Last updated: 04/2/2019
Author: Addictions.com Medical Review
Reading Time: 3 minutes
Thanks to the Affordable Care Act, or Obamacare as it is commonly known, there are ten categories of services and items that must be included on all small group and individual health care plans. Included among them are mental health services and addiction treatment. All plans cover services differently but the law no longer allows people to be denied care or charged more for care. Nor can you be prevented from receiving care because of annual lifetime dollar limits.
This is fantastic news for you because it means that limits applied to substance abuse treatment can’t be any stricter than those applied to surgical and medical services. American Family Insurance will provide you with the same access to drug and alcohol treatment that they would any other medical condition.
In 2009, only 11.2 percent of the total number of people who needed treatment for a drug or alcohol abuse problem received care, and access to health insurance was a contributing reason for the disparity between the number of people needing and the number receiving care. That has been addressed.
You may be happy to learn that these changes have taken place, but you may still question how much coverage you can expect when you choose to attend drug and alcohol treatment. The following will answer some of your questions. However, for information that relates specifically to your individual policy, you are encouraged to call us and speak to an insurance expert.
Does American Family Insurance Cover Drug and Alcohol Addiction Treatment?
You can rest assured that it does, as explained in the introduction. However, there are many types of treatment, including:
- Detox programs
- Inpatient programs
- Outpatient programs
- Aftercare programs
- Care specifically from a therapist or doctor
The kind of care that is covered will be determined by your specific policy. So, though you are entitled to coverage and it will be offered, you can’t expect all American Family Insurance coverage to be identical.
Once you have been diagnosed by a doctor, they will recommend a course of treatment. Next, you should work with a care provider to receive pre-authorization., When this is completed, you can feel comfortable knowing that a percentage of your care’s cost will be covered by your policy.
What Amount of Treatment Costs Are Covered by American Family Insurance?
Because of the parity between drug and alcohol treatment and other types of medical problems, you should have some idea of how much will be covered if you have had previous medical care. How your policy treats these events will cause your coverage to differ. You should safely expect that your coverage will extend to what is deemed medically necessary. Keep in mind that no policy will cover 100 percent of the costs.
Can I Pay The Difference Between the Total Cost and the Amount Covered by My American Family Insurance Policy?
Even when your insurance coverage is maxed out, you are perfectly able to pay for additional costs out of pocket, and it will not in any way affect your insurance coverage. If you feel that you would benefit from longer or additional treatment, you are welcome to cover those cost. In addition, there are costs that you will be required to pay before coverage is even extended, like deductibles and co-pays.
The policy you hold will determine how much coverage you can expect to receive. Choosing care that is considered in-network will always be the less expensive option. Meet with the financial department of the treatment program to get the most detailed overview of what will be covered in that specific situation. If it is beyond your means, research alternatives. Also, many places take credit cards or extend financial assistance; be sure to inquire.
What Treatment Length Will Be Covered?
Drug and alcohol treatment programs can be as few as 30 days or as long as 90 days. The coverage amount you can expect depends on the per-day and per-occurrence maximums on your policy. You may also encounter a lifetime maximum, but the Affordable Care Act should make it so that you cannot be barred from care because of lifetime limits.