Here at Coastal Detox, we understand the importance of insurance coverage for all health-related matters. Specifically in our field of addiction treatment. Having insurance that understands the necessity of covering addiction treatment centers is extremely important. Visiting a treatment center for addiction or substance use disorder can be costly. Especially treatment centers with many amenities that make those fighting addictions feel most comfortable and at home.
Insurance companies and their various healthcare policies or plans can be extremely difficult to understand. The plans each come with different benefits, coverage, and seem similar but often have hidden restrictions.
Insurance Coverage: Understanding the Basics
Some insurance companies cover all fifty states within the United States. Although that does not mean they will carry the same insurance plans or policies. Marketplace insurance plans, HMO, and PPO plans need to follow the requirements of the ten essential health benefits outlined within the Affordable Care Act.
Out of those ten essential insurance benefits, there is the inclusion of coverage for substance abuse and mental health. Each state has its own regulations and laws to abide by as well. Which when choosing a healthcare insurance company to purchase a plan from can become quite confusing, not to mention time-consuming.
Working with us here at Coastal Detox we are able to help those impacted by substance abuse not only with addiction treatment but also understanding the benefits and coverage of their health insurance.
Addiction Treatment Centers
Facing addiction or substance abuse treatment can be intimidating. There are many treatment center types to choose from, whether or not health insurance will cover the treatment, and the blatant reality of seeking treatment. The medical professionals at Coastal Detox understand and we are here and ready to help.
Addiction treatment centers range from outpatient treatment centers to residential treatment centers that can range between short term or long term. Each treatment center offers its own special bonuses or amenities to attending their treatment facility. This can make the cost of attending these facilities higher unless they are within the network of your health insurance provider. However, these amenities are also beneficial to the recovery process and signal towards a better facility and experience.
Substance Use Disorder (SUD)
A substance use disorder is a difficult and often a lifelong battle. That battle begins by first admitting that there may, in fact, be a problem. Once there is admittance to the problem those struggling need to receive their diagnosis and plan for recovery. Some facing addiction treatment will require a medical detox, then attend rehab within an inpatient or outpatient treatment center, followed by meetings and ongoing therapy.
Substance abuse or addiction impacts each person differently. For some, they were unable to admit their addiction for many months or even years. Others may have realized the addiction creeping in while on medications to treat pain. Addiction or a substance use disorder is not a one size fits all type of problem. Hence the need for treatment to be perfect for that person specifically.
Those that have gone through an assessment for a substance use disorder are then provided their own designated course of action. For many people that have been diagnosed their first step of treatment will be detox. Detoxing the body isn’t pretty and can be wildly dangerous and sometimes deadly if not done within a medical detox center like ours.
Co-occurring Disorders (Dual Diagnosis) & Mental Health
Substance abuse occurs for many reasons. A large part stems from the mental health of the person dealing with the addiction. On the flip side, other mental health issues occur due to substance abuse. Those suffering from more than one mental health occurrence receive a dual diagnosis or co-occurring disorder. Receiving treatment in these instances can be a bit more complicated but is most definitely possible.
Co-occurring disorders are another large reason for the importance of utilizing in-network treatment centers.
Insurance companies and their affiliates have certain healthcare providers that work with them under contract. This is known as an in-network provider. Essentially by becoming an in-network provider, they have already settled on an agreement with the insurance company for costs. Thus meaning they have accepted the rate the insurance company will pay for their service. Providers are considered any type of health care service given to the person in need. Listed below are some of the types of services:
Provider Service Examples
- Physicians (Specialty or Primary Care)
- Addiction Treatment Center
While some insurance policies or plans allow for the use of providers not within their network they can cost exponentially more than those within their network. Health insurance policyholders seeking addiction treatment should generally try and stay within their plan’s network to save them from having to pay more than necessary. Although not all healthcare plans or insurance policies will cover the full cost of addiction treatment it is much more likely to be covered in full by providers within their network.
Insurance policyholders that stay within their network are able to not worry about the large costs of attending an addiction treatment center. This is a huge burden lifted from those suffering from a substance use disorder. Utilizing in-network facilities is the absolute best route to choose, especially with not having to worry over the stress of lack of income or funds to pay for great addiction treatment centers.
Health Insurance Policy or Plan
Each healthcare insurance company carries many insurance plans or policy types. By providing a large number of policies they are giving options to the buyer or policyholder. There are three health insurance plan types that are most commonly seen in conjunction with in-network providers. They are HMO plans, PPO plans, and EPO plans,
An HMO plan or a Health Maintenance Organization plan is a policy that generally has lower monthly insurance premiums or pays for the policyholder. They also have lower deductibles, coinsurance, or copayments. They do need to have referrals from the insurance policyholders’ primary care doctor and generally do not require a pre-authorization for treatment service. They also do not pay for treatment services outside of their network unless there has been a need due to an emergency.
