Budgeting for Treatment
There is no question that addiction treatment can be expensive. However, there are ways to get help, and treatment is not nearly as expensive as the costs incurred by the addiction itself. Individually, the costs of unemployment, illness, and legal expenses related to addictions can be astronomical in comparison to the cost of treatment.
Nationally, the costs of addiction may exceed a half trillion dollars annually when one considers health care expenditures, lost productivity on the job, and the costs resulting from criminal activity. There are some encouraging trends when it comes to funding addiction treatments. Health care insurance is one major way that an individual can fund his addiction treatment. A person with health insurance benefits would be responsible for a co-pay determined by the insurance company.
Alert
The latest statistics indicate that 23.2 million Americans struggle with addictions. Shockingly, only about 10 percent are receiving the treatment they need. The stigma of having an addiction, the cost of treatment, and fear of losing one's job are reasons commonly cited for avoiding treatment. While understandable, these are all obstacles that must, and can, be overcome.
In July 2007, the House Education and Labor Committee voted to approve a mental health and addiction parity bill called The Paul Wellstone Mental Health and Addiction Equity Act of 2007. This bill would require any group health plan having at least 50 members to cover addiction and mental health problems at the same level as medical illnesses.
In September 2007, the U.S. Senate voted to approve the Mental Health Parity Act. The House passed a mental health parity bill in March 2008. Some differences need to be worked out yet and full congressional approval will be necessary before a national mental health parity law goes into effect.
The primary differences in the two bills that will require clarification include specification of the range of diagnoses to be covered, the management of benefits by health plans, and how out-of-network benefits will be covered. Nevertheless, major progress has been made toward ending insurance discrimination against mental health and addiction treatment. It is expected that congressional action on this issue will occur late in 2008.
On a state level, 43 states and the District of Columbia have active laws requiring insurance companies to provide some kind of coverage for addiction treatment. However, many have encountered problems with insurance companies delaying or denying treatment and/or placing restrictions on addiction treatment benefits.
What is mental health parity?
Parity is making two things equal. In the case of mental health parity, this refers to creating equality in the health insurance industry between mental health coverage and medical health coverage. Currently, only about 1 to 2 percent of health care insurance dollars go toward paying for mental health care. Many mental health services are excluded or severely restricted by insurance companies.
If a person encounters problems getting her insurance company to pay for mental health care and/or addiction treatment, there are some things she can do:
Know the details of her health care coverage.
Check coverage as described in her employee benefit handbook. Her employer may be able to override or negotiate with the insurance company on her behalf.
Contact the state insurance department, the health department, or even the Office of the Attorney General. These agencies have the power to enforce addiction treatment laws.
Ask a local or state legislator to intervene on her behalf. These elected officials appropriate funding to state offices and have an interest in seeing laws enforced.
Ask the administrators of health care facilities where treatment is being sought to help work with insurance companies.
Document all interactions with her insurance company and keep copies of all correspondence.
If someone doesn't have health insurance, what are the costs of treatment and how does she pay? Although facilities certainly vary in what they charge, the average cost for a single course of outpatient addiction treatment, which lasts about six weeks, can start at around $1,500.
Short-term residential treatment, typically lasting 20 days, may average approximately $4,000 per admission. Long-term residential treatment often lasts around 90 days. Costs can run much higher than this depending on the length of treatment and whether one attends a “no frills” program or one with all the luxuries.
All states have some funds for substance abuse prevention and addiction treatment for individuals who have no insurance or inadequate insurance. Federal funds from the Temporary Assistance for Needy Families (TANF) program may be available for non-medical drug and alcohol treatment. There is also the federal Welfare-to-Work program that may help fund individuals who are required to receive drug and alcohol abuse treatment in order to return to work.
Again, the funds are only available for non-medical treatment. Most treatment programs and individual providers also provide some pro bono services for those in need who have no other options.
Finally, some employers are now recognizing how helpful it is to their company to have healthy employees and are funding some treatment as a job benefit. Check it out with the human resource department. Don't be afraid to ask. Treatment is important and it is effective!
