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Insurance Coverage for Addiction Treatment in Pennsylvania

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As of 2017, there were 19.7 million American adults with substance use disorder. Heroin-related overdoses have more than tripled across the U.S. between the years 2002 and 2013, and those numbers continue to rise. For people seeking financial help for addiction treatment, it’s often difficult to determine whether and how much their health insurance coverage for addiction treatment will pay within their plan.

Prosper LogoMany insurance providers have plans that cover addiction treatment and rehabilitation services. Silvermist is an in-network provider with Blue Cross and Blue Shield. We also accept all major insurances with out-of-network benefits. Some out-of-network providers we frequently work with include Aetna, Cigna, United Healthcare, and Humana. We encourage you to contact us with any questions you have about insurance coverage. We also accept self-pay or financing plans organized through Prosper Healthcare Lending.

If you have questions about insurance coverage for our addiction treatment in Pennsylvania, contact us at (724) 268-4858 today.

Who Suffers from Substance Use Disorder?

Although not everyone with a substance use disorder seeks treatment or receives a medical diagnosis, there are reliable estimates as to how many adults, aged 12 and up, have had to deal with an addiction to drugs or alcohol.

Of the 19.7 million people with a substance use disorder in 2017:

  • 14.5 million of them were addicted to alcohol
  • 7.5 million used illegal drugs
  • 4.1 million used marijuana
  • 1.7 million were addicted to prescription pain medications
  • 2 million used cocaine and methamphetamine
  • 0.7 million were using heroin
  • 0.6 million people misused prescription stimulants
  • 14.8% were 18-25 years old

Within this group of 19.7 million Americans coping with addiction, more than 13.5 million people with substance use disorder in 2017 were over the age of 26, while 5.1 million were just 18 to 25 years old.

Insurance Coverage & Addiction Treatment

Thanks to the Mental Health Parity and Addiction Equity Act of 2008, most commercial health insurance companies will treat and cover substance use disorder the same as they would any type of disease. Prior to this federal law, people seeking treatment for substance use disorder often received only limited coverage that came under mental and behavioral health treatment auspices.

Today, addiction treatment is diagnosis as a disease, with the insured receiving medical benefits on par with other health-related diagnoses. However, it’s still important to be sure any health insurance policy you have lists substance use disorder as a covered diagnosis.

Paying for Rehab Treatment

There are various ways to pay for addiction treatment. One avenue to cover the costs of rehab treatment – including medications – is through your private health insurance policy. Most insurance plans cover part of or all your treatment plan in rehab. There are some policies that cover your entire addiction and recovery treatment.

If you are covered under the Affordable Care Act (ACA, and also called Obamacare), you don’t need to worry about a substance use disorder being listed as a pre-existing condition. Even if you are currently dealing with drug or alcohol addiction, you are still entitled to the important health benefits covered by the ACA.

How to Get Health Insurance

One of the most traditional ways to obtain health insurance is through your employer. Most policies require that you pay a monthly premium and adhere to a yearly deductible and co-pays with each health-related visit. The employer, however, pays the bulk of the cost of their employees’ insurance in most cases.

You can also purchase health insurance through the ACA if your employer doesn’t offer coverage. If you’ve lost a position and are uninsured, you may be able to purchase COBRA insurance for up to 18 months to continue receiving the benefits that came with your job. Other Americans may use their Medicare or other state-funded coverage to help offset the costs of addiction treatment.

Some employees may fear the stigma of making a claim for financial help with addiction coverage. They may also believe they will lose their job because of their substance use disorder status.

It’s important to know your rights if you or a loved one needs to access your employer-based health insurance for addiction treatment. The Americans with Disabilities Act (ADA) protects people suffering from substance use disorders so they cannot be discriminated against.

You cannot lose your job because you seek addiction treatment and enter a rehab program. This is true even if your recovery causes you to miss work for a state or local government position or within a private company that employees more than 15 people.

The Family and Medical Leave Act (FMLA) also protects from discrimination due to a need for addiction treatment. Under this law, a person can receive 12 weeks of medical leave every year, and that includes addiction disorders. You would have to be a full-time employee. This type of leave usually means you will not continue to receive a paycheck during your absence, but your job will be there for you upon your return. Applying for disability benefits while you are getting help for addiction is a long and complicated process, but it may be worth a try.

Your employer must keep your substance use disorder information confidential, just as any other medical issue would be considered personal, confidential information.