How to File Claims for Substance Abuse

Substance abuse treatment may require a doctor referral.

If you plan to seek professional treatment for substance abuse, figuring out how to pay for it can be a daunting task. If you have health insurance that covers substance abuse problems, the company may help pay for treatment if you file a claim. Follow all of your insurance plan guidelines to ensure the claim is accepted. If you don't have health insurance, other options exist to help you afford treatment.

Instructions

1. Call your insurance company and ask if substance abuse treatment is covered. Find out what your out-of-pocket costs will be. Some insurance plans may only cover substance abuse treatment if you have a dual diagnosis or a concurrent mental illness. You may be required to get a referral from your doctor before you can get substance abuse treatment.

2. Ask your insurer if you must visit a network treatment provider, or if you can visit the provider of your choice. Your insurer may provide you with a case manager to coordinate your treatment plan.

3. Bring your insurance card with you when you arrive at the office of your health care provider. If you do not have insurance, consider visiting a publicly funded mental health center. These clinics charge fees based on a sliding scale, so you only pay what you can afford.

4. Ask your employer if your company offers an Employee Assistance Program. EAPs may provide substance abuse treatment services to employees, even if your company does not offer health insurance.

Tips & Warnings

• If you don't have health insurance and meet income requirements, you may qualify for Medicare or Medicaid. These government-sponsored programs may help cover substance abuse treatment.

• Visit the Substance Abuse Treatment Facility Locator, developed by the Substance Abuse and Mental Health Services Administration, to find a treatment facility near you.

• Stay in treatment for as long as your health care provider recommends. Relapses are common, even while you're still in treatment. Stay in contact with your health care providers after you've successfully completed treatment. It may be helpful to remain in counseling.

References

• Counselling Resource: SAMHSA Guide on Health Insurance and the Provision of Mental Health and Substance Abuse Services
• NIDA: NIDA InfoFacts: Treatment Approaches for Drug Addiction; September 2009

Resources

• Substance Abuse Treatment Facility Locator