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The Climb

Understanding Costs for Substance Use Disorder Treatment

Aug 14, 2017 4:49:00 PM / by Jon Dower, CIP, PR

Many families struggle to understand the cost of their loved one’s treatment. How much will it cost? Of these costs, what will my insurance cover? Are there any hidden fees? Will this leave me bankrupt? The stress of having an addicted individual in the family can be daunting enough on its own, and adding the stress of financing high-quality treatment can leave families feeling paralyzed. Here are a few things that can help you better understand the cost to your family:
First things first, do you have private medical insurance? Since the implementation of the Affordable Care Act, all insurance providers must extend their benefits to include substance abuse services. When determining the cost of treatment, it is important to first call the member services number on the back of your insurance card. If there is a specific number for substance abuse like in the image below, that is the correct number to call.

Once you are speaking with a representative you will want to ask a few important questions. First, you will want to check what type of substance abuse services your plan covers. These services may include inpatient treatment, partial hospitalization (PHP), intensive outpatient services (IOP), halfway houses, and/or outpatient services. All of these services are broken into two categories: in-network benefits and out of network benefits. Make sure to ask about your plan’s deductibles. With each member of the family, there will be an individual deductible and a family deductible (which considers all medical services performed in a certain calendar year for the entire family).
insurance-post-ins-card_orig.pngNext, you will want to ask about the insurance coverage for both in-network and out of network coverage. Typically, in-network coverage is 80/20, meaning once you have reached your plan’s deductible, your insurance provider will cover 80 percent of the cost of treatment and you will be responsible for 20 percent. 
Out of network can be 60/40, 70/30, or your insurance provider may not offer out of network benefits. Lastly, you will want to ask about your plan’s “out of pocket max”. The out of pocket max is the absolute maximum amount you would be responsible for paying.  Once this number is reached, your insurance provider may cover 100 percent of the costs of treatment (separate numbers for both individual and family). Knowing these numbers is an important start to understanding out of pocket, upfront costs (which may be requested at the time of treatment), and what you will be billed for later.

If your loved one needs inpatient treatment, it is important to make sure the referral source you are using has copies of your insurance card, as well as the birth date and social security number for both the addict, and the policy holder. (Ascension Recovery Services offers high quality referrals through our addiction intervention and SBIRT pathways) They can have your insurance preauthorized with the identified treatment center to give you the most up-to-date costs you may incur.

What if you don’t have insurance? This issue can certainly bring your stress level to an all-time high, but do not be discouraged. High quality inpatient treatment is available at affordable rates. There are two main types of inpatient treatment approaches: clinical inpatient treatment, and peer-driven inpatient treatment. Clinical inpatient treatment often provides detoxification services, residential services, and accepts insurance. These programs have licensed and certified staff that may include nurses, social workers, counselors, psychiatrists, recovery coaches, resident assistants (RAs), medical directors, and other support staff. These programs use peer reviewed, evidenced based treatment modalities during treatment.  Peer driven programs on the other hand, are often staffed by individuals that are in long-term recovery and may or may not have licensed or certified staff.  These programs frequently follow the direction from mutual support groups, like Alcoholics AnonymousNarcotics AnonymousRefuge Recovery, or are mindfulness or even wilderness driven.

One of these approaches doesn’t necessarily provide better outcomes than the other. Choosing between the two really depends on the addict, previous treatment attempts, clinical and/or medical diagnoses, costs, and a variety of other factors. We highly recommend having an addiction professional’s guidance when selecting the appropriate approach, especially if there are other mental health issues.  The cost of these treatment approaches varies widely. The average clinical 28-day inpatient treatment center will cost $28,000 or about $1,000 per day. These costs are not fixed, and a solid referral source may be able to negotiate the price substantially. The average cost we see for referrals using the clinical approach is around $15,000 for 30 days. Costs for peer driven programs have a wider range in price point, and the average is around $10,000 per month. Various factors drive costs – we’ve seen extremely high-quality services available for less than $7,000 and some that are $30,000 or more. It is important to know that some peer driven programs do not provide detoxification services, which will be required prior to the addict attending the peer-driven program. This should be considered when identifying the total cost of inpatient treatment.

When thinking about the total cost of treatment, please understand that inpatient is only one phase of the treatment process. Quality treatment requires continuity of care. This means that treatment should be followed by aftercare programs. I often suggest that only sixty percent of the families total available resources be spent towards inpatient treatment.  The other forty percent is to be spent on aftercare. These aftercare services include: intensive outpatient services, sober living, monitoring services, and individual counseling. Statistics show that the longer someone is in a programmatic recovery program, the higher their chances are that they will maintain long term recovery.      

Topics: Addiction Recovery, insurance coverage

Jon Dower, CIP, PR

Written by Jon Dower, CIP, PR

Jon is a certified intervention professional through the Pennsylvania Certification Board as well as a certified recovery coach and peer mentor specialist in West Virginia. He earned his degree in political science with minors in communications and addiction studies from West Virginia University. Jon has performed many successful interventions in Minnesota, Pennsylvania, Virginia and West Virginia. Leading the clinical services side of Ascension, his duties include interventions, management and working with the families of those in recovery. Jon builds relationships and coordinates with substance abuse treatment centers across the country. He places hundreds of individuals in the most appropriate facility yearly. Additionally, Jon serves as manager of operations of a non-profit sober living company with 32 beds in West Virginia.

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