Paying for Drug and Alcohol Detox with Health Insurance

Published: 01/26/2018 | Author:

You may be concerned that your insurance will not cover certain services, especially in relation to substance use or mental health. The Affordable Care Act (ACA) changed the coverage concerns related to substance use disorder treatment, including detox with health insurance coverage.1 While each insurance company and plan will be different, detoxification can actually be a cost-effective service for insurance companies to provide. You have several options to begin your alcohol or drug detoxification process.1

In this article:

Signs You May Need Drug and Alcohol Detox

Anyone can benefit from professional detox if their withdrawal symptoms are distressing enough. There are, however, certain substances that may require medical detox. Medical detox is an intensive inpatient detox option that provides 24-hour, 7-day-a-week medical supervision and care.

Alcohol, benzodiazepines, and barbiturates, as well as opioids, have particularly difficult withdrawal syndromes that may require medical detox. These withdrawal symptoms can be severe and life-threatening. Examples of dangerous or severe withdrawal symptoms that may require medical treatment include seizures, hallucinations, delirium tremens (severe alcohol withdrawal), tremors, or excessive vomiting leading to electrolyte imbalances.2,3

You may want to consider medical detox if you have:

  • A severe addiction
  • A poly-drug addictions
  • A co-occurring mental health disorder, such as borderline personality disorder or depression
  • A comorbid medical disorder, such as diabetes or heart disease
  • A history of withdrawal seizures or severe withdrawal

The best way to know if you would benefit from detox is to receive a professional assessment from a treatment provider. But as a starting off point, you can consult the criteria for a substance use disorder. If you have six or more of the below symptoms, you likely have a severe substance addiction and may need medical detox:2

  • Experiencing unsuccessful attempts to reduce or control alcohol or drug use
  • Cravings for alcohol or drugs
  • Drinking or using the substance more or more often than intended
  • Giving up or reducing important life activities due to alcohol or drug use
  • Experiencing social or interpersonal problems caused by drug or alcohol use
  • Developing a high tolerance to drugs or alcohol
  • Experiencing withdrawal symptoms when abstaining from substances
  • Continuing to consume alcohol or drugs despite physical or psychological problems caused by use
  • Using higher amounts of substances or for longer than originally planned
  • Using substances in dangerous situations, such as while driving
  • Spending a significant amount of time using or obtaining substances, as well as recovering from effects

Recovery is possible—call today to find a detox program that’s right for you.

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Choosing to Enter Detox

Entering detox is the first step on the continuum of care for substance abuse treatment, but it is just that—a first step. Programs have agreed on general guidelines and essential components of the detoxification process.

There are medical and social models of detoxification, but most programs take on a combination of the models, meaning that medication management helps ease withdrawal symptoms, along with supportive measures to address mental health concerns.

The three general components of detoxification include:4

  • Evaluation: Assessing for the presence of drugs and alcohol in the bloodstream, measuring substance concentration, and evaluating for co-occurring medical and psychological conditions.
  • Stabilization: Managing acute intoxication and drug or alcohol withdrawal with the goal of achieving a substance-free, medically stable state.
  • Fostering readiness for entry into substance use treatment: Preparing the patient to transition into a drug or alcohol addiction treatment program by emphasizing the importance of moving through the continuum of care.

Finding a Detox Program That Accepts Your Insurance

Now that you’ve made the decision to enter a detox program, you’ll want to narrow down your search by choosing a program that accepts your particular insurance provider and plan. One way to do that is to login to your provider’s site and find a list of in-network detox programs through their database.

If you’re not super tech-savvy or would rather speak to someone, call the number on the back of your insurance card. You can speak to a representative who will assist you in finding detox with health insurance.

Another option is to call our confidential helpline at 800-483-2193(Who Answers?). We are available 24/7 and are able to verify your health insurance as well as find the right detox program for you.

Services Offered in Detox Facilities

The ultimate goal of detoxification is to stabilize you and clear your system of drugs and alcohol, so you can continue your care. Professional detox lasts anywhere from a few days to a couple of weeks, depending on the substance and any complications. Detoxification can be done in various settings and levels of care, such as inpatient medical detox, inpatient social detox, and outpatient, and should be tailored to your particular needs.

Below are services that may be offered at your detox program:

  • Medication management to ease withdrawal symptoms and cravings
  • Symptomatic medications for additional symptoms
  • Supportive treatment, such as IV fluids
  • Nutritional counseling, if necessary
  • Case management services
  • Referral to addiction treatment

However, the detox process does not address the psychological, emotional, or behavioral problems associated with addiction, and without additional treatment, lasting changes are unlikely.5 Therefore, it is recommended to follow up with a detox program with an inpatient, intensive outpatient, or partial hospitalization program.

