction treatment, but it also specializes in finding its clients the best possible care for mental health issues, and is in network with myriad healthcare providers all over the country. In fact, Beacon Health Options is an insurance company specifically designed to cover substance abuse and mental health treatment. As such, the client can expect a lot more choices for in-network providers, and even some luxury options.
Paying for Detox
Detox is often a necessary part of beginning the recovery process and usually deemed a medical necessity. Medical necessity is the criteria one has to meet in order to determine the level of care insurance companies will cover. The sudden cessation of drinking or using drugs can evoke myriad side effects so undergoing withdrawal with the supervision of a doctor who specializes in addiction medicine is essential. As previously mentioned, insurance companies are legally required to cover costs associated with substance abuse treatment, and detox is often an integral part. Whether someone needs to enter treatment at the detox level of care depends on several factors including the type of drug someone has been using, the amount he or she has been using/consuming, how long he or she has been using/consuming it, what it is being mixed or used in conjunction with, and their overall health.
Not everyone who seeks help in a formalized inpatient setting needs detox but for those who do, having access to the resources necessary for detox on-site, at the same location where they’ll be undergoing therapeutic treatment, is a major advantage. They won’t have to worry about transitioning to another facility to start residential treatment and, depending on how they are feeling, can even gradually begin the process of therapy and peer support meetings while in detox. Generally speaking though, the first priority is making sure the client is feeling physically stable and clear headed, so he or she is in the best condition possible for treatment.
The length of time in detox varies depending on the person but it’s usually an average of three to 10 days. The level of care at which one begins treatment depends on what the insurance company will authorize. Detox is usually always under the medical supervision of a doctor. Detox and residential treatment are considered 24-hour, around-the-clock care. In the detox phase specifically, there is always someone with medical credentials checking the client’s vitals and temperatures, making sure he or she is hydrated and stable. The process of detox can be uncomfortable and disorienting. Often clients suffer from nausea, anxiety, muscle soreness and sleeplessness. Thankfully, there are remedies to treat all of these symptoms, and they are most effectively executed within a licensed, medical detox facility.
People mistakenly believe that detox is a time to remove all drugs, even prescribed ones, from the person’s system. This is not necessarily the case. While it is true that certain prescription medications are highly addictive and do require a medically supervised detox, it is not always advised to remove everything suddenly and simultaneously. Additionally, not all psychiatric medications are prone to be abused. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “Although it is the philosophy of some treatment facilities to discontinue all medications, this course of action is not always in the best interest of the patient. Abrupt cessation of psychotherapeutic medications may cause severe withdrawal symptoms or the re-emergency of a psychiatric disorder. As a general rule, therapeutic doses of medication should be continued through any withdrawal if the patient has been taking the medication as prescribed.”
Making sure the client is medicated properly and safely, or weaned off a medicine properly and safely, is one of the many reasons why it’s wise to choose a rehab with psychiatrists or addictionologists on staff—medical doctors who can facilitate medication management that works in conjunction with the therapeutic component of treatment executed by counselors and clinicians.
Alcohol Addiction
The side effects of early abstinence from alcohol after a prolonged period of heavy abuse can be very uncomfortable and even dangerous. In addition to the aforementioned insomnia, anxiety and upset stomach, individuals detoxing from alcohol may also experience delirium or hallucinations. It is ideal to go through alcohol detox in a medically based setting such as a residential rehab or a hospital. While everyone’s circumstances are unique and not everyone requires a supervised detox from alcohol, it is usually a crucial component to beginning recovery.
There are also withdrawal symptoms associated with the emotional depletion that results from alcohol cessation. Often referred to as Post Acute Withdrawal Symptoms (PAWS), there are palpable side effects the moment one decides to no longer numb every emotion or feeling with a mind-altering substance such as alcohol. Treating both the physical and mental discomforts that result from stopping drinking is a necessity.
Opiate Addiction
Opiate addiction can be an entirely different beast than alcohol addiction, as evidenced by the deadly opioid epidemic that has plagued the US the past decade. Additionally, medicines that might be used to ease the withdrawal process from alcohol, such as benzodiazepines, can actually aggravate the symptoms associated with opiate withdrawal.
