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What to Ask Your Health Insurance Company about Drug Treatment Centers in Maryland
July 31, 2022 at 7:00 AM

If you or a loved one need substance abuse treatment, you may be wondering how much your health insurance will cover. Some policies may cover the costs of your drug treatment center in Maryland entirely, or may only cover a portion of the costs. Knowing which questions to ask your health insurance company can help ensure you know up front what treatment costs are covered.

The Valley is a leading addiction treatment center in Rockville. Our center provides a restorative approach to treating addiction, where patients can relax, take a break from daily life, and build a meaningful path toward recovery.

Below, we’ll cover some of the top questions to ask your health insurance company about substance abuse treatment.

1. When does insurance coverage start for substance abuse treatment?

First, you can’t be penalized for having a pre-existing condition or prior diagnosis for any type of substance abuse. For that reason, you should be entitled to substance abuse services and treatment from day one of your plan’s start date.

Things that may affect when insurance coverage kicks in:

  • After prior authorization: Some services may require pre-authorization before you can obtain coverage for them.
  • After meeting a deductible: You may be required to meet an out-of-pocket deductible before your plan starts to cover substance abuse services. Based on the plan you have, this may be significant.
  • After spending a minimum: In some instances, your plan may require that you pay a specified dollar amount on medical services before your coverage for drug addiction services can start.

2. What kinds of treatments are typically covered?

Some mental health and substance abuse services may be covered by insurance, including:

  • Co-occurring medical and behavioral health conditions, such as coexisting addiction and depression
  • Talking therapies, including psychotherapy and cognitive behavioral therapy
  • Unlimited outpatient sessions with a psychiatrist, clinical social worker, or clinical psychologist
  • Telemedicine and online therapy
  • Impatient behavioral and addiction treatment services received in a hospital or rehabilitative setting. Your plan may limit the length of your stay or cap the dollar amount they’ll pay for your care per benefit period.
  • Medical detox services, including medications

Insurers only cover treatments that are considered medically necessary.

The breadth of coverage for substance abuse services, such as the length of rehab or hospital stays, also varies from plan to plan.

3. Will my healthcare plan cover residential treatment?

Healthcare plans must provide medically necessary residential treatment. A residential treatment center provides long-term treatment and 24-hour supervision for individuals requiring ongoing and a more structured therapy environment.

A few questions to ask your health plan include:

  1. How long could residential treatment last?
  2. Is residential treatment covered for substance abuse?
  3. What will I have to pay?
  4. Where is residential treatment provided?
  5. What are the names of contracted facilities?

You will likely need prior approval from your health plan before you or a family member receives residential care treatment. If your plan says the treatment is not medically necessary, you can file a complaint with your health plan.

The Valley: A Substance Abuse and Drug Treatment Center in Maryland

The Valley is a substance abuse treatment center that offers full, inpatient residential services for those seeking help with their substance abuse problems. Our counselors are highly trained in treating and supporting people with co-occurring disorders.

If you or a loved one are ready to begin recovery, get in touch with us today.

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