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Insurance Coverage & Rehab – Will your insurance pay for treatment?

insurance billing chicago rehab alcoholThe reason for having health insurance is to alleviate the large financial burden when dealing with any type of illness.  However, insurance providers are not forthcoming with all the information related to an individual with chemical dependency or substance abuse treatment needs. Insurance providers claim there are no “limits” on benefits for rehab, but all benefits are based on medical necessity. What often goes unstated, is the insurance provider is the sole entity determining what constitutes to be medically necessary.

With the onset of managed care, insurance providers are less willing to cover the costs of the traditional 28-day inpatient rehab.  Insurance providers operate with the belief that if substance abuse or alcoholism can be detected in the early stages, it’s better for all parties – the client doesn’t get into the late stages of addiction and the insurance provider doesn’t have to pay out for medical consequences and potentially long stays in rehab.  Instead, insurance providers are opting to pay for other levels of care including brief interventions, outpatient treatment, educational sessions and individual therapy sessions.

The length of stay for someone seeking chemical dependency or substance abuse treatment is now averaging approximately 10-18 days of inpatient rehab before requiring the client to “step-down” to a lower level of care.  Often, Intensive Outpatient treatment benefits are easier to obtain, but may also be restricted by the insurance provider based on medical necessity. Unfortunately, this is forcing clients to fast forward through crucial steps in the recovery process in order to avoid accruing large medical bills.  We understand this is not fair.

Since these changes with managed care, New Hope Recovery Center and many other treatment programs have had to alter its method of billing and treatment planning.  New Hope Recovery Center bills for Partial Hospitalization 5 days a week for as long as the managed care/insurance company will allow, which is generally 10-18 days.  We then step the client down to our Intensive Outpatient Program which is 4 to 5 days per week.  Once the client has successfully completed Intensive Outpatient treatment, they transition into our Aftercare program. Aftercare meets once per week for an hour.  Aftercare usually doesn’t need pre-certification and most insurance providers will continue to pay for Aftercare for approximately 5 months.

Evidence based practices have confirmed that the longer a client is in treatment and connected to the sober community, the better their chances at achieving long term sobriety. Even though insurance companies won’t provide 28 days of inpatient rehab, there are many treatment centers that will work with their clients to use their benefits effectively and make sure they get the most out of their experience.

The best way to approach the financial responsibility of treatment is to be informed. Helpful tips:

  1. Call your insurance company prior to calling a treatment center
  2. Ask about your substance abuse/chemical dependency coverage (often it is coupled with “mental health” benefits)
  3. Inquire about whether pre-certification is required
  4. Find out what treatment centers in your area are in-network with your insurance company
  5. Call the in-network treatment centers and talk to the finance/billing department and ask them what they do when coverage is no longer approved and how much the treatment center bills per day for inpatient

There are many different treatment centers and substance abuse professionals, being informed will help you decide which treatment center is right for you. If you or a loved one is suffering from alcoholism or other addictions, call New Hope Recovery Center (773.883.3916) and we will help guide you as you take your first steps towards recovery.

Written By: New Hope Recovery Center

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