Drug and Alcohol Rehab

Insurance

Addiction Treatment in Orange County--Chapman House offers payment and insurance options so you can get the help you need to recover from substance use disorders.

Introduction

It's critical that people seek alcohol and drug treatment with the help of a professional rehab center.

Chapman House is here to provide substance abuse treatment to help anyone at any stage of recovery, and we also have information and resources you can use to help pay for treatment.

An alcohol and drug rehab center can provide vital resources, guidance, and treatment options to help those looking to recover from substance and alcohol use disorders. Unfortunately, one of the major barriers to treatment is the ability to pay for services. However, there are a variety of insurance options that can help clients get the help they need without any added financial burden.

Only at Chapman House will you be able to receive high-quality services licensed by The Joint Commission.

From Medically Assisted Treatment, to inpatient treatment, and long-term care through outpatient treatment, we're here every step of the way to make sure you or your loved one get the help you need, regardless of your financial status.
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Insurance Payment Options

3 Primary Ways to Pay for Treatment

Whether or not you have drug and alcohol rehab insurance, paying for treatment should not factor in your decision to attend a treatment facility. Alcohol and drug rehab centers are a worthwhile investment foryour health, your future, and even your life.

At Chapman House, we will explore payment options to help you cover treatment costs. There are several options when it comes to paying for treatment.

1

Private Insurance

Depending on your insurance carrier, private insurance plans will help pay for alcohol and drug treatment if it is accepted at the rehab facility you choose to attend. Private insurance can be obtained through your place of employment. They are required by law through the Affordable Care Act to cover at least a portion of your drug and alcohol treatment.

2

Government-Funded

Government-funded insurance plans include Medicaid and Medicare. These plans also vary by state. In California, government-funded health insurance is known as Medi-cal. These insurance plans do help cover drug and alcohol rehabs, at least in part. This depends on the state you live in, the types of services you'll need (luxury services are typically not covered).

3

Self-Payment Options

If the rehab center you are looking to attend does not accept public or your specific private insurance plan, or if for any reason you cannot use drug ro alcohol rehab insurance options, there are always self-payment plans available.

Does Insurance Cover the Cost?

Various Types

There are various types of insurance plans available to help you pay for substance abuse treatment. Some of these include private insurance plans, such as Aetna, Blue Shield, or Kaiser, while others are funded by the federal or state government (Medicare and Medicaid). Other insurance plans are only available for specific community members, such as veterans who receive VA benefits or military members that receive Tricare insurance.

These insurance plans will typically pay for the basic services of a drug and alcohol rehab. These include

  • Mental health counseling
  • Medical detoxification services
  • Short-term residential treatment stays

However, various factors will influence whether or not someone's insurance will be able to pay the full cost of treatment. These include:

  • Length of stay needed
  • Level of care
  • Specialized services
  • Dual-diagnosis treatment options
  • Luxury amenities included

Other Types

Other insurance plans will also cover the cost, either partially or in full, of outpatient treatment services. Outpatient treatment services that insurance generally covers include medication-assisted treatment for opioid use disorder, such as Methadone, Suboxone, and Naltroxene, and outpatient therapy. 

There are various laws in place to ensure insurance plans are doing their part to help cover addiction treatment. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 as well as the Affordable Care Act enacted by President Obama in 2008 mandates that insurance (including Medicare part B) treat substance use disorder like any other illness and pay for treatment and recovery. 

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Some Specifics

Insurance Terms

Insurance Verification

Before you enroll in a drug and alcohol rehab, the admissions team will take a look at your drug and alcohol rehab insurance.

They will need to take copies of your insurance policy, do a bit of background research, and determine whether your insurance is still in effect and able to help pay for treatment.

This insurance verification process can take a couple of days to complete, which can be a stressful time for clients. However, it is a necessary process to determine what financial assistance (if any) you will need before entering treatment.

Copay

Depending on the type of insurance plan you have, you might be required to pay copay, or co-payment, for different services. For instance, you might have to pay a copay of $15 every time you visit the doctor, or $50 for an emergency room visit, while insurance covers the rest.

You might also be subject to copay for medications, such as $5 for birth control. Fortunately, co-payments are very affordable, and some insurance plans don't require any copays (although these plans are slightly more expensive per month that plans that do require copays).

Pre-Certification

Pre-certification is also known as pre-authorization. It is a requirement that your drug or alcohol rehab insurance carrier must complete along with the help of your healthcare provider.

Pre-certification is, in essence, the insurance company's way of ensuring that the treatment you are requesting is medically justifiable and necessary.

Your healthcare provider will need to inform the insurance company of why you need alcohol or drug treatment, whether that includes long-term inpatient treatment, medical detox, or other services.

Primary Insurance Subscriber

This is the person who pays for the insurance premiums, or whose employment is the provider of insurance benefits.

Many times, it is the person who is seeking treatment that is the primary insurance subscriber. However, you can also fall under your spouse or parents' plans. In this case, your spouse or your parents or guardians will be the primary insurance subscribers.

Premium

Insurance premiums are the payments that are made by a person toward their insurance plans, regardless of whether or not they use their benefits.

Premiums must be paid on a monthly basis in order to continue to keep their insurance policy active. However, premiums can also be paid on a bi-weekly basis.

Premium costs can vary greatly depending on the type of plan you have, whether or not your employer pays a significant or small portion of the premium, and whether or not you have a PPO or HMO plan.

