Entering treatment can feel overwhelming for both the individual and their family.
Yes, addiction has taken a lot from you. And yes, you probably understand that seeking professional help is the way forward. Still, making that jump and committing to a sober life is never easy.
Getting cold feet and backing out now isn’t the answer, though. Instead, work on removing the barriers that make the jump look daunting.
Is money the biggest barrier on your road?
If so, know that this is perfectly normal. We understand that the cost of treatment keeps people from reaching out.
What we can do for you is help you verify your insurance benefits. Next, we can offer you the guidance you need to find a treatment program that works for your medical needs and coverage level.
3 Key Facts to Know Before Verifying Your Benefits
We’ll break down our insurance verification process in a minute. But, for now, let’s get a few things out of the way.
1. Your Plan Likely Covers Behavioral Health Services ( At Least Partially)
The Affordable Care Act considers substance abuse and mental health treatment as essential benefits in marketplace plans.
The specific behavioral health benefits that the provider offers, however, depend on the plan.
There can be some restrictions on which rehab center you can go to, how long you stay there, what therapeutic interventions you may receive, your out-of-pocket costs, and the needed documents.
Our specialist will be more than happy to look into your policy and get down to the real nitty-gritty of your insurance coverage. But here’s a general breakdown of the most common restrictions:
- Which rehab centers to go to? Most HMO and EPO plans limit the options to in-network centers only. POS and PPOs give policyholders a bit more leeway.
- What documents are needed? Your plan might require a face-to-face assessment for pre-authorization or certification of medical necessity (CNC) from licensed healthcare professionals at the facility.
- Which services are covered? Insurance can cover many evidence-based services such as individual counseling, group therapy, and medical detox. But don’t expect coverage for experimental or risky services such as rapid detox.
- How much of the stay is covered? There’s no universal length of stay limitation. You may get an initial authorization and request an extension later based on clinical evaluation. But the limitations are never more restrictive than those for medical care.
- How much to pay? Out-of-pocket pay depends on a few factors, but the plan category is the most important one. Bronze covers 60%, leaving 40% on you. As you go up the cost-sharing ladder, the balance shifts. On Platinum plans, you cover about 10%.
2. Insurance Verification Shouldn’t Cost You Money
There’s no need to pay to get your insurance benefits verified. Many addiction treatment centers will do it completely free of charge.
There shouldn’t be any strings attached, either. You have no obligation to enter treatment with a treatment facility just because their admissions team ran a benefits check for you.
3. Inquiring Won’t Hurt Your Coverage Status
Don’t worry; getting your insurance coverage checked doesn’t affect your coverage status or increase your premiums.
How Insurance Verification Works
At NJ Addiction Resources, our goal is to put residents across New Jersey on the road to recovery. Naturally, helping people understand their benefits and payment options is part of the process.
It’s not as cut and dry as filling out an insurance verification form, though. It’s more of a conversation. Whether you’re calling for yourself or on behalf of a loved one, our experts want to talk to you.
Once they have a better understanding of the substance use history, mental health, and unique medical needs, they start collecting the data (member ID, date of birth, etc.) needed for an insurance verification. Next, they contact the insurance provider to inquire about your benefits.
When they report back to you, they’ll have a complete, jargon-free picture of your coverage, including the following details:
- How much freedom you have when selecting a rehab center (in-network vs. out-of-network).
- Whether you need a referral from your primary care physician first.
- An overview of your deductibles, copay thresholds, and out-of-pocket maximums.
How NJ Addiction Resources Makes Admission Easier
There’s more to the admissions stage than just picking a facility and asking for an insurance verification. The whole process includes physical assessments, screening for nutritional deficiencies, drug testing, breath tests, and some paperwork.
You won’t actually get to start treatment until you’re done with the admissions process. And yes, it can seem daunting.
Here’s how we can make it all a bit easier:
We Have a Strong Network of Partners
NJ Addiction Resources works with partner addiction treatment programs, serving the Tri-State area. Through this network of partners, we can connect patients to:
- Detox
- Residential programs
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Medication-assisted treatment (MAT)
- Transitional sober living homes
No matter where you are right now in your recovery journey, we can help you get admitted to the right level of care.
Finding the Perfect Match Is Our Speciality
Our matching process isn’t arbitrary. In fact, we never want anyone who calls us to feel like they’re just a case number.
That’s why we listen first, refer second.
Specialists at NJ Addiction Resources consider each client as a unique individual, with their own set of symptoms, triggers, medical needs, and preferences. And they keep all these factors in mind as they match you to the appropriate treatment program.
For example, we won’t refer a patient with both an addiction and a mental health condition to a facility that doesn’t offer dual diagnosis programs. We hold every dual diagnosis referral to a more demanding standard of integrated care, too.
You Won’t End Up Stuck on Hold
The experts at NJ Addiction Resources are in contact with the admissions teams at partner substance abuse treatment centers. We’ll connect you to them directly, so you don’t have to wait on hold for too long.
We Do Our Due Diligence
At NJ Addiction Resources, we hold ourselves to a high standard. We pride ourselves on being a guide built for real recovery rather than band-aid solutions.
We only recommend treatment facilities that meet these standards. Rest assured that our staff has already done the research before connecting you with a vetted provider.
Our Work Doesn’t End When You’re Admitted to a Program
Our specialists do their best to connect you with a program that suits you perfectly. However, we don’t just cross our fingers and hope the placement works.
Part of our process is checking in later to make sure that the program is working for you. If something isn’t right, all you need to do is let us know, and we’ll help you find alternatives.
FAQs
Is the copay for substance use disorder treatment high?
Parity laws are here to control the financial requirements. In many cases, insurance companies can’t charge you way more for seeing an addiction treatment professional than they would for a visit to a medical or surgical care provider.
To find the exact copay or coinsurance, contact our team.
Can I still receive treatment if I’m ineligible or uninsured?
Yes. New Jersey has a number of state-funded treatment options. You can explore them through the Division of Mental Health and Addiction Services (DMHAS)’s service directory. ReachNJ also takes in calls from residents, regardless of their insurance status.
Plus, some rehab centers are willing to work with low-income patients, offering sliding-scale fees and payment plans.
Are partial hospitalization programs covered by insurance?
Yes, PHPs are covered by many plans. After all, the program can be quite cost-effective compared to residential treatment options. The bill no longer includes 24/7 staffing or round-the-clock housing. This causes a 40–60% drop in overall expenses.
Insurance companies recognize this aspect, which means you’re more likely to get the authorizations you need without much back and forth.
That said, PHPs aren’t made for every patient. Some people benefit from the overnight monitoring and full-time stay at the rehab center, especially those with severe addictions or intense psychological conditions.
How long does the admission process take?
The duration depends on your clinical needs and the facility’s specific protocols. To put things into perspective, assessment and lab tests needed for an outpatient detox can take 1–2 hours.
Don’t let that intimidate you, though. For the most part, it’s just the initial intake process that takes a while. The regular daily check-in is usually smoother.
Let’s Work Through the Details Together
Between the technical terms and the lengthy pages, insurance policies can be hard to understand.
The good news is that you don’t really need to have it all figured out to get your recovery journey started. We’re here to walk you through the first (and often hardest) steps.
Our team can coordinate between your insurance provider and our partner treatment centers, both New Jersey-based and out-of-state.
Get in touch today, and let’s explore your payment options together.