Insurers take responsibility for covering the cost of addiction treatment because they recognize the ill effects of substance abuse.
The Health Care Services Corporation is the largest health insurance company in the United States that is consumer owned. They offer many different packages through Blue Shield and Blue Cross. Since HCSC is consumer owned, it can keep its costs down because there are no stockholders. It also takes a serious approach to addiction treatment, seeing it as a chronic illness. Since addiction is viewed as an illness, they offer coverage for treatment as well.
This insurance company is unique and offers a huge array of plans. Exactly what they cover can vary greatly depending on your own personal needs and plan. You may receive cover for some or all of your detox and rehab needs.
HSCS Insurance Coverage for Detox
The Essential Health Benefits element of your HCSC insurance policy contains a Substance Abuse Disorder section that will tell you what you are covered for. Generally speaking, detox, which is the first step towards recovery, is covered as well. Detox takes around 10 days and will require a degree of medical supervision, but you may have a copay or deductible to meet first, however.
In many of the HSCS plans, a percentage of the bill will be covered through coinsurance. This means they will pay for a percentage, and you will have to pay the rest. There could also be limitations in terms of how often you can go through detox, so do make sure you look into this if this is not your first time.
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HCSC Insurance Coverage for Rehab
Your HCSC policy’s Essential Health Benefits package will tell you which rehabilitation services are offered. Usually, there is coverage for both residential and outpatient rehab. HCSC encourages its members to attend outpatient rehab, but you can be covered for residential treatment if you have medical documentation. If this is your first time going to rehab, you will generally be covered. However, if you have had treatment before, you may find it somewhat more difficult to have the treatment paid for. Make sure that you speak to a company representative and to the provider first.
HCSC Insurance Coverage and Length of Treatment
Every person suffering from addiction needs a different kind treatment; a residential treatment will lasts from 30 to 90 days, and in severe cases, it can be longer. How much of this will be covered will be depending on your insurance plan.
HCSC Insurance Coverage for Specialty Treatment
Some people feel that they will be better served in a more luxurious environment. No insurance company, including HCSC, will cover the additional costs for high end amenities, because there is no evidence of their medical necessity. However, HCSC may cover the medically necessary element of luxury rehab, which means you have to make up the difference.
Some people choose to go to luxury rehab facilities because they have far better amenities. These include gourmet meals, private rooms, massage, acupuncture, aromatherapy, and spa treatment. There are also executive facilities, which are designed to enable people to receive treatment while still remaining in contact with their work.
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HCSC Insurance Coverage for Residential and Outpatient Treatment
In general, HCSC will prefer that you attend outpatient treatment, but they will also cover you for inpatient treatment. You are more likely to receive full coverage if you attend outpatient treatment, but some plans also offer 100 percent coverage for residential facilities.
What coverage is available to you will depend on the stipulations and guidelines in your own plan. You may also have limited coverage if you want to go to an out of network facility. Your plan will come with a Summary of Benefits that explain exactly what you will and will not be covered for. Make sure that you look into whether your chosen provider is part of the HCSC network before you start. If you have any questions about this, an HCSC representative will be more than happy to clarify issues for you.
Regardless of whether you go to outpatient or residential treatment, both will start with you going through detox. After detox, there will be a period of intensive group, individual, and family therapy. These counseling sessions are designed on making sure you learn how to change your behavior and responses to triggers, thereby avoiding relapse later on in life.
With residential treatment, you will actually live in the facility for the duration of your treatment. During that time, you will be monitored around the clock. You will also be away from all the temptations of regular life, while also being surrounded by your peers. Inpatient treatment has been demonstrated to deliver better outcomes, including lower relapse rates.
However, some people prefer outpatient settings. They may have significant responsibilities at home that cannot be overcome. Outpatient treatment is also significantly cheaper.
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When You Have Some Out of Pocket Costs
If you find that your HCSC plan does not cover your treatment, or not in full because you have already had treatment but you have relapsed, if you want to go to luxury or specialty rehab, or if you want to go to an out of network or out of state provider, there are other options available to you. Most rehab facility give you the ability to enroll in a payment plan with them, usually on a sliding scale depending on your income.
The cost of treatment is a major barrier to many people who need treatment for their addiction. Addiction is a debilitating chronic illness that affects every element of people’s personal life, that of their family and loved ones, and that of society as a whole. While finances must be something that you think about, they should not stop you from getting help. Options are always out there, and you need to see going to treatment as an investment in your future. Without it, you will remain on the downward spiral that may even result in death.
By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.