Thanks to some of the legislative changes regarding health insurance in the United States in the past few years, more and more people are now eligible to receive health insurance coverage for heroin detox and related services. In some cases, that coverage is as readily available as coverage for routine medical issues. In other cases, it’s a complicated path to getting to the bottom of whether or not a health insurance provider will – or should – cover the cost of specific treatment services.
Unfortunately, heroin detox and whether or not services designed to help a patient through that process are riddled with gray areas.
What Coverage Should Include
When a patient experiences withdrawal symptoms after he stops taking heroin, it is clear that he is in detox and there is a medical need for treatment. All patients covered by a health insurance policy sold on the Health Insurance Exchanges can and should offer coverage for care. A visit to the doctor to address symptoms, for example, should be covered by insurance, minus any co-pays. Outpatient care designed to help the patient address the issue of detox and/or follow medication protocol used to treat symptoms related to detox should be covered as well. It’s here, however, that the specifics get hazy and will vary widely from provider to provider and plan to plan.
What Coverage May Not Include
There are a number of medications (e.g., methadone, Suboxone) and treatment services (e.g., inpatient, outpatient intensive, partial hospitalization, outpatient) that are available to patients in need of treatment for heroin detox. However, in order to get coverage through a health insurance provider, patients are going to have to show that their service of choice is “medically necessary” – and the increased risk of relapse if a less intensive option is chosen does not fill the bill.
Patients may find that their insurance providers will willingly cover the cost of an outpatient program but may find that they are unwilling to cover inpatient care unless it has been previously demonstrated that outpatient care was ineffective, or there are underlying medical issues that will require treatment during the course of detox.
Similarly, long-term medication options may or may not be covered by the health insurance provider as well. While they may offer payment for short-term, outpatient detox, it may take some work to secure coverage for ongoing medications and/or inpatient or intensive treatment.
Heroin detox in and of itself is not a life-threatening issue. Withdrawal symptoms will generally pass without treatment; thus, it may be difficult to convince a health insurance provider that they should pay for the costs of care to make the process more comfortable.
Talking to Your Provider About Substance Abuse Treatment Coverage
If you are trying to secure coverage for your own heroin detox treatment services, you can work with your doctor to determine what is medically necessary and how best to prove that to the insurance company. A thorough exploration of your medical and mental health history may help you to identify issues that signify that there is a medical need for medication-assisted treatment and/or inpatient detox.
Learn more about the process of securing insurance coverage for heroin detox and addiction treatment when you contact us at the phone number listed above. Call now.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.