Many insurance providers do cover the costs of addiction treatment. However, it’s important to understand how your insurance is verified for treatment, what information you need for the process, and how you can use your benefits to avoid financial surprises.
Most people who are seeking addiction treatment (either for themselves or on behalf of someone else) are already managing stress. Being clear about insurance payments is a big weight off your mind, and is wise to ensure longer-term financial stability.
What is The Mental Health Parity and Addiction Equity Act (MHPAEA)?
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that was passed in 2008 to make mental health coverage equal to physical health coverage. The law states that health insurance providers that cover mental health must do so to the same degree as their coverage for medical/surgical care.
The law ensures that:
- Health insurance providers can’t impose higher or stricter financial requirements for substance use/mental health benefits
- Treatment limitations can’t be more severe for substance use/mental health benefits
- Pre-authorization can’t be stricter for substance use/mental health treatment
- Health insurance plans that offer substance use or mental health benefits have to provide equal coverage for inpatient, outpatient, intermediate, and emergency care
However, MHPAEA:
- Does not state that health insurance providers have to cover substance use disorder or mental health
- Does not mean that mental health treatment will be affordable or without extra costs
How Do I Know If My Insurance Covers Addiction Treatment?
Once you know the addiction treatment you, or your loved one, needs, you’ll likely have to call the treatment center and go through a Verification of Benefits (VOB). These steps will confirm whether your health insurance plan will cover the specific program or service you need.
Verification of Benefits happens via a digital system and can be done in a few minutes. VOB can tell you:
- If your plan will cover the desired addiction treatment
- How much of the cost will be out of pocket
- If there are limits on the type of care/number of sessions your insurance will cover
What Do I Need For The Verification of Benefits?
Before you call to verify your insurance, it’s good to have all the information you need ready. Doing so can make the process faster and smoother, and make sure that all the information you receive regarding payment is correct.
You’ll need:
| A copy of your insurance card (front and back) | The type of treatment being sought (e.g., detox, residential, inpatient, outpatient) |
| Your full name and date of birth | Basic medical history of the person seeking treatment (past treatment, disorders, current symptoms) |
| The policyholder’s information | Name and address of the treatment facility, and whether it’s in-network |
| The group number and member ID | Information about your insurance coverage, deductibles, copays, and out-of-pocket costs |
| The insurance company’s phone number | Information about past prior insurance authorizations |
What Does ‘In-Network’ and ‘Out-Of-Network’ Mean?
‘In-network’ and ‘out-of-network’ are terms that you will likely hear as you verify your insurance.
In-network means that the treatment center you’re contacting works with your insurance provider and can cover the cost of your care (totally or partially), or can offer discounted rates and lower out-of-pocket costs.
Out-of-network means that the treatment center does not work with your insurance provider, and treatment will therefore have significantly higher costs.
Most treatment facilities state on their website the insurance providers they work with, making them ‘in-network’ for those providers. If you can’t see this information, be sure to ask the admissions team when you call.
How Can I Make Insurance Verification Easier?
Doing some research, having documents ready, and asking questions are all good ways to streamline the insurance verification process. The most important part of VOB is getting access to the right treatment and being able to focus on healing.
To make sure that you get the most out of your benefits and save time, follow these tips:
- Have all the documents and information that you need stored in one place before you call the treatment center
- Check that all the information you have is correct and up to date
- Confirm that the addiction treatment facility is in-network or out-of-network
- On the call, ask specific questions about if your insurance plan is accepted, what additional payments there may be, how long you can stay, and alternative payment options
- Take notes during the call, especially if you’re given reference numbers; if you have additional needs, let the admissions team know so they can accommodate you
- If you don’t understand something, ask for an explanation — it’s better to get clarity sooner
A Stepping Stone to Recovery
Insurance doesn’t have to be an obstacle in your path to healing. If you’ve found addiction treatment that makes sense for you or someone else, call the admissions team and discuss your options. You may be surprised about how you can use your benefits and begin treatment for a healthier, happier life.
Compassionate, Evidence-Based Addiction Treatment at Trinity Wellness Group
At Trinity Wellness Group, we recognize that recovery doesn’t happen in isolation. Our team of licensed counselors use approaches such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) to help people overcome addiction and make positive, ongoing changes.
Our goal is to guide people as they understand the patterns that drive substance use and build practical coping skills. Our treatment is both clinically sound and deeply human. We prioritize empathy, evidence-based therapies, and personal evolution.
We accept most commercial insurance providers, including Aetna, Blue Cross Blue Shield, Cigna, GEHA, Optum, and United Healthcare. We have a dedicated, patient admissions team ready to answer your questions and find you the best route to addiction support.
Call us to verify your insurance and make your health your priority.
FAQs
Does insurance cover addiction treatment?
Most insurance plans cover addiction treatment. The Mental Health Parity and Addiction Equity Act (MHPAEA) also states that health insurance providers cover treatment for substance use and mental health disorders to the same level as medical or surgical care.
You’ll still have to confirm with your preferred addiction treatment center that they accept your insurance provider and that your insurance plan covers all costs, or partial costs of the care program.
What insurance does Trinity Wellness Group accept?
We accept most commercial insurance providers, including Aetna, GEHA, Optum, Cigna, Kaiser Permanente, Highmark, United Healthcare, and Magellan. Call our admissions team to verify your benefits and get all the information you need to begin treatment without any financial surprises.
What is a benefits verification and why does it matter?
Verification of Benefits (VOB) is a process to confirm that your insurance provider is accepted by a treatment facility, and if your insurance plan covers all costs or partial costs for your preferred treatment.
We offer a free, straightforward VOB for anyone seeking addiction treatment. Call our admissions teams, and they will help you through the process calmly and quickly.
What is the Mental Health Parity Act and how does it protect me?
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that requires health insurance providers to cover treatment for substance use and mental health disorders in the same way that they cover treatment for medical care. It’s a law to restrict insurers from implementing higher co-pays, lower day limits, and stricter prior authorization requirements for mental health care.
Will my insurance cover day treatment for addiction?
Most insurance providers will cover day treatment for addiction programs. However, coverage — and the extent of coverage — will depend on your insurance provider and plan. You’ll first have to confirm with the treatment facility that your insurance provider is in-network. Call Trinity Wellness Group to understand more about insurance coverage for addiction.
How much will I have to pay out of pocket for addiction treatment?
Your insurance plan will determine how much you pay out of pocket (if at all). The specific treatment you want will also influence how much you may have to pay.
Our admissions team can provide a transparent overview of what costs you may have to pay out of pocket for our addiction programs. Speak with a member of our team to have everything clear before you start the path to recovery.
Sources
[1] Gomez-Dickinson, J. (March 2022). Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis. Drug and Alcohol Dependence Reports. PubMed Central.