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Will my health insurance pay for substance abuse treatment?

Amy Higgins

Those who need a hand with substance abuse treatment may be able to turn to their insurance providers for help. While coverage gaps still exist, recent laws (including the health care reform law) aim to expand alcohol and substance abuse treatment coverage to more insured Americans.

Coverage for substance abuse

Substance abuse treatment generally falls under an insurance plan’s mental and behavioral health coverage. For many group health insurance plans (such as those offered by employers), the Mental Health Parity and Addiction Equity Act comes into play.

This act requires group health insurance plans covering more than 50 employees to make sure their coverage for mental health issues is equal to that of their coverage of physical health issues, according to the U.S. Department of Labor. Group plans are not required to include mental health coverage — but, if they do, coverage cannot be more restrictive than it would be for medical and surgical care. Moreover, these group plans are not allowed to have separate deductibles, restrictions on the number of visits and higher co-payments for mental health care.

The Mental Health Parity and Equality Act does not, however, apply to small businesses with fewer than 50 employees or to individual health insurance policies. Some individual policies do offer mental health insurance coverage, including substance abuse treatment. And about two-thirds of substance abuse treatment centers accepted private insurance as of 2008, according to a January 2011 survey.

If you do have an individual policy, call your insurer to find out what kind of coverage you have. Your state’s laws may dictate what private plans are required to cover. Cigna, for example, covers alcohol and drug abuse treatment under certain circumstances (depending on your policy), but does not cover smoking-cessation programs. It also does not always cover court-ordered treatment unless it meets the insurer’s medical necessity standards.

Things will change for many when the health care reform law’s health insurance mandate goes into effect in 2014. At that time, insurance policies will be required to offer certain essential benefits, including substance abuse disorder treatment. However, the exact covered services have not been specified yet.

Misconceptions about addiction

There is a “great divide” between “mainstream” health care and treatment for addictions, according to the White House Office of National Drug Control Policy. Substance abuse all too often is discounted as a serious disease. But without proper treatment, the lives of addicts could be in danger. The mainstream health care system, according to the White House office, often uses only intense, short-term interventions like detoxification to treat addiction, whereas other serious conditions receive attention from several specialists who treat patients with stringent care, specialized medicines and follow-up visits.

Although more thorough substance abuse treatment is expensive, so is allowing addiction to go untreated, according to the White House office. Drug and alcohol abuse strains the economy, the health care system and the criminal justice system. According to the White House office, drug abuse cost the United States $193 billion in 2007.

For some, turning to family, friends and free local addiction groups for substance abuse help can be extremely beneficial — but others need more specialized care. Making substance abuse care more widely available could provide addicts a better path to recovery.

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