Health insurance can be confusing for anyone. Understanding your medical coverage can be confusing, overwhelming, and altogether difficult to understand. Copays. Deductibles. Out of pocket maxes. In-network. Out of network. Individual coverage. Family coverage. It is a lot for someone that has a limited understanding of health insurance to take in and digest.
Additionally, the medical community and the way it operates can cause even more confusion. Have you ever gone to receive an outpatient surgery? If you’ve never done it before, it can be confusing. You may receive multiple bills from multiple providers for a single surgery. The outpatient surgery center, the doctor, the anesthesiologist. Often, some of these providers have been outsourced from other medical companies, so each invoice is different.
In terms of insurance coverage in addiction treatment, it’s enough to drive someone mad. Insurance companies have traditionally not covered behavioral healthcare (addiction and mental health treatment) in the same manner that they have for traditional medical coverage. This is one of the reasons, as America’s addiction and opioid crisis rose, the Federal Government implemented parity, which is supposed to make sure health insurance companies cover and pay for addiction treatment and mental health services the same way they do for traditional medical care. Because of that reason, many addiction treatment providers haven’t always provided clarity in discussing the cost of addiction treatment- sometimes because they were confused and sometimes because they truly couldn’t tell a potential patient or family exactly what the cost of treatment would be because they were unsure of what insurance would actually cover. Then there are the unethical and unscrupulous treatment providers in the space. These are the treatment centers that offer no understanding to a potential patient or family on the front end, often tell them “yes, we’re covered by your insurance”, admit a patient, and then the patient or family get a bill for tens of thousands of dollars once the patient has completed treatment.
The first thing to know about health insurance is that every plan is different. Not every Blue Cross Blue Shield plan or Aetna plan is the same. There are many variations within each plan. There are individual plans. There are employee plans (that you receive by being employed at your job.) There are self-funded plans that are administrated by a third party. Each plan is uniquely different. Some insurance plans are HMO’s and only allow you to go to a provider that is in-network. There are also EPO’s. And there are PPO’s, which offer the ability to choose between an in-network provider or a provider that is considered out-of-network. Typically, HMO’s and in-network plans will provide a lower out-of-pocket cost for care, while PPO’s or out-of-network options may cost more. The benefit of a PPO is that it allows a person to choose whatever provider they would like for healthcare services, although it often will come with a slightly higher cost. It is important that when seeking help for addiction, you verify your health insurance benefits with your insurance company’s Benefits Administrator. You will typically have a toll-free number that you can call, and they will explain to you your plan and coverage. Many addiction treatment centers provide through their admissions or billing departments the ability to also verify your coverage. If this is the case, that rehab or treatment center should then be able to explain to you clearly what your health insurance coverage is and offer clarity on all costs associated with your treatment.
The important thing to remember is that you should always have a clear picture of the cost of treatment. You have a right to understand all costs associated with your care. When seeking help for addiction, make sure that you make the right choice of facility that can meet you or your loved one’s needs. But also make sure that the facility you choose can adequately offer clarity on your insurance coverage and the cost of treatment. If you don’t understand something, make sure to ask questions. Ask for an understanding of cost in writing before admitting and receiving care. For far too long, individuals and families have trusted rehabs and addiction treatment facilities on face value when they are told that “your insurance will cover treatment” and then received a high bill after treatment, causing even more personal stress, anxiety, and trauma, and ongoing distrust of addiction treatment providers. The truth is, there will almost always be some cost to you for treatment. Just like going to a doctor of a hospital, you may have a deductible that hasn’t been met or a copay that is required.
Too many times, families or potential patients are lied to or miscommunicated with by treatment centers to get them to admit. Often, we hear families tell us “Well, so and so place said they’re able to waive my deductible and it won’t cost me a thing.” It is important for individuals and families to understand there waiving insurance fees that are contractually agreed upon to in their insurance plans is illegal. There are obviously certain instances where financial hardships arise, and treatment centers will often create payment plans for potential patients to make treatment more accessible when someone is in crisis, but to outright waive costs associated with health insurance is illegal and speaks to fairly unethical practices by addiction treatment providers.
We absolutely understand that parents, spouses, and families are often in crisis when seeking addiction treatment for their loved one. Hearing a rehab facility say that they won’t owe anything often sounds like a Godsend, especially when families or individuals are in financial hardship and financial difficulties. However, it is also important to understand, just like any other segment of healthcare, there is typically always some cost associated with patient care. Just like walking into an Emergency Room or Emergency Department, a hospital stay, a surgery, or just seeing your primary care physician or a medical specialist, there is usually a cost. And just like a hospital or other medical provider, treatment centers will often work with a family to make sure they fulfill their financial responsibility based on their health insurance plan to best make it affordable. However, flat out waiving of fees that are contractually obligated based on that patient’s insurance contract or dishonestly telling a patient that their insurance covers a treatment episode when it doesn’t, and then sending a large bill on the back end, is wrong. This is why is it vitally important that both the patient and their family understand their insurance coverage, and that the treatment facility admitting the patient is clear and concise in terms of insurance coverage, cost, and pricing. A patient should never admit into a rehab or into an addiction treatment facility without them, their family, and/or their financial guarantor clearly understanding the entire cost of treatment and insurance coverage.
If you or someone you know needs help for addiction or co-occurring disorder issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at [email protected]. For more information on all of our drug addiction, alcohol addiction and co-occurring disorder services and recovery resources, please visit our web site at www.marylandaddictionrecovery.com.