This information is valuable for staff, students and parents.
Betty Mitchell,
Kingsway Regional School District,
Woolwich Township, NJ
Medication Misuse: What You Need to Know to Help Protect Children, Teens and Young Adults
~ Partnership staff
Special Considerations When Seeking Substance Use Treatment During COVID-19
~ Partnership to End Addiction Staff
In a Time of Disruption, Protecting Your Child from the Risks of Substance Use
~ Partnership for Drug Free Kids
COVID-19: Accessing Critical Medications for Your Loved One
~ Partnership for Drug Free Kids
Alcohol Prevention at a Time of Furlough and Layoffs
~ Jason Kilmer, Jennifer Jacobsen, David Arnol,d Leah Kareti
What is Vivitrol? Answers for Parents
~ Partnership for Drug-Free Kids
What to Know about Drugs Laced with Fentanyl & Other Substances
~ Partnership for Drug Free Kids
Carfentanil: A Dangerous New Factor in the U.S. Opioid Crisis
DEA Drug Information
Addiction and Sleep
How to Know if Your Kid is Vaping Marijuana - and What to Do About It
~ Partnership for Drug-Free Kids
Juul, the vape device teens are getting hooked on, explained
~ Julia Belluz, Vox Media
What Parents Should Know About Kids Using CBD
~ Partnership for Drug-Free Kids
Pediatricians warn against marijuana use: Not your parents' pot
~ By LINDSEY TANNER, AP Medical Writer
The Teen Years: How Parents Can Grant Their Teenager Privacy While Overseeing Their Well-Being at Home
Am I Enabling My Child by Helping Them?
~ Partnership for Drug-Free Kids, Master Addictions Counselor Mary Ann Badenoch, LPC
Not Getting Anywhere Talking to Your Child About Their Drug Use? Try Changing Your Tone of Voice.
~ Partnership for Drug-Free Kids
Your Child's Treatment & Recovery Roadmap: A Guide to Navigating the Addiction Treatment System
~ Partnership for Drug-Free Kids
Covering the Costs of Addiction Treatment, Whether Insured or Not
~ Partnership to End Addiction Staff
No Beds Available: What To Do When You're on a Waitlist for Addiction Treatment
~ Partnership for Drug Free Kids
What is Family Therapy for Addiction and How Can It Help MY Family
~ Partnership for Drug-Free Kids, Molly Bobek, LCSW, and Aaron Hogue, PhD, of the National Center on Addiction and Substance Use
I Was Blindsided By How Insurance Treated My Son's Substance Use Claim
~ Virginia Holleman, Parent & Advocate
Your First Call with Your Insurance Provider: What to Ask about Substance Use Coverage
~ by Lindsey Vuolo, JD, MPH, Associate Director of Health Law and Policy at the National Center on Addiction and Substance Abuse
      share   print  
  Covering the Costs of Addiction Treatment, Whether Insured or Not  
  ~ Partnership to End Addiction Staff  

puzzle piecesWhen your top priority is helping a sick loved one get well, it's overwhelming to add financial hurdles to the mix. We know that making treatment more accessible and affordable requires advocacy and work at the policy level. So what can you do when your child needs treatment now?

Paying for treatment — whether it's covered by insurance or not — can loom large in making treatment decisions. But to the greatest extent possible, your child's treatment plan should be based on their individual needs. Effective treatment is provided in different settings (inpatient or outpatient) and at different levels of care, and may incorporate medication. Understanding the types of treatment available will be important as you navigate this portion of the journey.

If Your Child is Covered by Insurance

The following are key questions to have answered about your insurance coverage. Along the way, keep good notes and records! Save any notices you receive from your insurance plan and from the treatment provider, including letters authorizing care, denial letters, Explanation of Benefits (EOB) and any bills you receive from providers. Record the date of any phone calls, the name of the person you spoke to (ask for a last name) and a summary of what was discussed.

Will your insurance cover treatment for substance use or addiction?

In many cases, insurance providers are required to cover treatment for substance use disorder (SUD) or addiction. It is the law. But this doesn't mean it's simple.

What types of treatment are covered?

insurance policyWhile your insurance plan likely provides coverage for some types of treatment, it may not provide coverage at all levels of care. For example, your plan may say it covers 30 days of residential treatment, but they could decline the use of this benefit if they believe a less intensive option is sufficient.

In the case where your child's treatment plan doesn't align with what is covered, talk to your child's provider about the level of care covered that is most appropriate. Note that a lower level of care may not address all needs, but a higher level of care than needed could mean unnecessary care at a higher cost.

