Treatment, Recovery, and the Realities of Insurance

How treatment and recovery services are paid for varies a great deal, and is highly dependent on an individual’s health insurance coverage. For instance, if you get your health insurance from your employer, or you are considered a “dependent” on a family plan that a parent or spouse may carry, the coverage you have will be different than if you have Medicaid or Medicare (which are state and federal government sponsored plans), or if you have an individual plan purchased on the healthcare exchange in your state. 

For the most part, because of the mental health parity law, insurance plans aren’t allowed to make it more difficult for someone to get treatment for mental health or substance use than for physical health. This includes both financial and network barriers that either make it too costly or difficult to find an “in-network” provider who specializes in mental health or substance abuse treatment and recovery.

Ultimately, there is no “one size fits all” approach when it comes to insurance coverage, and it’s always important to know your plan covers, and what you will be responsible for paying for. Also, it’s important to know how to manage it when a claim may be “denied” by your health insurance for any reason. It can be time-consuming, but following the appropriate channels for contesting these denials when they occur can be frustrating but rewarding in the end.

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Take Aways:

• Know what’s covered under your plan.
• Make sure that the place you go for treatment is covered by your insurance. If it’s not, make sure you are fully aware of what the out of pocket costs are.
• If a claim is denied, make sure to follow the appropriate channels for resolving the issue, particularly if you believe the denial isn’t justified. 
• Don’t hesitate to reach out directly to your insurance company when you have questions, and to take advantage of any support services that may be offered under your plan. 
• If you’re having difficulty finding in-network care in your community, make sure to call your health insurance company to let them know. Under some circumstances, a “one time service agreement” can be negotiated to use a local treatment provider who may not be in-network with your health insurance company.