Cost is, unfortunately, a barrier for many, and realizing the total cost of addiction and mental health treatments that may last for weeks or maybe even months can discourage a lot of people from seeking professional help, particularly if this entails having to create a financial plan over night when pursuing help for someone who needs to enter treatment immediately.
Luckily, for those who need help paying for addiction treatment, many options exist and here at StepHouse Recovery Center we believe that understanding your options is the first step to overcoming this barrier. Our guide below will help you to minimize your out-of-pocket obligations.
Insurance Information
Thanks to the Affordable Care Act and the MHPAEA, quality substance abuse treatment is now available for a fraction of the cost. So, whether you have insurance or need help enrolling in an insurance plan that meets your treatment need, we have trained, compassionate staff that can help you.
Want to know more about our programs and pricing?
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health (MH) and substance use disorder (SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical coverage.”
According to the MHPAEA, all health insurance plans acquired through the Health Insurance Marketplace or through an employer is required to provide coverage for behavioral health benefits (i.e., addiction treatment and mental illnesses services) at equal rates to other physical medical procedures.
Mental illness services and addiction treatment is also governed by the Affordable Care Act of 2010, making affordable health insurance available to more people. Compared to past coverage, benefits, and access to quality care, the Affordable Care Act (also commonly known as ObamaCare) has really stepped up to the plate by including provisions that have improved and expanded treatment for all Americans, from every socio-economic walk of life.
The ACA has made it possible for substance abuse treatment to be prioritized at the same level as regular medical care.
A great insurance policy might cover up to 95 percent of the treatment cost. However, coverage copays, deductibles and benefits will vary from insurance plan to insurance plan. Accordingly, many treatment centers work mainly with a small network of available insurance providers and plans.
Information about the coverage details of a specific policy can be found by visiting the insurance providers’ website, by calling the number on the back of your insurance card, or by contacting our admissions specialist at (888) 923-7623.
Questions You Might Want To Ask Your Insurance Company:
- What levels of addiction treatment does my insurance policy cover? I.e., Detox, inpatient treatment, outpatient treatment?
- What are my coverage limits and out-of-pocket maximums?
- How many days of treatment or individual therapy visits are covered?
- What are my deductible and copay amounts?
We are now in-network and able to accept Medi-Cal and Medicare with Aetna and Beacon Health Options.
If you have Medicare or Medicaid, call the National SAMHSA hotline at 1-800-662-HELP (4357) or visit their online treatment locator at https://www.samhsa.gov/find-help/national-helpline to find a state sponsored program.
The state of California partakes in Medicare and Medicaid health insurance programs. Medicare and Medicaid are both federal and state collaborations intended to provide healthcare for citizens who meet certain criteria.
Medicare is the federal health insurance program for: individuals who are 65 years or older, certain younger people with disabilities, as well as people with an End-Stage Renal Disease.
Medicare health insurance is divided into three sections of coverage. The different parts of Medicare help cover specific services, and using Medicare coverage for addiction treatment can be broken into three parts:
MEDICARE – PART A
Part A covers hospital stays and inpatient care services such as residential addiction treatment for up to 60 days in a skilled state licensed facility, and some home health care.
MEDICARE – PART B
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
MEDICARE – PART D
Part D covers prescription drugs used in addiction treatment, such as those used in medication-assisted treatment plans and harm reduction treatments.
State Health Insurance Plan assistance centers provide state-specific information on Medicare and can be accessed at: www.shiptacenter.org.
“Medicaid provides free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.”
Other Financing Options
Medical Loans
If you have a fairly good credit score, speaking to your bank or credit union about your loan options may be a good idea. A personal medical loan is another viable option that can bridge the gap between insurance and out-of-pocket expenses.
Medical loans can potentially cover the outstanding balance for an addiction treatment program after your insurance coverage has been withdrawn. If your current bank or credit unite do not offer a medical loan you should be aware that certain financial institutions specialize in providing loans specifically designed for substance abuse treatment, which may offer lower interest rates than other options.
