Paying for Treatment

Addiction takes a huge toll on those it touches: emotionally, physically, spiritually and certainly financially. Beyond the anguish and heartache of having to deal with the mental illness of addiction itself — whether to alcohol, drugs, sex, gambling or another type of behavioral addiction, and often in combination with another disorder like depression, anxiety or ADHD — for many, there’s the added burden of somehow figuring out how to pay for treatment. This can be layered on top of other financial difficulties, like a lost job or wages, medical bills and huge sums lost to gambling, shopping, drug use or other activities.

Treating addiction can be (but isn’t always) very expensive. To successfully reach recovery, some combination of the following types of treatment and therapies may be necessary:

  • Inpatient residential treatment
  • Outpatient rehabilitation
  • Individual, group and/or family counseling
  • Medication
  • Relapse prevention

And it may take more than one attempt for recovery to last: Forty percent to 60% of patients who receive substance abuse treatment will relapse within one year, according to the Journal of the American Medical Association. To make matters more complicated, while undergoing treatment, you may not be receiving a regular paycheck either.

It’s natural to feel overwhelmed at even the thought of paying so much to get help. In fact, cost is one of the biggest barriers to getting treatment, along with not being ready to stop using and not knowing where to go for assistance, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH) for 2013.

While there’s no denying that addiction treatment can carry a hefty 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 — the costs (financial and otherwise) of not getting proper treatment are often much higher. Without help, you may be at a greater risk for lost jobs, failed relationships, incarceration, health complications, overdose and suicide.

According to a cost analysis published in the journal Health Services Research, 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.

Fortunately, there are affordable, even free, options when it comes to treating addiction. Perhaps most important, you’ll pay nothing to attend a self-help support group, either online or in-person (although you may opt to make a small contribution if an in-person group passes a donation basket). Whatever your type(s) of addiction, chances are very good there’s a 12-step support group that can help. These include:

Those in treatment or recovery can attend as many meetings as they like — all free — to support their sobriety, and most cities offer dozens of options for meeting locations and times.

What’s more, many treatment facilities offer sliding scale fees for people without health insurance. This means that the cost of treatment will be calculated based on your income. Still other centers make available their own financing to create affordable packages, either directly from the treatment center or through third-party lenders. Visit SAMHSA’s Behavioral Health Treatment Services Locator to find a facility near you; you can search by both payment/insurance accepted and by whether the facility offers payment assistance (such as a sliding fee scale).

The passage of the Affordable Care Act (ACA) opened up new options in health insurance coverage by making treatment for mental health and substance abuse what the ACA calls an “essential health benefit” for most plans. This means that 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.

The law also requires mental health and substance use services to be covered at parity — meaning on fair and equal terms — as with other health issues. And insurance companies are also prohibited from denying coverage to people with pre-existing conditions, which include 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 will need to pay out–of-pocket depends on your individual health insurance plan as well as your state. According to the National Alliance on Mental Illness, plans may differ on the following:

  • Types of services covered (for example, the types of therapy for addiction)
  • Treatment limits (including the length of rehab stays and which medications are paid for)
  • Which health and mental health providers are covered

While insurance is a great way to reduce the cost of treating a mental illness (which addiction is considered to be), it can be hard to sort out the terms and conditions of the insurance policy. Call your insurance company to find out the specific details of your coverage. The ACA also requires health insurers to provide an easy-to-understand summary of your benefits. Or contact your state Consumer Assistance Program (CAP) for more information. If your state doesn’t have one, the CAP can point you to other consumer resources and links to the state’s Department of Insurance that may provide answers to your questions.

Many treatment facilities offer a free benefits check for potential patients — meaning the center will reach out to your insurer to see what you qualify for. To call for a benefit check, have the following information on hand to share with any facility you’re considering:

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

So How Much Will Treatment Cost?

Since addiction treatment is not one-size-fits all the truth is that what you will pay can vary a lot depending on the type of addiction you has, whether you also have a mental disorder like depression or anxiety and factors such as location and health insurance.

What’s more, the type of facility you choose and the services offered there, medication and length of stay will naturally have a big impact on the total price. For instance, a six-month inpatient stint at a luxury rehab center that bills separately for every therapy or group-work session will cost much more than a community center that you attend during the day and which offers one all-inclusive price for services. (Typically, treatment for addiction begins with detoxification, or purging your 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 withdrawal symptoms, reduce cravings and/or manage a mental illness.)

While you may not need all (or any) of these approaches, here’s what to expect when it comes to paying for the different types of addiction care:

Inpatient (residential) treatment: As its name implies, inpatient treatment involves staying for a period of time at a specialized facility. How long you remain on-site depends on the length and severity of your addiction(s) and any co-occurring disorders, like depression, anxiety, ADHD and other mental illnesses. When you live at a rehab for a period of time, you should expect that your treatment will be intensive and involve a multifaceted approach that includes one-on-one counseling, group therapy, educational discussions and lectures, physical exercise and group activities, family counseling (if applicable) and relapse prevention.