What is required to access covered treatment?

Ask your insurance provider whether any types of treatment services will require prior authorization. For example, your child's treatment provider may need to obtain approval before prescribing a specific medication or providing a specific treatment

If your plan does require prior authorization, they may review for medical necessity. Speak with your health care provider and ask them to request a conversation with the insurance company's internal reviewer(s) to go over the treatment options and level of medical necessity.

What if coverage is denied?

In case of a denial, be prepared to file a complaint with your state's insurance commissioner, appeal the decision, and work with your health care provider on proving medical necessity.

If your insurance company determines that a treatment is “not medically necessary,” they are required to share the standards used to make that decision. You will likely need to make a formal request for this information. You can coordinate with your child's doctor to work with the insurance carrier and to demonstrate medical necessity accordingly.

Your plan should offer both an internal and external process to appeal any denials. When filing your appeal, make sure to specifically note that the plan may be violating federal parity laws which require most insurers to cover substance use disorder and addiction the same as any other disease. Along with an appeal, you can also file a complaint with your state's insurance commission.

What costs will you be responsible for?

Make sure you understand the costs you will be responsible for even when services are covered.

Does your plan have a deductible? This is a fixed amount you may have to pay out-of-pocket before insurance begins to pay for services

What is your copay? Copayments are a set amount you must pay when receiving a service, for example, $25 per doctor's visit.

Does your plan impose coinsurance? Coinsurance requires a patient to pay a certain percentage of the total cost of a service. For example, a 30% coinsurance means that if a bill is $1,000, then the health plan will pay $700 and the patient must pay $300

Is your provider in- or out-of-network? Some plans will not cover any services from any out-of-network providers or you may be responsible for a larger portion of costs even if you have out-of-network benefits.

If Your Child is Uninsured

For most people, “treatment” means a residential rehab facility. In reality, treatment can take place in different forms, settings and for different lengths of time. Finding treatment begins with understanding these options and identifying what's best for your child's needs with the help of their doctor. From there, you can begin to explore more low- or no-cost solutions.

State & Federal programs

Most state governments, and even many cities and counties, offer inpatient and outpatient treatment that is free of charge. These programs range from short-term detox centers (note that detox is not a substitute for treatment) to long-term inpatient treatment centers to individual outpatient counseling.

The Substance Abuse & Mental Health Services Administration (SAMHSA) maintains a Directory of State Agencies (PDF) that makes it easier for you to determine who to contact.

Under the Affordable Care Act, substance use disorder and addiction treatment are classified as essential benefits. This has implications for many types of plans, however; families are actually 2-3 times more likely to get coverage under Medicaid than with private insurance.

Payment assistance

Some providers offer payment assistance or treatment on a sliding scale. SAMHSA maintains an online treatment locator tool with many sorting options. In addition to searching by your zip code and the type of treatment needed, you can further narrow your search by filtering for providers who offer payment assistance. Rehab scholarships are another form of assistance. Much like educational scholarships, these are provided by third-party organizations to cover the costs of one's treatment.

Beware of predatory practices

Unfortunately, many treatment centers put profit before patient care. Be careful when searching the Internet to find treatment, especially using keywords like “free,” as there are unethical organizations out there who will promise you nearly anything to make money off of you and your child. Read up on advice given to parents about how to steer clear of these predatory practices.



  Commercial Scale & Balance
36 Russo Circle
Agawam, MA 01001
p (877) 867-6272
  Anchor Cement
9 Joy Street
Johnston , RI 02919
p (401) 230-0763
  Oceanside Cabinets
26 Hawkes St
Marlehead, MA 01945
p 877-639-4199
  Stockbridge Funeral Home
141 Epping Road
Exeter, NH 03833
p 603-772-0400
  Valley Heating & Cooling
98 Kenyon Hill Trail
Richmond, RI 02898
p 401-539-0400
f 401-539-1188
  Joe's Electrical
34 North St,
Metheuen, MA 01844
p 978-320-3578
  DL Technology
216 River Street
Haverhill, MA 01832
p 978.374.6451
  Burke-Magliozzi Fineral & Cremation Service
390 North Main Street
Andover, MA 01810
p 978-475-5200
  Merrymac Games & Comics
550 Daniel Webster Highway
Merrimack, NH 03054
p (603) 420-8161
  Moura's Cleaning Service
P.O. Box 233
Hudson, MA 01749
p (978) 562-1839
f (978) 567-0802
The Publishing Group - Drug Prevention Times  
Website Powered By Creative SplashWorks - SplashSite