Following the passage of the Patient Protection and Affordable Care Act in 2010, which most people simply refer to as Obamacare or the ACA, providers of insurance are required to offer essential health benefits in their different packages of insurance services. Health benefits that are considered to be essential include pediatric care, emergency services, laboratory testing/services, vision care, and mental health treatments and assessments. The substance abuse and substance use disorder designation falls under the mental health treatments portion of the essential health benefits description; therefore, insurance companies are required by the government to offer the same level of coverage for behavioral health services, such as therapy, substance abuse treatments, detox, etc., as they do for primary care services. Therefore, all insurance policies are required by the federal government to offer some level of treatment for substance abuse problems.
The actual type of coverage that any single individual will have depends on the insurance provider they use, the particular policy they have, and other extenuating factors; however, insurance providers at the current time are not able to disqualify individuals for treatment on the basis of their issue being a preexisting condition. The bottom line is that all insurance policies cover some level of treatment for drug rehabilitation services.
What Is Luxury Drug Rehab?
Luxury drug rehab centers are residential or inpatient treatment programs that offer their clients upscale amenities that are often considered to be like the type of services available at resorts. A residential treatment center houses clients on site, but does not provide 24-hour medical services. Medical care can be provided on or off site.
An inpatient unit is a treatment unit where professional medical care from doctors and nurses is available 24 hours a day. Luxury drug rehab centers are most often residential centers, but there may also be luxury drug rehabilitation centers that operate as inpatient units.
These luxury facilities are designed to be very attractive, comfortable, and attentive to the clients in them. The ratio of clients to staff members is much lower than it is in other treatment facilities. Luxury rehabs are very often located in vacation-type settings, such as on beaches, in the countryside, or away from the hustle and bustle of urban areas.
Some of the other types of services that are offered at luxury drug rehabs that are not often offered in traditional rehab centers include:
- Spa-like amenities: These may include steam baths, saunas, whirlpool baths, state-of-the-art exercise equipment, swimming pools, massage services, and meditation classes.
- Nutritional counseling: Many luxury drug rehab programs employ nutritionists to assist their clients in developing a diet that will help to reduce cravings, eliminate toxins from the body, and recover from substance abuse.
- Fitness and exercise coaching: Keeping physically active in recovery is important, and many luxury drug rehabs offer fitness counseling and supervised exercise programs as part of recovery.
- Outdoor activities: Part of the attraction of a luxury drug rehab program is that it offers treatment that is not standard of traditional programs. Many of these facilities offer various outdoor sports and activities, such as horseback riding, tennis, golfing, skiing, and hiking.
- Complementary and alternative treatments: Luxury drug rehab programs often advertise the use of complementary and alternative treatments, such as art therapy, music therapy, yoga therapy, wilderness therapy, and acupuncture.
- Privacy: Luxury drug rehab programs have the added feature of offering the highest level of privacy to their clients. This may include having a private room as opposed to sharing a room, which is typical of standard residential treatment programs.
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Is Treatment Covered?
For most individuals, the additional amenities offered at luxury drug rehabilitation centers are probably not going to be covered by insurance. Some individuals with very extensive insurance coverage might be able to get some of the amenities covered; however, insurance companies operate like most businesses in that they try to minimize their expenditures and maximize their income.
Most insurance policies offer some coverage for the following services:
- Detox: Medical detox, or withdrawal management, is often covered under most insurance policies to some extent.
- Medications: Medications used in the treatment of withdrawal symptoms, to control cravings, or for other associated symptoms are often covered to some extent under most policies.
- Inpatient or residential treatment: Most insurance policies offer coverage for inpatient treatment services to some extent. Residential treatment services may be covered to some extent. There are often limits on coverage related to the number of days in treatment.
- Outpatient treatment: Outpatient treatment services are often covered to some extent under most policies. There are often limits on the number of sessions covered in a given time period.
- Counseling and psychotherapy: Therapy for substance abuse is often covered to some extent under most insurance policies.
Because insurance companies receive numerous claims, they are very meticulous in deciding which claims satisfy the stipulations of the individual’s insurance policy and which claims are not covered under the policy. The person’s particular policy will dictate acceptable coverage and length of coverage, but there are also some general concerns that individuals who are seeking treatment for substance use disorder should consider.
- Medical necessity: The concept of medical necessity is quite straightforward. The treatment should be considered to be essential in a medical sense for the person’s recovery from the specific condition that is being treated, and some other less expensive or less involved treatment cannot equally address the issues associated with the condition. The concept of medical necessity is often used in determining whether a person should be placed in an inpatient treatment setting, a residential setting, or an outpatient treatment setting.Withdrawal management is considered to be a medical necessity in the treatment of certain types of substance use disorders (e.g., opiate use disorders, alcohol use disorders, etc.), but the specific type of medical detox or withdrawal management treatment program is often determined by the individual’s situation. For instance, some individuals may not be considered appropriate for inpatient treatment programs, because they do not require 24-hour medical care, whereas others may be approved for this type of program due to their condition.
- Empirically validated or supported treatments: In addition to satisfying the concept of medical necessity, insurance companies also often require that the treatment being applied to the individual has sufficient documented and accepted research evidence to support its use for that condition. Very often, insurance companies look to the standard set by Medicare to decide which types of treatments are empirically validated for a specific condition and which type of treatments are not.Treatments that do not have empirical validation for use in the treatment of substance abuse will often not be covered. These can include acupuncture, rapid detox, nutritional counseling, exercise programs, and most of the leisure activities at luxury treatment centers. While some programs, such as exercise and nutrition, can help an individual in the recovery, these programs may lack empirical validation and are not considered to be medically necessary by many insurance coverage providers; therefore, they may not be covered. Obviously, insurance companies are not generally going to cover costs associated with golf, tennis, spa treatments, etc., as these are not deemed to be medically necessary for the treatment of substance abuse.
- Deductibles, copays, and other out-of-pocket expenses: It’s also important to understand how one’s specific policy works. This means understanding the plan’s deductible (how much a person is responsible for paying before their policy kicks in) and copays (the amount of a particular covered service that the person is responsible for) when evaluating potential programs.
Very often, the cost of a private room, housekeeping services, and other services not directly related to the treatment of an individual’s substance abuse may not be covered under a particular policy. Most insurance policies will not cover the extra expense associated with luxury drug rehab, and it is extremely important for an individual to understand this.
In order to find out what will be covered and what will not be covered under one’s policy, simply contact the customer service department of the insurance provider and discuss specific coverage under the policy with a customer service representative. Staff members at inpatient or residential drug rehabilitation programs can also communicate with the insurance provider regarding a client’s particular coverage, and they may be able to get the most coverage possible for particular services.