When someone is seeking treatment for a substance use disorder, their most pressing questions will be about the cost of treatment and whether their insurance provider will cover it.
The good news is addiction treatment is usually covered by health insurance companies, including Alliant Health Plans, which has provided group and individual coverage to the people of Georgia for the last two decades.
The exact coverage Alliant offers, however, will vary. Some plans will have higher monthly premiums that leave the patient responsible for a smaller deductible and coinsurance. Other plans will have much smaller monthly premiums, but the deductible will be much higher, and so will their coinsurance portion.
Affordable Care Act
The Affordable Care Act (aka Obamacare) turned substance use disorder and mental health services into essential insurance benefits, so most people with a plan will have at least some coverage. The type of plan will dictate what the copay, deductible, and coinsurance amounts will be.
Costs will vary among rehab centers as well, depending on the price of treatment as well as what kind of care they offer. Whether a center is a luxury rehab or a more standard medical facility will factor into costs, too.
To avoid sticker shock, it’s always a good idea to do research ahead of time. Contacting your insurance provider is a good way to learn exactly what is covered, and what you will be responsible for. Rehab centers can also tell you what the costs are for services. Getting care with a center that is in-network can save a lot of money, too.
Alliant Health Levels of Care
Like many plans available through the Health Insurance Marketplace or by employers, Alliant Health has several options.
- Platinum plans are considered top of the line, with the priciest monthly premiums, but out-of-pocket costs are lower. Some Platinum plans have no deductible.
- Gold plans also have higher premiums (but generally not as high as Platinum level). Gold plans usually have lower deductibles and co-pay charges, just not as low as Platinum plans.
- Silver plans are more middle ground. Premiums are lower than Gold’s but higher than Bronze. Out-of-pocket costs tend to be higher than Gold plans.
- Bronze plans have the lowest monthly premium but the highest deductibles and co-pays. These plans can be good for people who don’t need (or expect) a lot of medical care.
- Catastrophic plans are another option. People must meet criteria to qualify, including being below the age of 30 or getting a hardship exemption through the Marketplace. Monthly rates are very low, but the deductibles are high.
If you’re shopping for plans some things to consider include:
- How often you expect to see your primary care physician
- Whether you see specialists (and how often)
- If you have special procedures or surgeries planned
- Whether you have regular prescriptions
Going in-network can save money. Some plans may not allow any out-of-network care (especially health maintenance organization, or HMO, plans). PPO (preferred provider organization) plans usually offer out-of-network coverage, but the deductibles can be more than double, and the coinsurance may be higher.
Drug and Alcohol Rehab
Does Alliant Health cover drug and alcohol rehab? Generally, addiction treatment is covered, usually under behavioral health. That can include detoxification, inpatient, intensive outpatient treatment programs, partial hospitalization programs, and residential treatment center services. These require prior authorization in order for insurance to cover it, however.
How much Alliance Health will pay hinges on the type of plan. Platinum may mean no deductible needs to be paid, and the patient will have a lower coinsurance. Bronze plans are the opposite; a patient likely will have to pay a larger deductible and a larger percentage of the coinsurance.
Length of Treatment
The length of treatment Alliant Health permits can vary.
In prescribing a treatment stay, the National Institute on Drug Abuse (NIDA) suggests considering what a patient is dependent on (and for how long) as well as their medical needs (both physical and mental when shaping a treatment plan. Gender, ethnicity, culture, and age are points to consider as well. NIDA says a longer treatment stay — a minimum of three months — tends to produce better outcomes.
Rehabs also work hand-in-hand with insurance companies, too, requesting more treatment time for the patient when necessary, or when the patient prefers that.
Does Alliant Health also cover mental health? Mental health care is considered an essential service thanks to the Affordable Care Act, and Alliant Health does cover treatment for mental health conditions. Since mental health and substance use disorders often overlap, that can be extremely beneficial to patients.
Mental health care can include office visits, specialist appointments, counseling, inpatient and outpatient hospital services, and medications to help one manage their condition.
The exact cost of treatment and available options will vary depending on patient needs and what kind of plan one has.
Alliant Health inpatient rehab involves checking into a facility for around-the-clock treatment. Inpatient rehab can last 30 days or even 60, 90, or more days. There the patient is treated for their substance use disorder and/or mental health issues. Inpatient rehab involves several stages:
- Assessment: The staff examines and diagnoses the patient so they have a clearer picture of the extent of their substance use disorder and any other co-occurring issues, including mental health. That is used to create a treatment plan.