Continued opioid abuse can cause permanent damage to nerve receptors in the brain and therefore the withdrawal and treatment process is slightly more complicated, often warranting opiate-based withdrawal medication, commonly known as Medication-Assisted Treatment (MAT), that a client either tapers off gradually or remains on indefinitely. One of the most commonly known forms of MAT is buprenorphine, which is the main ingredient in Suboxone, a popular medication prescribed to treat the symptoms of opiate withdrawal. Buprenorphine is considered a partial opiate agonist, meaning it does contain opiates but the effect of usage is not as extreme as the effects of the most commonly abused opiates like Oxycontin or heroin. According to Suboxone California, “Buprenorphine also comes with a built-in dosage ceiling, which limits the slight feeling of euphoria the drug can give off, as to prevent abuse.” When Suboxone was initially introduced to the addiction treatment field, there was quite a bit of controversy over whether it was physically safe and morally sound. How could a person every get “clean” if they have to rely on a new drug to replace the old drug? As the war against opiate addiction continues to wage, however, many doctors are deeming the use of MAT to be medically necessary, and especially effective when paired with mental health treatment as well. Insurance companies are also beginning to acknowledge that complete and total abstinence from all drugs through a one-time detox and stint in treatment may not be a solution that’s effective for everyone.
Of course, sometimes MAT is not even necessary for the treatment of opiate addiction; it really again depends on the client and his or her history of usage. There are people who are able to overcome an addiction to opioids without the indefinite use of MAT. A proper detox is usually always required for opiate abuse but it’s up to the physician and the client to determine the best course of action after that initial withdrawal. Beacon Health Options does have coverage options for clients struggling primarily with severe opioid dependency.
Inpatient and Outpatient Treatment
Beyond detox, there are several levels of treatment one can receive. Most people attend either residential treatment, a Partial Hospitalization Program (PHP) or an Intensive Outpatient Program (IOP). Beacon Health Options has coverage choices for all of the above.
In residential treatment, the person is no longer detoxing but still needs 24-hour care. To be considered for full coverage, the insurance company usually requests that a residential treatment center facilitates at least four and a half hours a day of treatment. Evidence-based therapy and medication management are a given but clients usually also desire empathy, respect and kindness during inpatient care. A typical stay in residential treatment is five to 25 days. Lengths of stay do vary, depending on the person, their progress in the program and the coverage options coordinated with Beacon Health Options (or other insurance company) and the treatment provider.
A Partial Hospitalization Program (PHP) is the next level of care down from residential treatment. It’s the most intensive outpatient programming available and is usually six hours of treatment per day. Generally, clients can expect plenty of education, therapy, relapse prevention, trauma work and individual and group therapy in a PHP. There are different therapeutic interventions, but it’s typically always six hours a day. PHP typically lasts five to 20 days. Insurance companies usually authorize five days a week, sometimes six or seven days, depending on what the case manager determines is medically necessary for the client. A PHP is often a good option for when insurance companies want to see how the client operates with more freedom in the world, outside a contained facility. PHP is usually three hours in the morning followed by lunch and three hours in the afternoon. There is more freedom in PHP but also more content. There is more accountability too. It’s essentially asking the clients if they are willing to show up day after day and truly tackle the work involved with early recovery and sobriety. Beacon Health Options works with a number of PHPs across the US. The specifics details of what they cover, in terms of PHP, of course will depend on the person and his or her policy.
The step-down level from PHP is an Intensive Outpatient Program (IOP). IOP is only three hours of treatment per day. It’s usually seven days a week for the first five to 15 days; five days a week for five to 15 days, then three days a week for five to 15 days. Should there be a relapse or difficulty managing this level of care, the client can always petition the case manager and request a higher level of care to be covered. Often that request will suffice to get someone bumped up to a more intensive treatment level. Although, those stays are usually short—roughly five days per authorization. Beacon Health Options works with IOPs and can help to coordinate the best strategies possible for someone entering treatment at this level of care.
Beacon Health Options doesn’t typically recognize treatment centers that solely offer general outpatient services. Standard outpatient is considered the least intensive level of treatment and can occur as little as once a week, in the context of either group or individual sessions. Beacon Health Options does, however, recognize individual therapists in its policies so there are instances in which someone completing residential, PHP or IOP can continue further care with a therapist in private practice or other behavioral health organization, that’s not a formal outpatient rehab.
Verifying Benefits
Sometimes insurance policies can be confusing and hard to decipher. It’s best to call the company to confirm what the coverage options are for substance abuse and mental health treatment. It’s also worth consulting with one’s primary care physician in order to garner an official diagnosis, or just receive guidance on what might be the most effective next steps for getting well.