Out-of-Pocket Expenses

Not all insurance plans cover every single medical expense. Out-of-pocket expenses are anything that you must pay out of your own pocket that isn't paid for by your insurance plan.

These can include the aforementioned co-payments, deductibles, co-insurance, and paying for luxury amenities or services not covered by medical insurance. Some insurance plans will cause you to have more out-of-pocket expenses, such as PPO insurance plans. Using this type of insurance will allow you to have more flexibility to visit the doctors and specialists you want to choose.

However, out-of-pocket expenses are greater than in HMO plans.

Clinical Review and Insurance Substantiation

Substantiation and medical reviews are a typical part of receiving help and funding from insurance companies.

Insurance providers want to know that the services you are receiving are truly medically necessary, and that they are not paying for outlandish or unnecessary treatment.

Fortunately, Chapman House has experience in fulfilling clinical review and substantiation requests, which are often requested every 2 to 14 days.

These requests need to be fulfilled with the utmost care, or else risk denial of services.

At Chapman House, we will fight on your behalf so you can continue to receive the help you need from your drug and alcohol rehab insurance.

Policy Effective Date

The policy effective date is the date you will start to receive insurance benefits. Your policy effective date is typically during the first 30 to 60 days after you apply for insurance benefits through your employer.

Other employers or the military offer insurance benefits immediately after the hiring date. It's also possible to start receiving insurance benefits even if you didn't apply within your employer's open enrollment period.

Open enrollment is typically around the end of the fiscal year for your state or employers. This is the time where you can apply for private or government-funded insurance, and then receive your policy effective date later on.

However, if you have a baby, get married, or experience another "qualifying event," you can apply for insurance outside the open enrollment period.

Deductible

Your insurance deductible is the amount of money you will have to pay before your insurance plan covers any expenses.

For instance, if you experience an accident and must be admitted to the hospital, you will typically pay a deductible of anywhere between $500 to $2,000 before your insurance will contribute toward your medical expenses.

Deductibles can vary based on whether or not you have an HMO or PPO insurance plan. Fortunately, once you pay a certain amount in deductibles per year, the "annual deductible" is satisfied. This means all other expenses that year will be covered by your insurance plan.

Coinsurance

On top of deductibles, you will also have to pay for coinsurance as an out-of-pocket expense.

Let's say you have a serious illness and need $13,000 worth of treatment. Your deductible is $3,000, and your co-insurance is 20%.

You will need to pay the deductible, and then the co-insurance of the balance leftover, which would be $10,000.

Thus, you'd pay an extra $2,000 in co-insurance, for a total of $5,000. Co-insurance rates can be higher for insurance plans that have low monthly payments, and lower for insurance plans that have pricier monthly payments.

Insurance Plan Types

There are various insurance plans to choose from, but the most popular in terms of private insurance, are PPO and HMO plans.

PPO stands for preferred-provider organization, while HMO stands for health maintenance organization. Both have their pros and cons.

PPO insurance plans allow you to have maximum flexibility and get the help of any provider you prefer, but are generally more pricey.

HMO plans don't offer as much flexibility, and you must choose an in-network provider, clinic, or hospital to receive your care from.

However, they do end up having much less out-of-pocket expenses and monthly premiums.

Maximum Out of Pocket (MOOP)

You might be feeling flustered with all these out-of-pocket expenses, and think they will never end.

Fortunately, insurance plans put a cap on the amount of out-of-pocket expenses you will owe, known as maximum out-of-pocket or MOOP, and cover the rest of the costs themselves.

If you experience an accident or illness, for instance, and have to pay $8,000 in costs, but your MOOP is $6,000, you will only have to pay up to the $6,000.

Allowed Amount

The allowed amount might also be called the eligible expense or payment allowance.

It is the amount your drug or alcohol rehab insurance is willing to pay for a certain service.

For instance, they might only offer to pay $150 a night for inpatient treatment. This might be more or less than your facility, so you will have to pay for the left over balance out-of-pocket.

Chapman House will work with you for payment options in case your allowed amount is less than what is required for your treatment.

Balance Billing

As mentioned above, you might have to pay the difference between the allowed amount and the health care provider's cost.

This invoice is often given at the end of treatment, and can sometimes be a shock to patients!

At Chapman House, we will work with your insurance provider and you every step of the way to ensure no hidden costs or fees surprise you at the end of treatment.

Our goal is not to surprise you with a balance billing invoice at the end of treatment, but for you to get the help you need regardless of your financial situation.

Single-Case Agreement

Under special circumstances, single-case agreement can be used so that a healthcare provider, such as a drug and alcohol counselor, psychologist, or psychiatrist, can treat a patient regardless of whether or not they are in-network in their insurance plans.

Building a bond with a therapist is critical during mental health and addiction treatment.

At Chapman House, we want to ensure our clients feel safe and comfortable and aren't afraid to lose the connection and services of one of our high-quality treatment specialists. We use single-case agreement to ensure there is a fluid continuity of care with our clients.

Coverage Amount

Coverage amount is, in essence the opposite of co-insurance.

After you've paid your deductible and your co-insurance rate, the coverage amount is the amount of expenses your drug and alcohol rehab insurance will help pay.

If they agree to pay for 80% of services after your deductible, that means you will only pay for 20% of treatment while they cover the rest.