Insurance Coverage for Prescription Drug Addiction Treatment

Insurance paperwork used to Find Treatment

Contributor: Libby Lyons, MSW, LCSW, CEDS writer for Addiction Hope and Eating Disorder Hope.

Prescription drug addiction is a serious concern. Because of the addiction’s complexity and pervasive consequences, drug addiction treatment typically must involve many components. Some of those components focus directly on the individual’s drug use; others, like employment training, focus on restoring the addicted individual to productive membership in the family and society, enabling him or her to experience the rewards associated with abstinence.

Utilizing Available Treatment

Treatment for drug abuse and addiction is delivered in various settings using a variety of behavioral and pharmacological approaches. In the United States, more than 14,500 specialized drug treatment facilities provide counseling, behavioral therapy, medication, case management, and other types of services to persons with substance use disorders (Retrieved 3/18/16).

Insurance balance sheet for treatmentAlong with specialized drug treatment facilities, drug abuse and addiction are treated in physicians’ offices and mental health clinics by a variety of providers, including counselors, physicians, psychiatrists, psychologists, nurses, and social workers. Treatment can be delivered in outpatient, inpatient, and residential settings.

Because drug abuse and addiction are a growing public health problem, a large portion of drug treatment is funded by local, State, and Federal governments. Private and employer-subsidized health plans also may provide coverage for treatment of addiction. Most insurance policies don’t separate drugs into “covered” and “non-covered” categories.

If addiction treatments are considered a covered benefit, then care is provided to anyone who has an addiction, regardless of what that addiction is caused by. Some plans provide coverage for all levels of care (inpatient detox, residential treatment, and outpatient counseling) while other programs offer payments for just one type of care, and they might limit the amount of time that someone can access that care.

Options for Those Without Coverage

If you do not have insurance, you have a couple options to ease the burden of paying for treatment. One of these options is payment plans through the facility you are considering. This involves monthly payments over a period of time. Another option is a sliding scale fee where the fee structure is based on your ability to pay.

Young woman calling insurance companyThere is also the possibility of a free facility where they offer free beds which you can locate though the Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment payment options also include using health care credit cards, personal loans, or credit cards to cover the cos of treatment.

Even though prescription drug addiction may be different from that of drugs and alcohol, when looking for various levels of care, the coverage is the same with insurance companies concerning treatment. The best options for individuals and families looking for coverage is to call their insurance company and ask what their levels of care treatment option is for addiction services. If you are looking at a specific facility, often times the facility will check your insurance company on your behalf for benefits and eligibility.

Community Discussion – Share your thoughts here!

What options for treatment and payment have you or your loved one used in treating prescription drug addiction?



Image of Libby Lyons and familyAbout the Author: Libby Lyons, MSW, LCSW, CEDS is a specialist in the eating disorder field. Libby has been treating eating disorders for 10 years within the St. Louis area, and enjoys working with individuals of all ages.

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 24, 2016
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