Paying for Treatment for Your Loved One

paying-for-treatment-program

Figuring out how to pay for addiction treatment (or help your loved one pay) can feel like a huge undertaking. How much will it cost? Will you be able to afford it? What about already-looming bills or perhaps large sums lost to other addictive activities, like gambling, shopping or drug use?

Perhaps most important right now while you’re worrying about how to pay for addiction treatment is to take a deep breath. Remind yourself that the costs of your loved one not getting treatment are much often higher. Without help, your child, partner, relative or friend is likely to be at greater risk for unemployment, failed relationships, incarceration, health complications, overdose and suicide. In fact, every $1,583 spent on nine months of addiction treatment saves $11,487 that would otherwise be lost during the same time period to unearned wages and the costs of crime, injury or illness associated with addiction, according to a cost analysis published in the journal Health Services Research. Not to mention the high expense of your own health and sanity: Coping with a loved one’s addiction takes a huge toll – emotionally, physically, spiritually and certainly financially.

First, let’s take a look at the type of treatment your loved one may need. To reach successfully recovery, some combination of the following types of treatment and therapies may be necessary:

  • Inpatient residential treatment
  • Outpatient (day or evening) rehabilitation
  • Individual, group and/or family counseling
  • Medication
  • Relapse prevention, a type of cognitive-behavioral therapy
  • 12-step and other self-help groups (though free, contribution baskets are often passed around at each meeting)

There’s a chance, too, that your loved one will need to repeat the process more than once: According to the Journal of the American Medical Association, 40% to 60% of patients who receive substance abuse treatment will relapse within one year.

Addiction treatment can (but doesn’t always) carry a high price tag. In 2011, the average out-of-pocket cost (co-payments, deductibles and coinsurance) per admission for a patient getting treated for substance abuse was nearly $900, according to the Healthcare Cost Institute.

That said, affordable (even free) treatment options do exist. For instance, it will cost nothing for your loved one to attend a self-help support group, either in person or online. And there’s seemingly a 12-step support group for every addiction, including:

There are dozens of options for meetings and times – and your loved one can attend an unlimited number, even several times a day – at no expense (or a voluntary donation when the group passes a donation basket).

If you or your loved one don’t have health insurance, some treatment facilities offer sliding-scale fees, meaning the cost of treatment will be calculated based on income. Others offer financing options, via third-party lenders or their own facility. SAMHSA’s Behavioral Health Treatment Services Locator lets you search for nearby facilities by payment/insurance accepted and by whether the treatment center offers sliding-scale fees, making it a lot easier to find facilities that fit your financial needs.

Treatment for mental health and substance abuse is now what’s called an “essential health benefit” for most plans, thanks to the passage of the Affordable Care Act (ACA). This has opened up new options in health insurance coverage. Specifically, most major insurers and Medicaid must include mental health and substance abuse care as part of their plans, including free preventative services like adult and adolescent depression screening, alcohol-misuse screening and counseling and tobacco use screening and cessation interventions. Under the law, mental health and substance use services must be covered at parity — meaning on fair and equal terms — as with other health issues. And insurance companies can no longer deny coverage to anyone with pre-existing conditions, including schizophrenia, depression, bipolar disorder and drug or alcohol dependence.

While the ACA does cover substance abuse treatment, how much is paid for and how much you or your loved one will need to pay out–of-pocket  depends on your (or your loved one’s) home state and the terms of your or his/her health insurance plan. Plans may differ on the following, according to the National Alliance on Mental Illness

  • Types of services covered (for example, the types of therapy that are reimbursed for addiction treatment)
  • Treatment limits (including the length of rehab stays and which medications are and are not paid for)
  • Which health and mental health providers are covered

It can be confusing to sort through the terms of your insurance policy, so your first step should be to call your carrier to find out the details of your specific coverage. Thanks to the ACA, health insurers are now required to provide you with a clear and concise summary of benefits. If your state has one, a Consumer Assistance Program (CAP) can also help by connecting you with consumer resources and your state’s Department of Insurance to help answer your questions.

Some treatment facilities will even call your carrier for you; this is known as a free benefits check. Just be sure to have the following information about your loved one handy:

  • Name
  • Address
  • Date of birth
  • Social Security number
  • Policy number and group number on insurance card
  • Plan’s contact number and address on the back of the insurance card

So how much will your loved one’s treatment cost? Just as addiction treatment can vary a lot – depending on the type and severity of problem or whether someone has a comorbid mental disorder, like depression – so, too, can the cost. Health insurance coverage, location, facility type, services offered, medication and length of stay can all greatly affect the total price of care.

For instance, if your loved one stays for six months at a luxury inpatient facility that bills separately for every therapy session or group work it will cost far more than, say,  receiving services at a daily community center with an all-inclusive price. (Typically, your loved one’s treatment for addiction will begin with detoxification, or purging the system of the drug(s) or toxic behavior(s), followed by intense counseling and self-help support groups. In addition, medication may be used to manage your loved one’s withdrawal symptoms, reduce cravings and/or manage a mental illness.)

Sources: Consumer Reports; Health Care Cost Institute; Healthcare.gov; Health Services Research; Journal of the American Medical Association; National Alliance on Mental Health.

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