What you may not realize about insurance will make you think twice
If you have insurance, checking into rehab during the months of January through October is the most cost-effective. However, addiction isn’t “convenient” anytime in a calendar year. Here is what you need to know to make good a good decision regarding the timing of rehab.
In a perfect world when someone is ready to enter drug or alcohol treatment, they just go. Well, in November and December when people are considering going to drug or alcohol inpatient treatment they don’t realize there is a clock ticking away. This invisible clock may make the cost they are required to pay for going to treatment more than double. This is true even when you have the best insurance. If you are looking for longer than 30 days of addiction treatment then “time is really of the essence” in November and December. Please do yourself a favor and read on.
Deductibles, copays and the dreaded out of pocket max
These are insurance terms that are very important towards the end of the year. The reason being, they are usually reset on January 1st of every year. So how do they affect your treatment costs? I’m glad you asked. When you call a treatment center to find out how much of the cost, is not going to be covered by your insurance, the rehab will verify your insurance benefits and give you a dollar amount needed by you in order for you to get into treatment. The amount they are going to ask you to pay is the balance of your deductible and copays up to the out of pocket max of your policy.
If you need to stay past December 31 the amount of money they ask you for, will more than double because you will have to pay your deductible, copays and out of pocket max twice once for this calendar year and again for next. This effectively doubles the cost to you or more of treatment.
End of year warnings
[box type=”alert” size=”large” border=”full”]Deductibles, copays and the dreaded out of pocket max are insurance terms that are very important towards the end of the year. The reason being they are usually reset on January first of every year.
What about hardship cases and financial assistance
Some treatment centers offer “hardship cases and financial assistance” for people that do not have the funds to pay all or part of their deductible, copays and out of pocket max. I would love to believe that all treatment centers that offer hardship financial assistance do it solely out of the goodness of their heart but I don’t think that is the case. If that was the case it wouldn’t matter when a person was going to treatment financial assistance would always be available.
Starting around November 15 of each year I have noticed that drug and alcohol treatment centers tighten up their admittance policies and requirements and it is very hard to place someone in treatment that needs financial assistance for being a hardship case.
My opinion on why this happens is that if someone is going into treatment while there are still three months left in the year treatment centers can financially afford to offer financial assistance to people in need because they will be billing the insurance company for three full months. They can afford to write of five or ten thousand dollars but not when there is only one month of the year left they would be writing off twice as much or more and they would likely lose money on that client.
Most treatment centers are for-profit companies. This is often true despite appearances.
Turmoil going on with health insurance marketplace
Now factor in all the turmoil going on in health insurance marketplace. At the beginning of every new year, treatment centers are concerned that your insurance policy may not be renewed or your benefits will change for the worse the following year. This makes it very difficult to secure treatment when care is being split over calendar years.
Here are recent examples of what stalling going into treatment can do.
John wants to go to treatment for 90 days and decides in late September to research things. John finds out he has a deductible of $5,000 and an out of pocket max of $10,000 for a total cost to go to treatment of $15,000. John doesn’t have $15,000 but John hears about a hardship and financial assistance program being offered by some treatment centers and finds a treatment center that will accept him. All he needs to come up with is $1,000 to get into treatment.
John armed with what he thinks is a “Get into Treatment anytime Card” procrastinates like a lot of drug addicts and postpones going into treatment in September. In late October John gets arrested on a possession charge and his public defender makes a deal where if he goes to treatment for 90 days he doesn’t have to go to jail. Well it’s now November 15th and John tries to cash his “Get into Treatment anytime Card” and nobody wants it. You see the amount of money in financial aid needed just doubled and went up from $14,000 to $29,000 because his 90-day treatment will incur two deductibles and double the out of pocket max since it falls into two separate calendar years.
[box type=”alert” size=”large” border=”full”]Even worse there is no guarantee that the insurance policy John is using this year will renew next year let alone on the same terms.
Don’t ever give up hope if you need addiction treatment.
Now, this article is only about the potential negative financial impact of seeking treatment at the end of the year. Worse than the monetary impact is the risk of loss of life for delaying treatment. Substance abuse is a deadly disease killing over 60,000 people a year in the U.S. I wrote this story hoping to give one more reason for someone with an addiction to seek treatment as early as possible. There are a lot of free resources to help with a drug or alcohol addiction. If you do not have financial resources or insurance to pay for much-needed treatment. Free help is available for alcohol at Alcoholics Anonymous, drug addiction at Narcotics Anonymous, Heroin Addiction at Heroin Anonymous and free federal substance abuse and mental health programs at the Substance Abuse and Mental Health Services Administration SAMHSA.
You can and should go to rehab in November and December
Don’t put it off for any reason. If your frustrated about your insurance benefits and confused what your cost for rehab will be, just give us a call.
About the Author
Bruce Berman personally has assisted several hundred people into treatment for alcohol, substance abuse, and dual diagnosis. He has maintained continuous recovery from various addictions since September 1989. Besides himself, he has placed his own children, employees, family members, friends and other loved ones into various treatment programs. Whether you are struggling with addiction or a loved one is most likely the author has dealt with a similar situation in the past. Bruce is a father of four children ages 9 to 31 and happily married to his wife Victoria who has also been in recovery since November 1995. Together Bruce and Victoria run 800 Recovery Hub a company that specializes in placing people in need of treatment into the best treatment center they can.
Bruce Berman is not a medical doctor, holds no degrees or licensees in addiction and has no formal education in treating addiction. He relies solely on his personal experience gained in attending and participating in over 10,000 hours in various 12 step meetings since 1989 as well as the experience he has working with addicts and their families since 1989.