Traditionally, health insurance offered very little coverage for treatment of cocaine addiction. However, the institution of the Affordable Care Act (Obamacare) ushered in a slew of health care reform laws in 2014 and changed the way that substance abuse treatment is covered by small group and individual policies. Mental health and substance abuse treatment are now considered one of ten essential benefits of care. They must be provided for. For this reason, you can depend upon APS to offer you a level of coverage.
This change in coverage has been great news for the hundreds of thousands of Americans with a cocaine use disorder. According to the National Survey on Drug Use and Health, roughly 913,000 people in the United States meet the Diagnostic and Statistical Manual of Mental Disorders criteria for cocaine abuse or dependence in 2014. For those scores of people, improved access to professional, structured treatment could literally be a lifesaver.
Knowing that you can go to treatment, isn’t the same as knowing where to go or how to get APS to cover the expenses. You need help. For assistance understanding the specifics of your policy and to compare it to treatment offerings from appropriate treatment facilities, call 800-654-0987. Our representatives have years of experience in both addiction medicine and health insurance coverage.
Does APS Insurance Cover Treatment for Cocaine Addiction?
Yes. As mentioned, health care reform laws guaranteed that you will receive coverage for the level of care deemed medically necessary. What, however, is considered necessary will depend upon a number of factors, including your policy, your plan, and the state in which you live. Another consideration is the treatment program to which you intend to apply coverage. For example, in-network providers have contracts with APS that keep payments for services low. If you choose an in-network provider, you will receive a higher level of coverage than you would out-of-network.
How Much of the Treatment’s Cost Can I Expect APS Insurance to Cover?
Another benefit of the health care reform laws was the institution of what are called “mental health parities,” which require a level of coverage equivalency between services for substance abuse treatment and the treatment of any similar medical condition. IF you have been hospitalized or treated for a chronic disease and used your APS insurance to cover cost, you have some idea of how much coverage you can expect. To fully understand the amount of care your policy will extend to, you will need to do some research.
Can I Pay the Difference Between Total Cost and that Covered by My Insurance?
Naturally, you will be paying for some portions of the treatment yourself. There are no policies that pay for every single aspect of care. As with any other treatment program, you can expect to pay out-of-pocket for things like copays and deductibles and to have coverage limited by per-day and per-stay maximums.
You may also incur additional out-of-pocket expenses by choosing to lengthen or enhance your treatment. If you, for instance, felt 90 days of treatment would be better for your cocaine addiction treatment, but APS would only cover 30, you could choose to pay the difference. The same would be true if you upgraded to a luxury residential program. Ad mentioned earlier, out-of-network providers will also receive less coverage and leave you paying a larger percentage of the total cost out-of-pocket.
Is Outpatient Care Covered?
Yes. In fact, it is more likely to be covered.
Outpatient care is defined as care that care which does not require you to live at the facility where treatment is provided. You get to attend therapy or classes or both daily or multiple times per week and return to your job, family, and home afterwards. For people with demanding jobs, parenting responsibilities, and strong social networks, this type of care is preferable. It is also less expensive.
In addition, it is more commonly provided than inpatient care. Research gathered by the 2013 National Survey of Substance Abuse Treatment shows roughly 82 percent of the responding treatment facilities offered outpatient treatment, while only 24 to 28 percent offered non-hospital inpatient care. This is the most common type of treatment available.
Because cocaine withdrawals are relatively mild and cocaine treatment relies more heavily upon therapy than any other method of care, outpatient care works beautifully. For more information about the coverage provided by your APS policy, give us a call at 800-654-0987. Get started today.