Like many other states, Long Island finds itself in familiar territory battling explosive heroin and drug use.
As Long Island, N.Y. continues to fight the problem on the streets, parents have taken it to the politicians in hope of change. Parents have been pressuring officials in Albany to pass a bill that would require inpatient drug rehabilitation to be paid for by health insurance.
Parents and Senator Hannon are trying to pass a bill that will require insurance companies to cover more drug rehab treatment options. The Albany Insurance lobby is trying to discourage the bill based on the premise that it would significantly increase the cost of health care coverage. Most states, 43 of them, have laws that require insurance plans to cover drug rehab.
But the stigma associated with drug addiction often requires individuals to fight with their health insurance carrier if they deny coverage. The bottom line is group health insurance carriers are required to follow state law. It is important to research you state laws before you contact your carrier and do not take no for an answer. Every insurance plan is different and every level of coverage is different.
If an insurance carrier covers drug rehab, it is likely there will be a portion of the treatment they will not pay for. The New York Senate Task Force is examining the expanding problem of addiction in New York and Long Island. The task force is looking at the growth of heroin and opiod addiction and how to overcome hurdles regarding treatment and insurance coverage. In New York State, insurers do not have a standard definition of “medical necessity” which allows them to operate in a gray area and approve and deny coverage at will. Do not forget that health insurance is a business.
Is Drug Rehab Covered?
With Obama Care, the health insurance market place has to offer 10 essential health benefits: These essential health benefits include at least the following items and services:
- Outpatient care—the kind you get without being admitted to a hospital
- Trips to the emergency room
- Treatment in the hospital for inpatient care
- Care before and after your baby is born
- Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy.
- Your prescription drugs
- Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Your lab tests
- Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
- Pediatric services: This includes dental care and vision care for kids
- Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans.
From the description on healthcare.gov it does appear that drug rehab treatment should be covered.