At Fairwinds Treatment Center, our primary focus is providing the highest level of treatment for all those in need. Our staff has been thoroughly trained to ensure a seamless experience in every step of the treatment process, from understanding your ailment to exploring available payment options for substance abuse and mental health based on your specific situation.
With regard to payment options for substance abuse, we’ve seen significant improvement pertaining to the level and extent that insurance companies are willing to go to cover mental health and substance abuse treatment, thanks in part to the passing of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
What is the MHPAEA?
The Mental Health Parity and Addiction Equity Act of 2008 is a federal law that prevents health insurance companies and group health plans that provide benefits for those dealing with mental health or substance disorders from receiving less than favorable benefits, in comparison to the medical/surgical benefits.
In 2010, the MHPAEA was amended by another piece of legislation, titled the Health Care and Education Reconciliation Act (also known as the Affordable Care Act), which extended coverage to individuals as well.
Level of Coverage
Insurance companies determine what they will pay based on the type of plan you have. For those on a basic plan, insurers may be able to cover up to 30% of your treatment, while those on a premium plan have the ability to cover up to 90% of all expenses. Patients will still be responsible for deductibles and copays.
Health insurance for substance abuse treatment, or any other type of affliction one may be dealing with, could range in price depending on the level of insurance you have and the recommended treatment.
Treatment and Payment Options for Substance Abuse
Inpatient and Residential Treatment – Our inpatient and residential program refers to treatment where patients receive around the clock emotional and medical support at the clinic. Patients looking to receive inpatient treatment must meet the “medical necessity” criteria set by his/her insurance plan. Once the patient has been assessed, our admissions staff will recommend treatment, and if the insurance company agrees with our recommendation, the admission of the patient will be approved (which includes the level of care the patient will receive and the duration of the patient’s stay).
If the insurance company disagrees with our recommendation, coverage will be denied and they will recommend an alternative level of care.
It is common for insurance companies to only cover a portion of residential treatment. In that case, our staff will assist you in determining additional benefits entitled to you under your plan and will work to try and obtain authorization of any benefits that may apply.
Intensive Outpatient Treatment – Intensive outpatient programs (IOPs) are a form of treatment used to address issues that don’t require 24-hour supervision or detoxification, such as eating disorders, depression, and addiction. Essentially, IOPs allow patients to continue their daily routines in a way in which inpatient treatment programs do not. IOPs are sometimes used in addition to some form of an inpatient program, which is intended to help patients seamlessly adjust back into their regular lives by adopting support mechanisms and coping strategies designed to combat their urge to relapse. Most insurers will cover some of the costs associated with outpatient treatment, depending on the details defined in your plan.
Private Payment – For those whose insurance plans won’t cover the cost associated with their treatment, the patient or their voucher will be responsible for payment. Patients opt-in to private forms of payment for various reasons, such as to ensure uninterrupted treatment or to guarantee privacy. Patients who select private payment have the option to pay via check or credit card, and if they can’t afford to pay the cost upfront, financing options may be available.
Those paying out-of-pocket may also be able to avoid costs through medical tax deductions.
If you or a loved one is dealing with an eating disorder, mental health or substance abuse problem and would like to know your payment options for substance abuse treatment, please contact Fairwinds Treatment Center today.
Figuring out if your health insurance for substance abuse treatment will be covered can be a frustrating experience. Let us deal with the insurance company so you can focus on getting back to leading the life you deserve. Simply verify benefits here, and we’ll take care of the rest.