Guide to Utilizing Insurance for Drug & Alcohol Addiction Treatment

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Since the Affordable Care Act has taken effect, many more Americans have been able to obtain health insurance. With mental health parity legislation, many more insurance companies are providing mental health and substance abuse treatment benefits to their insured members. This article will provide guidance on how to select an insurance plan if you know you are going to be utilizing your health insurance for drug and alcohol treatment and how your insurance will help you in affording substance abuse treatment.

Many health insurance plans are on a calendar year meaning that your policy will renew on January 1st of the following year and with your policy renewal you will be subject to your full deductible and coinsurance for the new policy year. If you or a loved one is searching for addiction treatment in November or December and some of the treatment episode will take place the following year, you may want to review your insurance policy prior to the renewal to ensure:

  • Your policy has substance abuse and mental health treatment benefits
  • The drug and alcohol treatment center you intend to enroll in is able to accept your health insurance (is the facility in-network or out-of-network?)
  • You select a low deductible insurance policy with a low out-of-pocket maximum. Even after you meet your deductible you will still have to pay co-insurance up to your out-of-pocket maximum so it is important to pay attention to this number.

If you are in need of substance abuse treatment services and you are in a high deductible health insurance plan, you may be able to switch to a more advantageous plan under the provisions of the Affordable Care Act. Typically, open enrollment is limited to Nov. 1st-Jan 31st time period. However, if you have a “qualifying life event” you can enroll in a new health insurance plan outside of this time period. Examples of qualifying life events are:

  • Moving to a new state (even if for treatment)
  • Losing other coverage (loss of job, dropping out of school, aging off of a parent insurance plan)
  • Leaving incarceration
  • Marriage
  • Divorce
  • Child Birth

In the event of any of the above circumstances, you may qualify to enroll in a new health insurance plan during a “special enrollment period.” This would allow you to choose more advantageous insurance coverage for your medical condition (i.e. drug and/or alcohol addiction or abuse) and allow you access drug and alcohol treatment at a lower out of pocket cost.

Please keep in mind that in-network drug and alcohol rehab centers are going to have a lower out of pocket cost than out of network addiction treatment centers. However, out of network providers are typically able to provide more individualized and comprehensive addiction treatment services.

NorthStar Transitions is a Colorado state licensed addiction treatment center and is out-of-network with all major insurance companies including Anthem Blue Cross Blue Shield, United Healthcare, Cigna, Aetna, Humana, Compsych, Value Options and others.

NorthStar offers high-end sober living homes in Boulder, Colorado as well as Partial Hospitalization and Intensive Outpatient Addiction Treatment. If you would like NorthStar to perform a verification of benefits on you insurance to see if we can help you obtain coverage for addiction treatment or our sober living program, please complete the verification of insurance benefits form located here.