The main difference between inpatient and outpatient treatment is that the latter requires attendance only during treatment sessions. Once the sessions have been completed, the client can return home and carry on with their normal lives. Inpatient treatment programs require individuals to remain on site and stay in the facility.
Most insurance plans offer some form of outpatient treatment for alcohol use disorder (AUD). However, the individual’s insurance policy may not cover the entire cost of treatment, but it will cover at least some of the costs.
This is because Affordable Care Act (often referred to as Obamacare), passed in 2010, made stipulations that insurers must provide essential health benefits as part of their overall service packages. The term “essential health benefits” is based on the definition from the National Academy of Medicine that designates the services as including mental health treatment, behavioral health treatment, and treatment for substance use disorders.
What is the Affordable Care Act?
The Affordable Care Act (ACA) also extended the policies provided by the Mental Health Parity and Addiction Equity Act that required insurers to provide the same level of benefits for mental and behavioral healthcare treatment that they do for other primary health care services.
This means that under the ACA, both private and group insurance companies need to provide these benefits, and the level of coverage provided for the treatment of substance use disorders, such as alcoholism, should be equivalent to the level of treatment provided for other primary health care issues.
Thus, most insurance companies should cover at least some of the cost of outpatient treatment for AUD. Specific behavioral health benefits may vary depending on your state and the health plan you choose.
Types of Services That May Be Covered
The ACA was enacted to ensure that individuals would be provided with sound standard healthcare policies by insurers and that individuals who had pre-existing conditions (health conditions that were present before the person signed up for the policy) would not exclude someone from coverage. Therefore, even though an individual may have been developing an alcohol use disorder for years before signing up with an insurance company, they cannot be denied benefits.
Most insurance companies require some form of copay for treatment services and some policies may have deductibles or certain amounts that individuals must pay out of pocket prior to getting coverage for services. Once the deductibles are reached, then the insurance policy begins to cover services and provide benefits. Individuals should check with a customer service representative from their insurance company regarding their financial responsibility for different forms of outpatient programs for alcoholism.
Many insurance companies will provide some coverage for outpatient programs, including:
- Withdrawal management or medical detox programs: This includes treatment within a supervised medical detox facility and withdrawal management programs that require the use of medications to control withdrawal symptoms.
- Other medications used in the treatment of alcohol use disorder: Typically, insurance will provide coverage for medications that have evidence showing they can be used for alcohol use disorder. Medications that are prescribed by a physician but not specifically designed to treat issues with alcohol use disorder may not be covered.
- Outpatient therapy: This is typically covered to some extent. Some therapies, such as rapid detox or therapies that are not directly associated with treating alcohol use disorder, such as acupuncture, may not be covered.
- Follow-up counseling: Follow-up counseling or aftercare services may be covered.
Additionally, insurance companies are often able to provide lists of treatments and medications that are covered as well as a list of those that are not covered.
Aspects That Determine Coverage
There are a number of factors that may determine the amount of coverage an individual will receive for outpatient treatment. Some of the main factors that are considered by insurance companies regarding paying for treatment include:
- Medical necessity: This refers to the idea that the treatment provides the most efficient and practical form of care for the condition in question (i.e., alcohol use disorder).
- Referral source: When physicians refer an individual to outpatient treatment for substance use disorders, insurance companies may be more likely to approve coverage if there is any question regarding whether the individual should receive coverage for the treatment.
- Research evidence: Research evidence regarding the effectiveness of the treatment is important to insurance companies. Often, they will more readily approve these forms of treatment which includes different forms of behavioral therapy and medications.
- Policy type: The type of insurance policy one has will have an effect on the extent of coverage for outpatient treatment.
To learn more about your coverage, contact your insurance provider’s customer service representatives to discuss your treatment options. You can also discuss treatment with an outpatient therapist, physician, or other treatment provider; these professionals may be able to determine the extent of insurance coverage the person has that can be applied to outpatient treatment.
If you don’t have health insurance, you can visit the Affordable Care Act website in order to find out what type of insurance programs you may qualify for. Those who have a little or no income may also be able to apply for Medicaid. Medicaid coverage includes treatment for substance use disorders, including alcohol use disorders; however, not all treatment providers accept Medicaid.
Treatment with American Addiction Centers
Alcohol.org is a subsidiary of American Addiction Centers (AAC), which offers a network of addiction treatment facilities across the nation. We work to make addiction treatment accessible for every person in need.
Don’t let finances to become a roadblock to getting the help you deserve. We accept many insurance plans and can work with you on a manageable payment schedule. We also offer a 90-Day Promise, which allows a person who has successfully completed our 90-day program to receive a complimentary 30 days of treatment in the case of a relapse.*
Find out if you or your loved one’s insurance covers rehab at an AAC facility by filling out the confidential form below. Or, learn more about our approach to alcoholism treatment including levels of care offered, what alcohol addiction treatment entails, our unique medical capabilities, which therapies are used and how we treat co-occurring mental health disorders.
*Terms and conditions may apply, and results may vary.