Paying for Addiction Treatment
Getting someone you care about into treatment can mean jumping over a lot of hurdles; one of the bigger hurdles to get over is coming up with the money to pay for it all.
There's no doubt treatment can be expensive; according to a recent article published on WebMD, the cost of treatment can be as much as $80,000, depending on several factors, such as how long someone stays in treatment, location, amenities, and the number of individual therapy sessions the patients has every week.
Being conservative, I advise my clients they should expect to pay about $1000 per day for rehab, although I have placed many clients in high-quality treatment centers for as low as $350 per day. It's important to remember that more expensive does not necessarily mean better treatment, nor does it indicate a more successful outcome.
In fact, One of my favorite adages about the cost of treatment is that it doesn't matter if you send your addicted family member to the Betty Ford Center in Palm Springs or the Salvation Army in Detroit; people who achieve long-term recovery go to AA meetings.
In 2004 I checked into a well-known treatment center expecting to be pampered. In fact, I chose this rehab because of its reputation for being the hotspot for affluent and famous, which I was neither. Fortunately, this treatment center was the real deal and deeply rooted in the twelve steps. Had this place turned out to be a pleasure cruise I hoped for, I might not be sober today.
As an interventionist, it's my responsibility to place my clients in the most appropriate recovery programs based on their clinical needs, still cost is almost always a factor that affects these decisions.
Note: treatment is rarely 100% covered by insurance.
Some of my clients have the resources to choose any treatment center they want; however, a majority of them rely on insurance to cover a bulk of the cost. Still, most insurance policies require the client to contribute some amount of money on top of that in copayments and deductibles.
Using Insurance to Pay for Treatment
Depending on your insurance policy, the copayment and deductible can add up to a lot of money. Sometimes these out-of-pocket expenses are high enough where it no longer makes sense to use the client's insurance benefits. If the client has some money, we can usually make something work.
As you might suspect, clients who can afford to pay for treatment in cash also have good insurance benefits, while people without money have crappy benefits. The opposite is true every once in a while, and I will get a client who hasn't worked in six months and surprisingly good benefits or a wealthy entrepreneur with the worst insurance.
The Affordable Care Act has made it easier for people to get treatment for addiction and mental illness. The ACA says all marketplace plans must include coverage for behavioral health treatment, such as psychotherapy and counseling, mental and behavioral health inpatient services, and substance use disorder.
Be careful because every policy is different. Insurance hardly ever covers the full amount of treatment unless you're a union member that has specifically negotiated one-hundred percent coverage.
Use caution calling treatment centers you find on the internet. One of the first things they'll do is run your insurance benefits, like a car dealer running your credit before he lets you sit in the car.
Make sure you know if the treatment center is in-network with your provider, which means they have a pre-negotiated arrangement with your insurance company. If the treatment center is out-of-network, the economics are entirely different and are likely not in your favor.
The last thing you ever want to happen is to get a call saying your insurance benefits have been exhausted and you have to write a big check or come pick up your kid from rehab. A situation like this could yield heartbreaking and possibly fatal consequences.
Use caution: make sure the treatment center carefully walks you through what is covered by insurance and what monies you are responsible for paying. If you feel like the rehab is being vague or something doesn't feel right, move on. Some rehab centers will eat the cost of treatment if your insurance craps out midway through, but this kind of benevolence is the exception and not the rule.
We could talk about insurance all day and still not have all the bases covered. If there's a risk of the treatment center discharging your son or daughter because your insurance fails and you cannot afford to write a check for the daily rate, don't send them to that treatment center.
All of my contracts contain this warning: NOTE: Commercial insurance benefits are granted based on proving medical necessity. Every insurance company is different, and there are no industry standards for the level of care or length of care covered. Insurance companies can deny coverage at any time and for any reason. We are available to discuss with you in greater detail before making any treatment decisions but make no guarantees.
Never be afraid to call your insurance provider to verify your behavioral health benefits. Ask them to walk you through your policy. Take notes, including the representative employ ID number, date, time, etc.
The Cost of Treatment is Determined by Length of Stay
One of the factors that drive the cost of treatment up is how long someone stays in rehab. Historically the length of treatment is 28 days, which may have been imposed by insurance companies even though research shows more extended treatment yields better success rates.
Note: It takes one year for the human brain to recover from the damage caused by prolonged substance use, according to David Ockert, Executive Director of the Parallax Center in New York City.
A lot of treatment centers build their programs around a 28-day curriculum, but more commonly, we are now seeing programs with minimum 60 and 90-day stays.
Some of these longer-term treatment centers price their programs based on a thirty-day rotation, for example, $25,000 per month regardless of how many months you stay in treatment.
Other programs will incentivize patients to commit to longer treatment by reducing cost for each consecutive month. For example, the first thirty days is $25,000, the second month is $20,000, and the third month is $15,000, and then the price stays there regardless of how much longer the patient stays in treatment.
When paying for treatment in cash, the critical thing to remember is that prices are negotiable based on simple supply and demand. If a treatment center has multiple available beds, they will be eager to admit new patients even at a discounted price. If they are full or running a waiting list, they will be less inclined to accept a lower price.
You don't jeopardize anything asking for a discounted rate. Treatment is expensive, and its not the only cost you will incur putting someone in rehab. There are several additional expenses on top of the treatment center bill, such as travel, medications, clothing, cigarettes, etc.
The goal is to get the most amount of treatment with the least amount of out-of-pocket exposure. Prioritize your search like this:
- Meets clinical needs;
- Provides most in-network or maximum insurance coverage, and
- Your ability to pay out-of-pocket.
Marc Kantor is a certified interventionist and the founder of South Florida Intervention. If someone you care about is struggling with addiction or mental illness, please call 202-390-2273.