A PPO plan or a Preferred Provider Organization plan, is a healthcare policy that is higher in monthly premiums. Which is simply the amount paid by the insurance policyholder monthly for health insurance. They also can sometimes be higher for a copay, coinsurance, or in their deductible. Although they are generally higher in cost to the insurance policyholder they allow for more choice by the policyholder. Thus agreeing to pay for some costs even with providers that are not within their network. Although the cost-sharing, what the insurance policyholder pays out of their pocket, can be higher when the provider is not within the network. With a PPO plan there is a need for a referral but generally, do not need a pre-authorization.
An EPO plan or an Exclusive Provider Organization plan is nearly identical to a PPO plan but will not pay for any service that is not within the health insurance companies’ network. However, they do not need a primary care physician which means they do not require a referral. An insurance policyholder will need a service to be preauthorized beforehand.
Coastal Detox & In-Network Insurance
Coastal Detox accepts many different types of health insurance companies within our facility. Although some health insurance companies do not have us within their network there are some that do. Cigna, UnitedHealthcare, and UMR each have Coastal Detox within their network of providers. Those struggling in the face of addiction should always try and find an addiction treatment center within the insurance companies’ network. By doing so provides the peace of mind that most of their addiction treatment will be covered by their health insurance, if not its whole costs.
Cigna insurance company provides healthcare insurance within several states across the United States and spans to over 30 other countries worldwide. As a whole, they are able to provide insurance policies and healthcare plans to around 95 million individuals.
Cigna insurance is able to provide many different insurance policies to people seeking healthcare coverage. Through their healthcare plans, they are able to provide the needed coverage for addiction treatment centers and mental health. They also have a variety of resources within their website offering important information regarding substance use disorders and mental health.
Cigna insurance provides a huge network of healthcare providers across the world. An added bonus with Cigna’s network is their requirements for their healthcare providers. Their in-network providers must pass their set requirements to be accepted within their network. Some of the requirements are the provider’s standard of care or even their follow-up protocols.
Cigna insurance does require preauthorization for many of its services, including addiction treatment. So for those policyholders seeking substance abuse treatment they should receive a pre-authorization before entering into a treatment program. Without doing so, Cigna insurance may not cover the expenses of the insurance policyholders’ treatment.
UnitedHealthcare insurance is one of the most well known and largest healthcare insurance companies today. Throughout the United States they are able to provide healthcare coverage for people individually, within families, and through their work. Outside of the United States, they provide coverage in over 130 different countries across the world. Their large size provides comfort to their policyholders in knowing that their network will cover a large number of healthcare providers.
Many of UnitedHealthcare policies will cover at least part of addiction and mental health treatment within their behavioral health benefits selection. In addition to the more well-known policies within health care, UnitedHealthcare offers short-term health care coverage options. Like Cigna, UnitedHealthcare also offers a range of resources within its website providing information regarding substance abuse and mental health and their treatment or preventative options.
Some policies allow policyholders to skip the need for referral for services but generally require preapproval for services. Utilizing UnitedHealthcare’s vast network does benefit the policyholder from paying large sums in coinsurance, copays, or deductibles.
UMR is a branch of UnitedHealthcare insurance, making it a third party administrator. As a third party administrator, they are able to provide the service for insurance companies to make sure claims from employees are paid. While UMR is a branch of UnitedHealthcare insurance it has access to the same benefits insurance policyholders of UnitedHealthcare have. Therefore able to provide health care coverage for treatment services for detox, in-patient, out-patient, residential, intensive, partial hospitalization, and mental health care.
Due to not being an actual insurance provider, they can not personally cover costs associated with medical care. They will work with the addiction treatment provider of the insurance policyholder to cover addiction treatment costs. Thus helping to get the policyholder the best health care coverage for treatment services they can. Although they are a branch of UnitedHealthcare insurance they also work with a variety of other health care insurance companies.
How is Coastal Detox Unique
Our facility here at Coastal Detox is an accepted provider for each of these insurance company branches. This makes our facility unique in providing addiction services. We are proud to pass all requirements made by Cigna, working with UMR and the companies they provide services for, and having the benefit of working with one of America’s largest insurance companies, UnitedHealthcare.
The medical professionals at Coastal Detox want to help anyone suffering from addiction receive the help they deserve. Contact us at 1-877-978-3125 and begin living again.