Paying for Treatment: 6 Things All Consumers Need to Know

Friday, November 6th, 2015

office girl-2-cropHelping a loved one—or yourself—get treatment for an addiction, clinically known as substance use disorder, can feel overwhelming, and questions about how to pay for treatment may compound your worries. To ease your concerns, we’ve put together key points every consumer should know about covering the cost of treatment.

Treatment is in Reach
Chances are, if you have insurance, you have addiction treatment coverage. Under the Affordable Care Act, substance use disorder treatment is one of 10 benefits insurers must provide. (Unfortunately, a few providers have not yet complied with this provision.) Additionally, about 87 percent of employer-based insurance also cover treatment for substance use disorder, according to the Society for Human Resource Management. So check your plan to see if you have behavioral health benefits, specifically substance use disorder treatment benefits, and don’t assume you’ll have to pay everything out of pocket.

Look Beyond Your Deductible
How much treatment is going to cost depends entirely on your plan.  It’s important to find out your specific benefits. While you may know what your deductible is, look into the type of treatment covered and its length, what it means if your plan specifies that treatment needs to be deemed a “medical necessity” to be covered, and other benefit aspects. If you don’t understand something, call your member benefits representative and have them walk you through the fine print.

Costs vary for Residential versus Outpatient Treatment
Understand how coverage differs for intensive outpatient treatment versus residential treatment. Usually the cost of intensive outpatient treatment is determined per session, and treatment lasts a set number of sessions. This means patients start treatment knowing exactly how much they will be out of pocket for their care. Residential treatment, however, is determined by date of stay. If your head is in the bed that night, you will pay a flat fee. Residential treatment at high-quality facilities averages $300 to $500 a day; luxury providers can run $1,000 a day or more. Cost of care, however, begins with an estimate. That’s because your length of stay is usually dependent on your progress, specifically, when you are ready to step down for a lower level of care. This differs from person to person. Most people stay in residential treatment from 30 to 90 days. So, with residential care, it’s important to understand that you are dealing with an estimate of your costs.

Check Your Maximum
Find out your out-of-pocket maximum for the year. This is amount that must be spent before your benefits cover 100 percent of essential services. This information will give you good idea your worst-case scenario with regard to costs.

Start with an Assessment
The path to treatment starts with an assessment. Each person’s substance use disorder is different and requires individualized care. Come in for an appointment. Then once your needs are determined, you will have the information you need to discuss your options with a facility’s financial counselors (even if you don’t have insurance). Some facilities, including Phoenix House, offer third-party financing through health care lenders. Some of our facilities also provide in-house financing for small amounts. At Phoenix House, especially, our main goal is that people get the treatment they need, so we are willing to work with people, especially within reason, to help them or their loved one achieve wellness and recovery. Similarly, stay in touch with the finance department over time, so you don’t end up with a bigger bill than you might expect. For example, when you sign financial paperwork at admission, check how many days the agreement covers. Often the words “30 days” will appear on the paperwork, but not everyone notices this. Ask, “If we go over this time, will you contact me?” “What will this look like?”

Recovery is an Investment
Remember that addiction is a disease requiring treatment just like any other. You are investing in eliminating a problem that is harming you or your loved one. At Phoenix House, we see a lot of lives restored. This can mean increased earning power, savings of future health or legal costs, and saving the costs of the alcohol or drugs. However, the real value of a loved one who is restored to health is incalculable. At least that’s what our clients and their families tell us.

Jamie Phelps
Financial Counselor
Phoenix House Texas


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