The ABC’s of Insurance Coverage

When you are looking for treatment, the last thing you want to worry about is insurance coverage. Navigating the maze of health insurance terminology and the specifics of coverage can be stressful at the best of times. Get to know these often-used insurance terms you’re likely to hear from admissions coordinators and intake specialists when describing your policy and benefits:

Premium – A premium is the amount people pay at regular intervals to their insurance companies. This is the individual’s contribution to his or her policy, and for those who have insurance through their employers, the premium is automatically deducted from paychecks. Employers may also contribute to this premium. Premiums are determined by what kind of coverage a person has, such as HMO or PPO plan.

Deductible – This annual cost is an amount you must pay before insurance will begin to cover your expenses. If you have a high-deductible plan, you accept a higher overall cost in order to lower your monthly premiums. If you have a low deductible plan, you premium will be higher each month. Once the deductible is met, your insurance will cover all or a certain majority percentage of your health costs.

Out-of-network coverage – This applies to a treatment provider that does not have a predetermined contract or cost agreement with the insurance company, but people can still receive treatment with this provider. The rates won’t be discounted to the same extent they are for in-network providers but finding a specialized facility may be worth the out-of-network rates.

Out-of-pocket expenses – Your out-of-pocket cost is any amount not covered by insurance that you are responsible for. These costs are usually due at the time treatment begins, but you may be able to set up a payment plan. Out-of-pocket expenses include deductibles, co-pays and co-insurance.

When someone is in need of treatment for addiction and a co-occurring mental health issue, the main focus is getting that person into treatment — but there are also concerns about how much it will cost and who will pay. The added urgency of a substance abuse problem puts pressure on an already confusing process. Talbott Recovery’s admissions center has a special team focused solely on working with insurance companies to verify benefits and sort out coverage. We can help you explore your options, discover what kind of treatment is the right fit and determine what your policy covers.

You Are Not Alone in the Process

HMOs, PPOs, in-network, out-of-network — with so many options and variables from plan to plan, it can be a full-time job just dealing with insurance companies. And this is not a one-time thing. To ensure the highest level of coverage throughout the treatment process, your insurers will need ongoing information. Staying on top of this can be frustrating, but lack of communication can be costly. That’s why it’s important to have a reliable, experienced team on your side. Our staff knows whom to contact and when, keeping your insurance provider in the loop, ensuring that each new phase of treatment is approved, and saving you from a lot of red tape. We understand how the process works, and we will work hard to help you get the treatment you are entitled to.

How Parity Law Affects Treatment Coverage

New legislation makes it easier to get addiction treatment covered by insurance providers, but it’s important to understand the law. The Parity Act seeks to equalize coverage for those seeking treatment for mental health and addictive disorders. For years, there have been restrictions on this treatment that didn’t apply to other disorders, keeping those in need from getting help. The problem was rooted in prejudice and misinformation about the cost of treatment and the nature of mental illness and substance abuse.

The truth is that money spent on treatment may actually save the US billions annually in the criminal justice, welfare and healthcare systems. What does the Parity Act accomplish? Financial or treatment limitations must be made equal between medical, surgical and behavioral and addictive services if a health plan covers mental health and addictive services. All plans are not required to provide coverage for behavioral and addictive services, but more than 90 percent of current employer-subsidized healthcare plans do provide such coverage and the requirements for parity apply to them. Health plans must disclose the criteria used to determine medical necessary and the rationale behind denials of any claims for behavioral and addictive services.

Verifying Your Benefits

We work with a number of providers, but coverage may vary by state or policy. Some of the major providers that we work with include CIGNA, Blue Cross Blue Shield (varies by state), Aetna, Humana, UnitedHealth, MultiPlan, ValueOptions, ComPsych and Exclusive Care, but this does not cover the full range of companies that we work with.