I Was Blindsided By How Insurance Treated My Son’s Substance Use Claim
I practice insurance coverage law and was not clear on my rights for substance use disorder insurance coverage when trying to help my son.
We work with a special group of moms and dads – Parent Coaches – who, just like you, have been affected by a child’s substance use. They are volunteers who receive special training from the Partnership and our clinical partner in order to help other families through similar struggles. In these blog posts, they answer parents’ most frequent questions.
Often insurance policies will include a residential or rehab benefit, but that doesn’t mean a family can automatically use it. A number of factors are taken into consideration including whether a person has had previous treatment within the past year or two, and the outcome of that treatment. Insurance companies will opt for what is considered the least restrictive level of care, which may mean an outpatient program for your loved one.
If you believe that your loved one needs inpatient care, there are a few options.
Appeal the Decision: The first is to appeal the decision, providing as much information as you can as to why your teen/young adult needs inpatient care. Medical issues, legal problems, risky behaviors that would endanger others (e.g., driving a bus for work or operating heavy machinery under the influence), potential or actual loss of a job, or being expelled from school, detailed drug history, etc., may help change the decision.
Investigate the Florida Model: Another option is to see if the insurance company will pay for a Partial Hospitalization Program or an Intensive Outpatient Program that has a boarding component. In some treatment facilities, families can pay for boarding separately, while in others, the cost for boarding is absorbed by the treatment program. This is known in the industry as the “Florida Mode” and while quite prevalent in Florida, can be found in other states as well.
Ask for a Scholarship: A third option is to ask treatment facilities if they will scholarship your child in whole or in part, to help reduce out-of-pocket costs. Often local addiction related advocacy groups will know which facilities may be willing to help.
Check with Your County: In some parts of the country, the local county department of human services will have funding for detox and treatment. Typically treatment will be at a facility they have contracted with as opposed to one of your choosing.
Look into Faith-Based Programs: There are also some programs that are faith-based that provide treatment, often in exchange for work. The Salvation Army Adult Rehabilitation Centers is an example of this kind of program, as well as CURA.