Treatment for a substance use disorder comes with a price tag that stops many people in their tracks. A person’s readiness to decide to change is also important, but questions like “Can I afford it?” or “How will I pay for this?” are also on someone’s mind.
These concerns, while understandable, should not deter someone from seeking professional help for a substance use disorder. With all that’s at stake, such as one’s life, health, and personal relationships, one can’t really afford to pass up a chance to start the process in a setting that promotes sobriety.
Fortunately, Family Recovery Services works with insurance companies to make treatment an affordable reality. We proudly accept Beacon Health Options, a company that says it has changed the way people live with behavioral health conditions for more than 30 years.
Providers of health insurance generally are aware that addiction is a treatable medical condition under the Affordable Care Act. Under this measure, insurance plans must cover Essential Health Benefits regardless of the kind of insurance a person has. The benefits included help people with mental health disorders, drug or alcohol abuse, and counseling and therapy.
Insurance companies must comply with mental health parity laws by covering mental health and substance use disorders on the same level as medical needs. They cannot provide coverage options for medical needs by only offering limited coverage for mental health needs.
The Diagnostic and Statistical Manual of Mental Disorders has officially diagnosed addiction as a disease, which means insurance companies must cover treatment for it. The medical community also recognizes addiction as a complex brain disease that affects mental and behavioral health.
Insurance helps you cover the expenses of substance abuse treatment. This includes the costs of medication, therapy, and the kind of program you enter, such as inpatient treatment or residential treatment. Patients must still be aware of what their insurance plan covers.
The services that a health plan covers can vary, depending on the provider. It is the patient’s responsibility, however, to pay for the services that the plan does not cover. For example, health insurance companies may cover addiction treatment, but they might not cover certain kinds of therapy or a specific type of addiction treatment facility.
You will not have to figure this out on your own. Case managers and other medical professionals can work with insurance specialists, including those at Beacon, to determine what kind of treatment would best fit your needs.
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Yes. Beacon aims to provide substantial coverage options for members who need drug and alcohol treatment. Click here to learn more about Beacon’s model of substance use disorder care. It covers medication-assisted treatment (MAT) and short-term, structured outpatient treatment programs.
“We offer long-term support for substance use disorders based on the principles of recovery and resiliency as we work to return people to their communities,” says the company’s website.
Before a person can receive care, their provider must have the required medication or procedure cleared during the precertification process. This means Beacon must approve you for what you need before it covers it.
Some services, however, may not need precertification.
Providers usually look for the most suitable treatment options that align with nationally recognized guidelines, such as those in the ASAM criteria.
The services and resources that your Beacon plan covers will depend on several factors, such as your specific policy, the state where you live, and the level of care that is necessary for your needs. To determine what the company will pay for, reach out to an insurance representative to discuss your options. Family Recovery Specialists can guide you in determining what’s right for you or your loved one. Our intake specialists are available 24 hours a day, seven days a week, to discuss your treatment options. We make you our focus, and we proudly offer you support as you take steps to change your life.
U.S. Centers for Medicare & Medicaid Services. (n.d.). Affordable Care Act (ACA). Retrieved from https://www.healthcare.gov/glossary/affordable-care-act/
Unknown author (January, 2018). What Marketplace health insurance plans cover. HealthCare. Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
U.S. Department of Health & Human Services. (2019, March 22). Health Insurance and Mental Health Services. Retrieved from https://www.mentalhealth.gov/get-help/health-insurance
American Psychiatric Association. (n.d.). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm
“Best Practices in Managed Substance Use Disorder Treatment.” Beacon Health Options, https://www.beaconhealthoptions.com/best-practices-in-managed-substance-use-disorder-treatment/ “Clinical Forms.” Beacon Health Options. Retrieved from https://www.beaconhealthoptions.com/providers/beacon/forms/clinical-forms/
American Society of Addiction Medicine. (n.d.). What is the ASAM Criteria? Retrieved from https://www.asam.org/resources/the-asam-criteria/about