Essential Health Benefit
Under the Affordable Care Act, mental health services are considered an essential health benefit. All health plans sold through state marketplaces and that meet minimum coverage requirements are required to offer mental health services, including treatment for substance use disorders. However, each health insurance plan will have its own terms, with some plans providing better coverage than others.
As of the time of this writing, 43 states required insurance providers to cover substance abuse treatment. This is in addition to the ACA requirements. This means that most states require health insurance providers to cover substance abuse treatment, even if the ACA is repealed.
In-Network vs. Out-of-Network
Some health insurance plans require you to go to an in-network treatment center to receive covered treatment while others allow you to choose your own treatment program. It is usually less expensive to choose an in-network treatment program when one is available. Each plan’s in-network providers list is different, so it is important to check with your insurance provider to determine in-network providers.
Deductibles, Co-pays, and Limits
The cost of residential treatment programs will likely exceed your annual deductible. This means that you’ll be responsible for your annual deductible, any co-insurance, and co-pays that are applicable to your treatment under plan terms. If your health insurance plan has annual limits for certain types of services, you may only be eligible for a certain number of days of treatment each year or self pay for what’s over the plan’s limits.
May Not Cover All Services
Even if your health insurance company covers residential treatment, the provider may not cover all associated costs. Certain amenities, treatments, or add-ons could be billed separately. For instance, a health insurance company may cover counseling, room, and board, but deny claims for laundry and transportation services. Many treatment programs are knowledgeable about what charges are covered by insurance plans and what services are not.
New Hope Ranch works with most major insurance companies. We work with clients to ensure that they can receive the substance abuse treatment they need. To find out if your health insurance plan is accepted at New Hope Ranch, call (512) 534-9440. You can learn more about what makes our program unique.