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There is an overabundance of medical insurance companies available in America, and within each company a myriad of different (often tiered) healthcare coverage plans are offered.

Each plan has extremely specific details surrounding the exact types of medical services that will be considered eligible, which indicate what services will be covered under the plan. Each plan will have a different monthly premium fee, and in many cases if a monthly premium payment is missed the plan is terminated. Some plans cover a portion of fees associated with obtaining services from an out-of-network provider, and some do not. Each plan has different co-payment fees for different services (e.g., filling a prescription, a specialist visit, surgery, a primary care visit, etc.). Insurance is complicated, and insurance companies change the fine printed information yearly. 

It’s The Law

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was passed, which stipulates that insurance companies are no longer able to deny coverage or discriminate against individuals that struggle with substance abuse and/ or addiction. Not long after, in 2010 President Obama signed the ACA (Affordable Care Act) into federal law. This act classified mental health in addition to addiction services as essential healthcare benefits. The purpose for signing the ACA into law was threefold: to create affordable health insurance coverage, enabling more individuals to obtain healthcare; to expand the Medicaid program; and to support “innovative medical care delivery methods designed to lower the cost of health care generally.” Prior to the passing of this litigation, insurance companies were not obligated to cover pre-existing conditions (e.g., eating disorders, substance use disorder, etc.). The ACA requires all health insurance plans to provide coverage for pre-existing condition. Furthermore, the ACA stipulates that health insurance companies are obligated to provide similar coverage for the treatment of all diagnosable mental illness.

In short, yes; the passing of these two acts essentially forced insurance companies to treat mental health and substance abuse treatment akin to regular health treatment. Therefore, all insurance companies are required to include some level of coverage for in-network providers delivering outpatient, intensive outpatient, and inpatient services. Prior to committing to a treatment program, it is best to verify with the rehab program you are considering that they accept your plan. It can also be helpful to call a health insurance representative associated with your insurance company to make sure you are aware of any potential out-of-pocket expenses related to attending the rehab program you selected. 

Further Information and Support

Navigating the challenges that arise from living with mental illness, struggling with substance abuse, and/ or addiction can not only be all consuming but are often impossible to effectively handle without proper support. If you are concerned for yourself or a loved one regarding mental illness, substance abuse, and/ or addiction we recommend reaching out for help as soon as possible. Bear in mind that you do not have to be on this journey alone. At Upwell Advisors, we offer unique, customized concierge therapeutic services to provide our clients with unparalleled support throughout every step of the recovery process. 

If left untreated, substance abuse, addiction, and/ or mental illness can result in long lasting and potentially life-threatening consequences. The earlier you seek support, the sooner you and your loved ones can return to leading happy, healthy, and fulfilling lives. Please do not hesitate to reach out for guidance. We welcome the opportunity to discuss how we might best be able to help you or your loved one in the recovery process. Feel free to reach out by phone at 917-475-6775. You are also welcomed to contact us anytime via email at [email protected] We look forward to supporting you on your journey.

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