Detox with Health Insurance

Paying for detox with health insurance is not only possible but probable. Health insurance coverage should generally cover at least a portion of any substance use treatment, including detox.

Just as with medical coverage by insurance, your specific coverage will vary by your plan’s benefits. The Marketplace requires that insurance coverage include mental health and substance use treatments as essential. Marketplace insurance also cannot put any dollar limits of coverage for essential services, such as substance use and mental health treatment. Keep in mind that coverage will still depend on the plan you choose and the state in which you are located.6

Private vs Public Health Insurance

Insurance can generally be divided into two categories: private and public.

Private health insurance consists of employer-covered insurance, direct-purchase (i.e., Marketplace), and TRICARE, which is offered to military members and their families.

Public health insurance includes Medicare, Medicaid, CHAMPVA, and VA. Medicare is given to individuals 65 and older and some individuals with long-term disabilities who are under 65 years of age.

Medicaid offers coverage for low-income individuals administered by the state, including CHIP. CHAMPVA and VA are for Veterans and their families, as well as the Civilian Health and Medical Program of the Department of Veterans Affairs.7

Regardless of whether you have private or public health insurance, you should have partial or full coverage for detox services.

Substance Use Treatment Coverage

Since the Affordable Care Act (ACA) was implemented, more substance use costs have been covered, especially in states that chose to expand their Medicaid coverage.8

Regardless of the insurance plan or type, any plan available on Marketplace will include the essential mental health and substance use coverage.9 To receive coverage, your insurance company may require you to use their in-network detox programs.

The United States Department of Health & Human Services defines essential coverage by the state’s benchmark plans. You can take a look at your state-required benefits here.

The Centers for Medicaid and Medicare Services (CMS) reports they cover substance use inpatient stays, including detox. Generally, they report a limit of five days for detox, but if you have documentation by a physician showing longer detoxification was necessary and reasonable, then they will cover it.

CMS also states that while the detox process needs to be inpatient, not all substance use treatment requires inpatient services. It must be shown that it is medically necessary to require that level of treatment versus an outpatient service, such as intensive outpatient (IOP), partial hospitalization (PHP), or standard outpatient detox.10

If you are unsure whether your detox with health insurance will be covered, each insurance company is required to provide you with a short and simple Summary of Benefits and Coverage (SBC).11

Using FSAs and HSAs to Cover Detox

Your employer may offer Health Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs). The amount you or someone else can contribute to these tax-exempt plans depends on various factors. Qualified medical expenses that you can use your FSA or HSA for are generally considered the same as the IRS medical and dental expenses deduction.

Medical care must be to reduce medical or mental health-related illness. This includes the diagnosis, treatment, or prevention of the illness or disease. Therefore, drug and alcohol detoxification should be covered as a qualified medical expense for which you can use your FSA or HSA card. Once again, always check your coverage before services, and you may have payment limits depending on your flexible spending or health savings account.

To speak to a specialist about addiction recovery services—like drug or alcohol detox—call 800-483-2193(Who Answers?). We are available 24/7 to help you.

Resources

  1. Abraham, A. J., Andrews, C. M., Grogan, C. M., D’Aunno, T., Humphreys, K. N., Pollack, H. A., & Friedmann, P. D. (2017). The Affordable Care Act Transformation of Substance Use Disorder Treatment. American Journal of Public Health, 107(1), 31-32.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
  3. National Library of Medicine. (2021). Alcohol Withdrawal.
  4. Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  5. National Institute on Drug Abuse (2018). Types of Treatment Programs.
  6. Healthcaregov. Mental health and substance abuse health coverage options.
  7. Keisler-Starkey, K., & Bunch, L. N. (2021, September). Health Insurance Coverage in the United States: 2020.
  8. Andrews, C. M., Pollack, H. A., Abraham, A. J., Grogan, C. M., Bersamira, C. S., D’Aunno, T., & Friedmann, P. D. (2019). Medicaid coverage in substance use disorder treatment after the affordable care act. Journal of Substance Abuse Treatment, 102, 1-7.
  9. Healthcare.gov. What Marketplace health insurance plans cover.
  10. Centers for Medicare & Medicaid Services. Inpatient Hospital stays for treatment of alcoholism. CMS.gov.
  11. Healthcare.gov. Summary of Benefits and Coverage.
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