Last updated: 04/2/2019
Author: Addictions.com Medical Review
Reading Time: 4 minutes
When the Affordable Care Act, also known more casually as Obamacare, was passed in 2014, it had an effect on your APS insurance coverage for drug and alcohol addiction treatment. It introduced ten essential benefits, ten categories of services and items that must be included on every small group and individual insurance policy, including your APS policy. Of course, different policies will provide different levels of coverage, but the Act ensures that you will not be denied services or charged exceedingly for them. You also will not be subjected to lifetime dollar limits that would otherwise stand in the way of your receiving care.
The Act emphasizes what they term “parity,” which is the treatment limits placed on medical and surgical services must be no more accessible than those placed on drug and alcohol treatment services. You will be given the same level of coverage for your drug and alcohol treatment as you would for any other medical condition that might present itself.
According to the Substance Abuse and Mental Health Services Administration, among those entering substance abuse treatment in 2006, roughly 33 percent were unemployed; that number rose to roughly 41 percent in 2011. The increase can be attributed to the greater access to insurance provided by the act. The lack of insurance would previously have kept people out of treatment. Now, that difficulty has been alleviated for many, many people.
But, this isn’t all about the Affordable Care Act; this is about what level of coverage you can expect from your APS insurance policy. Some common questions will be answered in this post, but you will probably be left with questions that can only be answered by experts consulting your exact policy and that is something that we can provide.
Can You Depend Upon APS to Cover the Costs of Drug and Alcohol Addiction Treatment?
As the introduction stated, you can certainly count on APS to offer some level of care. But, there are many types of treatment and APS may not cover all of them. Treatment types include:
Your policy may cover only one of these, or you may be able to pick and choose among them. All APS policies are different, and ultimately those are what determine what you can expect.
When you are ready to seek treatment, you will generally go about getting costs covered in the following way. You will need to see a doctor and have your problem diagnosed. Then, that doctor will recommend a treatment type. Based on that recommendation, you will contact appropriate programs. When you find the right one for your needs and your finances, you will have the program gain pre-authorization. After that, you can be sure that you will receive some coverage.
How Much of the Treatment Costs Will APS Cover?
Thanks to the Affordable Care Act, you can be confident that APS will provide the same coverage for your substance abuse treatment that it would for any other medical condition. This means that you probably already have some idea of your level of coverage because you have used your policy in other similar situations. You can rest assured that the policy will cover whatever is considered medically necessary, but as that will differ from individual to individual, so will the amount of coverage. No policy, however, will completely cover 100 percent of the cost associated with drug and alcohol treatment.
How Long Will My APS Health Insurance Cover My Treatment?
As you certainly know, there are different lengths of treatment that are recommended based on individual needs. Drug and alcohol treatment may take 28 days or may extend for 120. Although the Affordable Care Act will prevent a lifetime limit from excluding you from care, you may still meet per-occurrence and per-day maximums as part of your policy; these maximums will limit the length of treatment that you can anticipate having covered. In order to fully understand what length will be covered, study your policy and communicate with experts.
Can I Pay More Than the Costs Covered by My APS Health Insurance?
Many people worry that paying expenses out of pocket may have a negative impact on their insurance coverage. Don’t worry; this isn’t the case. In fact, you will find that you have to make some out of pocket payments as part of your insurance coverage. For example, copays and deductibles place the burden of payment upon you.
You may end up paying additional cost if you decide that you would like luxury treatment, treatment for longer than coverage is provided for, or out of network treatment. The cost associated with these changes will fall to you to pay.
If you feel that your financial responsibilities may end up being exorbitant, there are ways to limit what you are responsible for. Opt for in-network care. Be sure to speak with the financial department of the treatment center you are considering attending and fully explore the amount of insurance coverage you will receive against what would be covered elsewhere. Make the most of your APS insurance.