Factors in Treatment Pricing

There are many different factors in pricing for addiction treatment including insurance coverage, parity law, and and more.

Addiction treatment costs are as unique as a person’s needs, but any expense associated with treatment is far less than the long-term costs of suffering with addiction.

The Disease of Addiction

Current medical opinions about addiction differ dramatically from beliefs held even 50 years ago. Today medical professionals agree addiction is a chronic disease that benefits from treatment.  American researchers at scientific institutes–the National Institute of Drug Abuse (NIDA), the National Institute of Alcohol Abuse and Addiction (NIAAA), and the Institute of Medicine (IOM)—agree addiction treatments should follow several basic guidelines. The following principles should guide all addiction treatment, according to the California Society of Addictive Medicine (CSAM):

  • Addiction is a chronic disease
  • Addiction is treatable
  • Addiction treatment must be on-going and continuous
  • No single treatment is effective for all individuals
  • Co-occurring medical and psychiatric conditions must be addressed

Health Insurance and Addiction Treatment

Health insurers cover substance use disorders through their behavioral health plans, although treatment options vary by policy. Insurers contract with area addiction treatment centers and clinicians to get the best rates. When a person is treated at an in-network facility the copayments and coinsurance will be lower than services offered at an out-of-network facility.

Broader addiction coverage takes effect in 2014 with the requirement that all large employer plans as well as plans sold through state Health Insurance Exchanges offer mental health and substance use disorder treatment.

Ensuring effective and affordable treatment is a goal for the Substance Abuse and Mental Health Services Administration (SAMHSA), which worked with states and consumer groups to ensure the benefits offered on the exchanges provide the kinds of treatment options needed for substance use disorders. The plans also open up more options for low-income people, who will be eligible for assistance with premiums for commercial plans or be eligible for coverage through Medicaid.

Cost Benefits of Addiction Treatments

Effective addiction treatment programs greatly reduce long-term costs associated with addiction, including the expense of related health care conditions and incarceration. Addiction is expensive for both the individual and society. The NIDA notes that treatment can bring significant personal savings including the following:

  • Improved relationships and reduced interpersonal conflicts
  • Greater workplace productivity
  • Fewer drug-related accidents, especially overdoses and deaths

By opening up addiction treatment to the people who need it, the country benefits with reduced crime rates, lower healthcare costs and more innovation and stability in the workplace.

Payment Options for Addiction Treatment

Depending on the community, several options may exist for substance use treatment. In a SAMHSA report on substance abuse treatment options, the agency notes many communities have free or reduced cost addiction treatment programs. Most programs are offered by private non-profit organizations, so it’s best to check if programs are available locally.

Another option for many people is an Employee Assistance Program (EAP). Employees at mid-size and large companies may have access to an EAP that can offer guidance about addiction treatments. In addition some state and local governments run addiction treatment programs that are offered on a sliding-fee scale.

Private pay treatment centers also are an option. Many facilities work with clients to develop a payment plan or offer certain services at reduced rates.

Types of Addiction Treatments

The best addiction treatments are offered without limits on days of care or number of visits covered, according to CSAM. In reality, the majority of insurers have strict policies that limit services and people must make personal decisions about paying for services not covered by insurance. A person suffering with an addiction may need some or all of the following treatments and services:

  • Substance use disorder assessment
  • Medically supervised detoxification
  • Addiction treatment services
  • Outpatient services such as group and individual therapy
  • Inpatient services such as stays at residential facilities including appropriate medical and psychiatric care
  • Treatment for co-occurring disorders, including mental health disorders
  • Medication-assisted treatment
  • Aftercare, including support during recovery

Because addiction is a chronic illness, long-term treatments should be available to address relapses and provide ongoing support. Depending on a person’s individual needs, he or she may need several treatments or only a few.

Need Help Finding Addiction Treatment?

The cost of avoiding addiction treatment is high–addictions destroy lives and lead to disabilities and even death. Fortunately addictions respond well to scientifically proven therapies, and there are many successful treatment options available. If you or a loved one is struggling with an addiction, we can help.

Individuals who know help is needed are ready to begin treatment. Our toll-free helpline is available 24 hours a day, seven days a week to provide options. Don’t wait to find the help you need. Call us today and get started on a more fulfilling, productive life.