The cost of residential treatment centers can range hugely, from free to $80,000 a month, depending on the center’s location and the treatments and amenities offered. An inpatient program for technology addiction (which isn’t recognized as an official mental disorder and therefore is not covered by insurance), for example, can cost $14,000 for a 10-day stay.

Outpatient treatment: These centers offer the same types of treatment as residential programs — one-on-one psychotherapy, group therapy, 12-step meetings, medication therapy and other holistic approaches like yoga and mindfulness meditation — but because you don’t stay overnight, you can more easily continue to work or attend school while still fulfilling your treatment plan. In general, outpatient addiction treatment is much more affordable with an average weekly cost under $500.

Day treatment/partial hospitalization: A day treatment program (which is a type of outpatient treatment) may be an ideal choice if you’re looking for more structure and intensive treatment than a regular outpatient program can provide. Day treatment is often affiliated with a hospital or private residential facility, and you may attend up to seven days a week for several hours each day, including evening 12-step meetings or educational seminars. Costs vary but day treatment is generally more expensive than an outpatient treatment program but less costly than residential treatment.

Sober living homes (formerly called halfway houses/homes): These are live-in, drug-free living environments that offer peer support for recovery and long-term sobriety. While it’s less common to find a sober house for behavioral addictions like gambling or sex addiction, those who are addicted to substances, including alcohol, cocaine, heroin and methamphetamine, have been found to benefit from transitioning to recovery with the help of these sober environments.

Prices for sober living homes can range from $450 to $10,000 per month and vary depending on the location, utilities, meals, laundry facilities and other amenities. You will also pay more to have just one roommate or a room to yourself. Most sober-living houses are privately owned and will bill residents directly, though some accept insurance or Medicaid.

Psychotherapy:

  • Cognitive behavioral therapy (CBT): This is the go-to psychotherapeutic treatment for a variety of mental illnesses, including anxiety and mood disorders as well as addiction. CBT is a leading form of one-on-one psychotherapy that focuses on questioning and changing negative and unproductive thoughts and beliefs in order to stop the triggers, behavior and underlying emotions that contribute to mental illness(s) and addiction(s). While very effective, CBT can also be expensive, costing $100 or more per hour, according to the Anxiety and Depression Association of America. Some therapists and clinics offer therapy on a sliding scale, which means they charge based on your income and/or insurance coverage; ask about payment options when you call or visit a therapist for an initial consultation.
  • Group therapy: This type of therapy is a lot like “talk therapy,” except that it typically involves a group of people with the same or a similar type of addiction or the same co-occurring disorders, such as depression and alcoholism. The therapist acts primarily as a guide, keeping the group conversation productive and focused. Group-therapy sessions typically last 90 minutes and cost roughly half as much as one-on-one counseling — between $35 and $80 per person, according to the American Group Therapy Association.
  • Family and couples therapy: Family therapy (also sometimes called multidimensional family therapy, or MDFT) is structured so that every member of the family has a voice. With the guidance of a professional therapist, the goal is to improve the interworking of each family’s relationships and their home life. In couples therapy, the therapist works with a couple dealing with an addiction to help both partners come to terms with the ways in which the problematic drug and/or behavior has hurt their relationship and find ways to reconnect, or, if necessary, part ways. According to the National Directory of Marriage and Family Counseling, rates vary from about $75 to $200 per hour, and some therapists will offer sliding scale fees based on income.
  • Drug therapy: Medication can be used to help ease symptoms of withdrawal and to prevent cravings that can lead to relapse (starting to use again); this is called medication-assisted therapy (MAT). Prescription drugs are also used in treating addictions to some drugs (specifically opioids like oxycodone and heroin and alcohol), tobacco and even video gaming.

Prescription drug coverage is what’s called an “essential health benefit,” meaning that under the Affordable Care Act it is required. That said, the specifics of exactly which medications will be covered vary by plan; some insurers offer different coverage for “preferred” drugs, for generics and for “specialty” drugs. If you take a prescription medication to treat a mental illness and/or addiction, check your insurer’s formulary (the specific list of the drugs included on your plan) to find out exactly what’s covered.

According to Consumer Reports, retail prices for commonly prescribed antidepres­sants, for instance, range from about $21 a month (sometimes even less) to more than $1,000 monthly.  Certain generic antidepressants may cost as little as $4 for a month’s supply through drug programs offered by large chains such as Kroger, Sam’s Club, Target and Walmart.

If you’re having trouble paying for medication that you need for an addiction or a mental health issue, there are several non-profit organizations that offer help with prescription costs, co-pays and premiums; these include NeedyMeds, Partnership for Prescription Assistance, RxAssist and RxHope.

Similarly, many pharmaceutical companies have patient-assistance programs that make available medication at little or no cost to uninsured patients. Visit the National Alliance on Mental Illness for a list of commonly prescribed psychiatric drugs and information about how to contact each pharmaceutical company directly to ask about their drug-discount programs. You can also ask if your doctor has any free samples of the drug(s) you’re taking.

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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