American Family Insurance Coverage for Opiate Addiction Treatment

Addictions Content Team Info icon
Calendar icon Last Updated: 07/15/2019

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If you have been following the news, you know that America is in the middle of an opiate epidemic. Although heroin use is certainly a part of the epidemic, the driving force is prescription opiate use. And, it’s actually fairly common for people with prescription opiate addiction to transition into heroin use.

The American Society of Addiction Medicine reports four out of every five new heroin users began with misusing prescription painkillers. They believe this led to an increase in heroin overdose deaths, which almost quadrupled between 2000 and 2013. Between 2000 and 2010, the rate of increase was 6 percent a year, but the rate of increase between 2010 and 2013 was 37 percent per year.

Opiate use is one of the more difficult patterns to break and it generally requires professional, qualified rehabilitation. If you have American Family Insurance, you are interested in the effect that your policy will have upon the cost of your treatment. The following overview should give you some basic information, but because each policyholder has a different level of coverage, you are encouraged to contact us. Our representatives are insurance experts and they can walk you through the specifics of your individual coverage.

What Effect Has the Affordable Care Act (Obamacare) Had on Insurance Coverage for Substance Abuse and Mental Health Treatment?

Requirements for covering mental health and substance abuse treatment have been increased; they now require amounts of coverage comparable to other levels of medical care. All plans in the Marketplace are required to:

  • Cover substance abuse treatment
  • Offer coverage even in instances of pre-existing conditions
  • Refrain from putting a yearly or lifetime dollar limit on coverage of substance use disorder services

These changes have led to increases of substance abuse rehabilitation in other insurance programs, like American Family Insurance.

Does American Family Insurance Cover Treatment for Opiate Addiction?

Most of the policies offered by American Family Insurance cover treatment for opiate addiction. Now, the degree of coverage will vary from plan to plan. You will want to check into medication, psychotherapy, and inpatient or outpatient coverage. As opiate addiction is incredibly difficult to treat and often requires medication, like methadone, you may need both inpatient care and medication-assisted treatment. Most plans will cover these options.

How Much of the Cost of Treatment Will American Family Insurance Cover?

Different levels of treatment will be covered depending upon the program and the individual policy. By researching your coverage, you can prepare for any out-of-pocket expenses and reduce them. There will often be a relationship between the level of coverage for substance abuse treatment and treatment for other serious medical conditions, meaning co-pays, deductibles, and maximum per-day costs will have some level of coverage.

Is It OK for Me to Pay Above What American Family Insurance Covers?

Depending upon the policy, you may be entitled to complete or partial coverage. It is unlikely that your American Family Insurance Policy will cover 100 percent of the treatment. Often, policies demand that you meet a minimum co-pay and deductible before insurance coverage commences. When you select a treatment facility, meet with the financial department to determine your coverage and establish how much you will have to pay in order to obtain the level of treatment you desire. One way to get the most coverage is to remain in-network. However, if you are able to cover additional expenses and you find a program that will require it, you are more than welcome to pay out of pocket.

Should I Choose Inpatient Treatment?

As mentioned earlier, opiate addiction is difficult to treat. For this reason, you should have some form of professional treatment and the two basic models are inpatient and outpatient care.

Inpatient, or residential, treatment involves living at the rehab facility, where you are given care 24 hours a day. In this safe environment, you are kept in a state of strict sobriety and separated from the environmental and social cues that cause and continue your opiate use. However, this form of treatment is more expensive and will involve a complete absence from your established daily life.

If you feel that inpatient care would best meet your needs, you need to determine the level of coverage that American Family Insurance will provide and we can help you to do that.