How to Pay for Residential Programs

Health insurance, Residential drug rehab, or inpatient addiction treatment, can be pricey. Combining medical care, psychotherapeutic treatment and support, and room and board often adds up to a significant bill. Many families are worried about their choices: opt for the comprehensive care that improves the odds of long-term recovery and pay the hefty bill, or pay less for outpatient treatment or a combination of addiction treatment services that may or may not address all their addicted loved ones’s needs.

The good news is that there are a number of ways to cover the cost of inpatient drug rehab including health insurance. Families almost always used a combination of options in order to pay the whole bill. Here are the most common sources utilized to pay for drug rehab. 

Health Insurance

Health insurance should always be the first stop when it comes to pulling together the funds to pay for treatment. Substance abuse treatment services are one of the 10 “elements of essential health benefits” included under the Affordable Care Act. This means that all health insurance policies that are purchased on the Health Insurance Exchanges or that are provided by Medicaid must cover substance abuse treatment services.

Here’s where health insurance can be confusing – nowhere is it defined exactly which substance abuse treatment services must be covered. Nor are there any indications how much should be covered, either in percentage or dollar amount. Therefore, there can be some tussle back and forth between the patient and the insurance provider as they determine whether or not inpatient care will be covered.

Many providers, for example, would like proof that residential treatment is “medically necessary” and the increased chance of relapse if treatment occurs by health insurance on an outpatient basis does not fill this requirement. Other providers may require that patients undergo outpatient treatment first and only if this less intensive measure proves ineffective will they agree to cover inpatient care.

Health Insurance Savings

Many families turn to personal savings for health insurance and determine whether or not they feel comfortable using all or part to cover the cost of drug rehab. Funds allocated for others purposes (e.g., retirement, college, etc.) may be tapped if necessary, but emergency funds and investments are usually the best places to start. Additionally, the sale of a luxury item with respect to health insurance can help to increase the amount of cash readily available for payment for treatment.

Personal Loan For Health Insurance

Often extended family members are willing to contribute to the cause of treatment by health insurance. In some cases, it may be appropriate to create a formal contract for the loan, providing how and when the money will be paid back – perhaps by the addicted person once they have completed recovery. Others may prefer to make a gift of the funds in order to cover part of the cost of treatment.

Health Insurance Financing

Most families will finance all or part of the cost of addiction treatment. Many families will be able to create a payback plan for health insurance that makes sense for their schedule at a monthly payment that works for their budget. All or part of the cost of treatment can be covered through financing. Rates and payback plans are determined on a case-by-case basis. 

Payment plans are also available in-house at a treatment centre. Make direct contact with them for health insurance and request to speak with someone in charge of that department. Keep in mind that the higher the quality of the programme, the higher the cost. The length of time your child will be there will also have an impact on the total cost.

Comparing rates and programmes for health insurance can assist you in determining where the best overall value can be found. What is available in terms of a specific residential treatment facility varies. Don’t say that they’ll all function in the same way. With such a programme, you want to give your child the best chance of success.

Many individuals do not have health insurance and cannot afford to pay out of pocket. Look at sliding scale services at a residential treatment centre or in your neighbourhood. Investigate options via social services or your child’s education, since both can provide programmes that you are eligible for.

Have direct contact with your health insurance provider. Tell them about your child’s needs and what they’ll be covering. It’s likely that they’ll pay for all or part of the residential care. You’ll have a better idea of what you need to come up with on your own once you know what they’ll pay for.Don’t give up if the health insurance provider initially informs you. In certain cases, they would initially refuse such requests. Inquire as to why they are refusing to pay for medication. If required, request a meeting with a supervisor. Be courteous, yet diligent in your attempts to obtain the coverage you need to assist in the payment of such costs.

The good news is that more health insurance providers are beginning to cover residential care. They were previously restricted to only outpatient treatment services. If you’re having trouble with your health insurance provider, you may want to have the facility that your child will be attending attempt to speak with them on your behalf.

Health Insurance Payment Arrangements

Be open and frank with the residential treatment centre about your financial situation for health insurance. They may have some grant money that can be used to help your child pay for school. They will even try to come up with payment plans. It might be easier to fit into your budget if you can pay a fixed sum per month rather than trying to come up with it all at once. If you can get the funds to pay it (health insurance) off in full, do so. If you are willing to pay, some residential rehab facilities will give you a discount.When approached to subsidise the cost of a residential treatment facility, most health insurance providers would look for a few specific things.

Make sure that you have checked most or all of these boxes before communicating with yourhealth insurance provider:

  • You and your troubled teen have attempted weekly outpatient counselling sessions with little or no results, indicating the need for a more advanced and specialised treatment.
  • Before seeking their assistance to pay for service registration, you received a directory of in-network options from your health plan.
  • Demonstrate that your teen’s actions have resulted in an unhealthy home climate.
  • Demonstrate that your teen’s capacity to care for themselves has been seriously harmed as a result of their actions.
  • Your child’s current environment (home, school, etc.) has harmed their growth.
  • Residential care has a greater chance of succeeding, according to the evidence.

Medicare and Medicaid include a large number of health maintenance organisations (HMOs) and other organised care plans. These health-care programmes also have benefits beyond those provided by Medicare and Medicaid, and they are skilled at “coordinating” a member’s health-care needs. Some HMOs may also provide additional medical or social care, while others may not need a hospital stay until approving admission to a nursing home.

If your loved one is participating in a health maintenance organisation (HMO) or competitive medical plan (CMP), inquire about health care coordination between the HMO/CMP and the residential care facility with a representative from the plan. Inquire about the HMO or health plan’s local partnerships. If your loved one wants to go to a facility that isn’t in his or her HMO’s service area, talk to the plan members about it.

For those who meet coverage criteria and need treatment in a skilled nursing facility, Medicare pays for at least some nursing home expenses for up to 100 days per benefit span (SNF). The resident has no deductible or health insurance rates from the first to the twentieth day; however, the resident has a health insurance balance from the twenty-first to the hundredth day. This number is equivalent to one-eighth of the annual hospital deductible and is measured per year.

Medicare only provides for skilled nursing or skilled rehabilitation (physical therapy, speech therapy, or occupational therapy) services that must be performed or monitored by specialists on a regular basis during a hospital stay of at least three days.

There are Medicare and non-Medicare sections of several long-term care facilities. Even if the treatment required meets the medical requirements for coverage, Medicare law prohibits reimbursement for residents in non-Medicare parts of the facility. As a result, in order for Medicare to pay, the resident must be put in a Medicare-certified portion.

Get Started

Money is often cited as an obstacle to recovery but it need not stand in the way of your loved one’s ability to address addiction through treatment. Contact us at 615-490-9376 and discuss your options for securing a spot in the right treatment program or health insurance for your addicted family member.

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