One of the great challenges facing America heading into the 21st century was addressing how rising medical treatment costs were making it difficult for ordinary Americans to be able to afford to get treatment for medical conditions. At the time, there were tens of millions of people who couldn’t afford either healthcare insurance nor the medical costs they would incur for treatment. It seemed to be an untenable problem for which there was no easy resolution.
THE BIRTH OF THE AFFORDABLE CARE ACT
Heading into the 2008 election cycle, this healthcare issue would end up being one of the most significant issues facing American voters. As both political parties put forth their best plans to ensure all Americans could afford to care for themselves and their families, it was the Democrat party and next, US President Barack Obama, who would carry the day.
The first order of business for the ruling party that now had supermajorities in the House and Senate was to fulfill the campaign promises to put healthcare insurance in the hands of all Americans. After several months of fierce battles between the political parties, the Democrats with the President leading the way brought the Affordable Care Act of 2009 to the table.
Without input from the minority Republicans, the Affordable Care Act easily passed in both houses of Congress and made it to President Obama’s desk for signature. By the time he had affixed his name to this new law, the Affordable Care Act had become one of the most aggressive pieces of legislation in American history.
THE MAIN TENANTS OF THE AFFORDABLE CARE ACT
As House Speaker Nancy Pelosi so famously said in the run-up to the passing of the Affordable Care Act, “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.” Indeed, the new law was very comprehensive and controversial, leaving a lot of Americans skeptical about how it would affect their lives.
Over the next couple of months following President Obama’s signing of the bill into law, the powers to be were able to educate Americans about how the bill was designed and what safeguards were in place to make sure the bill would work for all Americans.
The primary tenant of the Affordable Care Act was and is all Americans are required by law to maintain a healthcare insurance policy either as an individual or through their employer. Failure to secure coverage by a prescribed date would result in a penalty to be assessed by the Internal Revenue Service. For individuals who could not afford to purchase an insurance policy, supplemental funds were put in place to make sure everyone had the means to get healthcare coverage. Note: the part of the law regarding the penalty assessment for noncompliance has since been lifted.
Beyond the personal mandate, there are other tenants in the Affordable Care Act that have had a profound effect on the healthcare industry in the US. For instance, insurance companies are no longer allowed to discriminate against customers with a preexisting condition. Regardless of an individual’s current health status, healthcare insurance providers are required to offer them coverage up to and including anything to do with the preexisting condition.
The law also has a mandate about how insurance companies are required to handle coverage for addiction treatment. In the sections below, the discussion will focus on the Affordable Care Act and addiction treatment.
AFFORDABLE CARE ACT AND ADDICTION TREATMENT
For decades, healthcare insurance providers were able to avoid covering addiction treatment costs under two premises, legally. First, the existence of addiction was undoubtedly a clear indication there was a preexisting condition. Fair or not, this was a common position for many insurance companies. Fortunately, the premise is no longer acceptable or applicable.
Second, healthcare insurance providers would commonly take the position that getting treatment for addiction was an elective process. Most insurance policies back in the day were written to exclude coverage for elective procedures and treatments. Amazingly, they took this position in spite of the fact the medical and psychiatric professions had boldly moved forward to proclaim that addictions are, in fact, diseases.
Using this fact, the Affordable Care Act stood the healthcare insurance industry on its tail-end. It did this by proclaiming that healthcare insurance providers would henceforth be required to cover addiction treatment costs in the same manner they would cover any other medical condition.
The effects of this particular mandate have had a profound impact on the addiction treatment community. Now, millions of Americans who couldn’t afford addiction treatment can get the care they need if they have the required healthcare coverage. It’s worth noting that while the Affordable Care Act requires insurance providers to cover addiction treatment costs, the insurance companies have also been given a little wiggle room as to the extent of coverage they must offer.
ADDICTION TREATMENT COSTS MANDATED BY THE AFFORDABLE CARE ACT
As mentioned above, healthcare insurance providers do have a little wiggle room as far as the extent of addiction treatment they must cover. It’s noteworthy that people with elite insurance coverage would likely have no problem getting most, if not all, of their addiction treatment costs covered. It’s the folks with standard healthcare coverage that need to be aware of precisely what the Affordable Care Act requires insurance companies to cover.
Getting right to it, here’s a list of the basic addiction treatment costs healthcare insurance providers must cover:
- Drug and alcohol detox programs
- Prescription medications prescribed as part of the addiction treatment process
- Basic inpatient (residential) care
- Outpatient care programs
- Aftercare programs, including access to sober living
There are a few things to note about this list. First, it’s a good bet that insurance companies will pay almost all of the costs related to detox. After all, there is no recovery if the client can’t rid themselves of their drug/alcohol dependence.
Second, there are usually limitations on inpatient care. Most insurance companies will cover a good portion of inpatient care as long as it doesn’t include advanced treatment methods like holistic and evidence-based therapies. Also, there’s a high probability a particular insurance company will cap inpatient care coverage at 90 days. Finally, insurance companies will heavily promote outpatient care as the best treatment option. That should surprise no one given the fact outpatient care costs are significantly less than inpatient care.
THE INSURANCE VERIFICATION PROCESS
All insured individuals should be able to determine their extent of addiction treatment coverage. It should be listed on the policy’s summary page. If the information is confusing or not readily available, the insurance company’s customer service department should be able to clarify the facts. To ensure the addiction treatment center understands the parameters of treatment they can offer, they do employ administrators who have experience in working with insurance companies. These administrators would most certainly be willing to help with the insurance verification process.
If you are struggling with an addiction and have healthcare coverage, the above information is good news. Thanks to the Affordable Care Act of 2009, you won’t have to wreck your financial stability to get the addiction treatment you need. With this in mind, it’s time you reach out for help. You’ll be amazed at how good your life could be if you don’t have to live in the cycle of addiction any longer.
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