Below, you will find some of these providers:
MY TREATMENT LENDER
Provides loans specifically tailored for addiction treatment. My Treatment Lender offers a number of packages with varying terms for different credit ratings. Additionally, My Treatment Lender features same-day loan payouts and is advertising some of the lowest interest rates in the industry.
LIGHTSTREAM
Offered by SunTrust Bank. Is currently advertising interest rates as low as 5.49 percent. This lone option features a simple way to calculate your interest rate and provides a simplified application process that can be completed by a single phone call. Loans are available in amounts from $5,000 to $100,000, and repayment terms range from 24 months to seven years.
PROSPER HEALTHCARE LENDING
Offers loans to pay for a wide variety of healthcare services, including addiction and substance abuse treatments. Prosper healthcare lending offers loans up to $35,000 with repayment terms of up to 60 months. Applicants receive a response within two minutes of completing the online questionnaire to determine creditworthiness.
Medical Credit Card
CareCredit is a financing option for health care treatments not covered by insurance. This form of credit account offers short-term compensation options of six to 24 months and can be used to pay your addiction treatment copay/deductible or any services that might not be covered by your current insurance plan.
Be forewarned, interest rates may be high, though some programs do offer promotional, interest-free periods if the balance is paid in full within a certain period of time. Learn more at https://www.carecredit.com/.
Payment Plans
For those that don’t have insurance or whose insurance does not cover addiction treatment, we offer affordable self-pay options. We accept credit cards, bank cards, cash, and checks, and we can also set up payment plans. Contact our Executive Director at (855) 201-2832 to learn about our prices and payment options.
StepHouse now offers family and friends the ability to pay for their loved one’s treatment program and send them money, through our easy to use payment portal.
You can access Payment Authorization Form here.
Understanding Your Investment
Spending any amount of money, whether it be from your out-of-pocket savings or a personal/medical loan, is an investment in your future or the future of a loved one. Such an investment can for many be overwhelming and frightening, but it has the potential to garner a priceless return—the restoration of your or your loved ones’ life and the possibility of a balanced and fulfilling future, as made possible by sobriety gained from quality treatment.
Insurance Terms
Insurance Verification
If you are unsure if rehab is covered by your insurance, fill out our insurance verification form! We will get back to you within one to two business days to discuss your coverage.
In-Network Coverage
If StepHouse Recovery is “in network” with certain insurance providers, treatment rates are often discounted. This is a very cost-effective option, depending on your insurance.
Insurance Substantiation
StepHouse Recovery works with your insurance provider to provide any necessary “check-ins” that may be required to prove the person receiving insurance coverage still requires treatment. We work to ensure that recovery is effective and hassle-free.
Out-of-Network Coverage
Even if treatment centers are not “in network”, the insurance is still accepted, though at different rates. Some treatment plans may be worth the cost of out-of-network coverage, due to the treatment limitations of some insurance plans.
Deductible
An annual, minimal cost amount that the insurance holder must pay before the insurance company will cover all (or a majority of) healthcare costs.
Premium
The premium is how much money is regularly paid to the insurance company for their coverage.
Copay
A regular, fixed cost paid for certain services, often specified in the insurance plan.
Out-of-Pocket Expenses
Expenses not covered by insurance, including the deductible and copay. Payment plans are available for out-of-pocket expenses!
How Prices are determined:
- Type of treatment offered
- Length of stay
- Location
- Amenities
- Type of Center
- Size of the facility
Paying for treatment options:
- Credit Cards
- Loans
- Crowdfunding, example) Gofundme
- Home Equity Loan
- Medicare and Medicaid
- Government Programs
Resources for funding Addiction Treatment in any situation:
SAMHSA’s National Helpline: 1-800-662-HELP (4357)
National Institute on Drug Abuse: 301-443-1124
National Institute on Alcohol Abuse and Alcoholism: 301-443-3860