Tips for Getting Addiction Treatment Covered by Health Insurance

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There are thousands of Illinois residents who need care for addiction issues and now more than ever they have access to addiction treatment through their health insurance. Gateway's goal is to help people understand their treatment options and their insurance benefits.

“Substance use is a treatable healthcare disorder - and people should know it is covered by insurance, similar to diabetes, hypertension and cancer.” - Michael Darcy, President & CEO, Gateway Alcohol & Drug Treatment.

Chicago-based Gateway Alcohol & Drug Treatment urges Illinois residents—even if denied health benefits for alcohol or drug rehab in the past—to check their current healthcare plan to determine if substance abuse treatment is covered by insurance. Now that federal parity laws, Illinois Parity, and The Patient Protection and Affordable Care Act have all taken effect, many health plans include the same coverage benefits for treatment of mental health/substance use disorders (MH/SUD) as they do for general medical and surgical treatment.

“There are thousands of Illinois residents who need care for addiction issues and now more than ever they have access to treatment through their health insurance. Our goal is to help people understand their treatment options and their insurance benefits” says Michael Darcy, President & CEO, Gateway Alcohol & Drug Treatment.

Here are the top five tips Gateway provides to those seeking coverage for drug or alcohol rehab their health plans:

1.    Know Your Illinois Parity Rights: In the state of Illinois, unless an insurance plan is exempt, large employer plans are required in each calendar year to cover the following for substance use disorders:

2.    Understand What Insurance Plans Must Follow Federal Parity Laws:

  •     Health plans sponsored by private and public sector employers with 51 or more employees, including self-insured and fully insured arrangements.
  •     All insurance plans sold inside and outside the state exchanges, which are available to individuals and smaller companies with 50 or fewer employees.
  •     Some state and local government health plans.

3.    Understand What Health Insurance Plans Do Not Have to Follow Federal Parity Laws:

  •     Medicare
  •     Individual plans not purchased through the health insurance marketplaces
  •     Group plans with 50 or fewer employees.
  •     Plans who received an exemption based on increase of costs related to parity.

4.    Look for a Reputable Treatment Center: Substance Abuse Treatment is a specialty service and it’s important your Financial Counselor is an accomplished expert who can work on your behalf to gain the most from your insurance coverage.

5.    Don’t Take No for an Initial Denial: If your health plan meets the criteria of state and federal parity, it’s important to realize an initial denial does not always mean no coverage is available. Knowledgeable Financial counselors may be able to obtain insurance coverage for treatment by exploring different avenues with your insurance company.

“Substance use is a treatable healthcare disorder - and people should know it is covered by insurance, similar to diabetes, hypertension and cancer.” says Michael Darcy.

For more insight into helping people take on their addiction issues, check out Gateway’s Roadmap to Understanding Substance Abuse at RecoveryGateway.org/Roadmap.

About Gateway Foundation Alcohol & Drug Treatment

Gateway Alcohol & Drug Treatment Centers provide substance abuse treatment services for adults and adolescents at drug treatment centers throughout Illinois and the St. Louis Metro East area. Gateway’s outpatient and inpatient treatment centers are licensed by the state of Illinois and accredited by The Joint Commission. Each year, Gateway’s professional clinicians help thousands of individual's successfully complete treatment. To learn more about treatment options or insurance coverage for treatment related to alcohol or drug abuse, call Gateway at 877-505-HOPE (4673).

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Kymberly Vasey
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healthcare laws, addiction treatment