One concern many people have when considering starting detox is does insurance cover medication-assisted treatment when it is part of their care. However, while having assistance to pay for treatment is beneficial, it should never deter you from seeking treatment for alcohol use disorder (AUD) or substance use disorder (SUD).
What Is Medication-Assisted Treatment?
Medication-assisted treatment (MAT) is a form of treatment used when someone is going through detox and a medical detox center. Since doctors and other healthcare professionals oversee the detox, they can prescribe various medications that often help alleviate many of the intense and severe withdrawal symptoms experienced during detox.
Does Insurance Cover Medication-Assisted Treatment?
When the Affordable Care Act (ACA) went into effect, part of the essential required coverage was paying for alcohol use disorder substance use disorder treatment services. This requirement included paying for MAT.
So, if you have insurance coverage through the Healthcare Marketplace or your employer, your plan should include coverage for detox and MAT. However, due to variations in plans, deductibles, networks, and covered services, you should check with your insurance provider to find out if your plan covers detox and MAT. Alternatively, you can contact the medical detox center for assistance in determining if your insurance would cover your treatment.
Can My Insurance Provider Tell My Employer If I Go to Detox?
It is against the law for your insurance provider to share any details about healthcare treatments, services, and prescriptions you have received. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects this privacy. The Act is a federal law that prevents sharing personal patient health information without your prior consent. Insurance providers can get into serious legal issues should they violate HIPAA laws.
So, you can go to detox and receive MAT and not worry about your employer finding out. Many people use their personal time off or ask for time off for medical reasons without disclosing they are going to detox treatment. HIPAA laws also prevent your employer from asking what medical condition you have, so again, you do not have to say you are going to detox treatment.
What Should I Know About My Insurance Coverage?
Several key concepts you should know about your insurance coverage include the following:
- Deductibles. Your insurance plan will have a deductible. You may need to meet this deductible before your insurance pays for detox and MAT.
- Co-Pays. Some plans can have a co-pay, a set amount you are required to pay for treatment. Once you pay the co-pay, then your insurance usually pays for detox and MAT, provided you do not have to meet a deductible.
- In-Network Provider. An in-network provider is one your insurance company has negotiated special rates with to provide medical care and services. Choosing an in-network provider may waive deductibles and have a lower co-pay than out-of-network providers.
- Out-Of-Network Provider. This type of provider is one that your insurance company has not negotiated special rates. While you are free to choose your own provider, be aware the amount covered by your insurance plan can be less. You may also have a higher deductible amount and higher co-pay.
- Referrals. Some insurance plans require you to obtain a referral from your primary care physician before starting detox and MAT.
- Covered Medications. All plans will have a list of what MAT medications they will cover, along with the co-pay amount.
Treatment Limits
Some plans may cap the length of treatment or the number of MAT prescriptions you can receive. However, there may be exceptions in certain cases.
We understand this can be a lot of information to process and take in. As such, working with a medical detox center can help address many of these things on your behalf.
The benefits coordinator at the facility can speak directly to your insurance provider to find out the exact coverage benefits you have, the co-pay amount, deductible, and other details. Then they will inform you of what your insurance will cover and your costs of detox and MAT.
What If I Have Medicaid?
Medicaid plans follow federal rules and require that they cover all MAT prescriptions. Medicaid also covers the costs of detox and AUD, and SUD rehab programs. However, you must go to a treatment center that accepts Medicaid.
What If I Have Medicare?
Medicare is another federal-sponsored insurance plan for retirees. However, Medicare has different rules. You may have a deductible, and you may have a co-pay for your MAT prescriptions. Furthermore, you must have Medicare Part B to have coverage for MAT prescriptions.
Again, the benefits coordinator at the medical detox center you select should be able to help provide details about the types of coverage available through Medicaid and Medicare.
Detox with MAT in Nashville, TN, at our Medical Detox Center
Detox Nashville in Tennessee offers detox with MAT at our medical detox center. Our benefits coordinator can help you determine your coverage for detox and MAT at our facility. Contact us today for further information or to start detox with MAT.
