Last updated: 04/2/2019
Author: Addictions.com Medical Review
Reading Time: 3 minutes
Alcohol use disorders all look a little bit different. Some alcoholics can barely maintain their job and their social relationships and other have a high degree of functioning. Some drink all day and others don’t even drink daily. Because of this, it can be hard to admit to yourself that you have a problem. But, if you can’t limit your drinking, even when it causes bad things to happen, you are an addict and you deserve the best addiction treatment program possible.
A lot of people who need treatment don’t get it. Why were so few people getting help? A lack of insurance was a contributing factor. According to the Substance Abuse and Mental Health Services Administration, roughly 6 in 10 drug treatment admissions stated they had no health insurance. But, changes instituted by the Affordable Care Act have had sweeping ramifications, making addiction treatment insurance coverage greater than ever before.
Your APS health insurance will allow you to seek treatment and cover many of the associated costs, which is wonderful. But, you probably have a lot of questions about both funding and treatment. The following information will answer some general questions. For more specific answers about your policy and its applicability to specific programs, contact us.
Does APS Insurance Cover Alcohol Abuse Treatment?
Yes. Due to the changes made by the Affordable Care Act, all individual and small group policies must provide ten essential services and items to all carriers, and substance abuse treatment is one of them. You can depend upon a level of coverage that is consistent with the level you would receive for any other medical condition or hospitalization. This is what is called parity, and it is the law.
Treatment for alcoholism takes many different forms. Some of the more common are inpatient and outpatient care, but you might equally benefit from detox, aftercare, and medications-assisted programs. For this reason, it is important that you determine which types of care your policy covers.
Each policy will provide a different level of coverage and factors like the specific plan and the state you live in will have an effect on your coverage. As will the treatment facility you intend to attend. Expect less coverage for out-of-network treatment.
How Much of the Treatment Will APS Insurance Cover?
APS will cover each type of care at a different level and learning more about your policy will give you a better idea of the kind of coverage you can count on. You can depend upon the costs you pay following the same patterns you would face with any similar medical condition, so if you have dealt with such a situation before, you might have some idea of the amount of coverage available to you. Clearly, you can expect copays, deductibles, and per-stay and per-day maximum limits.
If APS Insurance Doesn’t Offer Me Full Coverage, Can I Pay the Difference?
Obviously you know that you will be responsible for certain portions of your treatment’s cost, like copays, etc. But, you may also make a choice about treatment that places you outside of the coverage offered by your APS policy. For instance, you may be covered for a 30-day stay, but prefer a 90 day one. Your insurance will cover days 1-30 and you will have to cover 31-90. In these instances, you are more than welcome to cover the cost yourself with no effect on the coverage offered by APS.
How Can I Make the Most of My APS Insurance Coverage?
Alcohol addiction treatment is not inexpensive. You will face high costs. But you can limit what you have to pay out-of-pocket by remaining informed. By researching your policy, you can determine your level of coverage for various courses of treatment and you can pick the one that offers the most benefit with the lowest cost.
You should also stay in-network because those providers have contracts with APS that keep their rates lower that out-of-network providers.
Another important step is consulting with experts. Out representatives know the ins and the outs of insurance coverage for alcohol addiction treatment. Call and get the expertise you need to make the most of your APS policy.