- Detoxification. A lot of patients need to undergo detox before their addiction can be treated. That’s when the body is rid of drugs or alcohol. Sometimes medication is given to lessen the uncomfortable side effects of withdrawal, including vomiting, anxiety, and insomnia. Medication-assisted treatment (MAT) also helps keep the patient safe and stable, since some substances (alcohol, benzodiazepines, and opioids, especially) can be dangerous to quit outright.
- Treatment. Treatment involves a number of therapies, including cognitive-behavioral therapy, to look for potential causes of addiction. Such therapies also help the patient find healthier coping mechanisms than substance use. Holistic therapies may help with relaxation and anxiety, and support groups help the patient understand they’re not alone in this.
- Aftercare. Here, the staffers prepare the patient for life after rehab. This could include scheduling regular check-ins to note progress or discuss challenges. The patient will be put in touch with support groups or counseling closer to home. The goal is to remain focused on recovery and prevent relapse.
Alliant Health outpatient services sometimes can replace inpatient care but they can also act as an extension of it.
For intensive outpatient programming, a patient may visit the clinic several times a week, usually for a few hours at a time. During their visits, they’ll take part in therapy and build on ways to stay sober. Some patients graduate from inpatient treatment to a nearby sober living facility so IOP can serve as a transition between residential care and independent living.
Outpatient care may also include behavioral therapies and counseling, where patients will work on reinforcing their sobriety.
Suboxone sometimes is used as part of medication-assisted treatment (MAT), to treat opioid use disorder. It contains two drugs, buprenorphine, and naloxone (which happen to be the generic version of suboxone).
MAT is a blend of behavioral therapies and medication to treat addiction. Suboxone (or its generic equivalent) gives a user many of the effects of opioids while reducing the intensity. That has been found to help with withdrawal symptoms. By preventing the highs and lows of an opioid with a shorter half-life, taking suboxone can prevent relapse.
Does Alliant Health cover suboxone treatment? It, or the generic buprenorphine-naloxone version, is on the list of the covered drugs.
Many plans won’t cover suboxone because it’s the name brand and tends to be pricier. Many plans, however, do cover the generic version. Copays will vary, however.
Methadone is another drug used to treat opioid use disorder, frequently as a part of medication-assisted treatment (MAT).
Methadone is a long-acting opioid agonist that helps by lowering opioid cravings and reducing withdrawal symptoms. It also prevents the soaring highs and crashing lows that accompany some drugs, making it easier to stop using. That can lower the likelihood of relapse.
Does Alliant Health cover methadone treatment? Methadone is one of the drugs on Alliant’s list of approved prescription medications. Not all formulations may be covered, but many will be. Exact costs will vary by plan.
Paying for Rehab
Addiction rehab, especially when it involves detoxification and inpatient care, can be expensive. Hesitance about a huge bill can shy some people away from considering rehab. Insurance can make it more manageable, however. With coverage, approval of care, and going for treatment at an in-network facility, those all can help keep costs down.
Deductibles and coinsurance are usually a given. A Platinum plan has higher monthly premiums but lower out-of-pocket costs when it comes time for care. A Bronze plan has lower monthly premiums but the patient will pay the most out-of-pocket. Then there are the Catastrophic plans for members younger than 30 with hardship exemptions. Catastrophic plans have very low monthly premiums but high deductibles, usually best for worst-case scenarios, according to Alliant. Gold and Silver plans fall in the middle between Platinum and Bronze.
Treatments provided by a facility outside one’s insurance network can expect to may more. It’s a good idea, when researching treatment, to consider deductibles, coinsurance, and out-of-pocket maximums.
Insurance companies can provide a lot of information about what you will be responsible for and whether you’ll need approval. Addiction centers can also clear up a lot of questions about the services they offer and what the costs will be.
When paying for services not covered by Alliant Health, rehab centers can help work out a billing plan so you don’t feel such an intense burden. Financing may be an option, too.
- alliantplans.com – Shopping for Health Coverage?
- healthcare.gov – Mental health & substance use disorder coverage
- alliantplans.com – SoloCare Individual/Family Plans 2022
- healthcare.gov – Health insurance plan & network types: HMOs, PPOs, and more
- alliantplans.com – Prior Authorization Requirements
- drugabuse.gov – Principles of Effective Treatment
- drugabuse.gov – Types of Treatment Programs
- nami.org – Buprenorphine/Naloxone (Suboxone)
- nami.org – Methadone
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.