Is Tramadol Rehab Treatment Covered By Insurance?
Rehab treatment is one of the essential benefits of health insurance plans. This has been strongly pushed by the Affordable Care Act of 2010, which aims to support individuals struggling with substance use disorder (SUD) and encourage them to seek treatment.
As the opioid epidemic continues to affect billions of people in the United States, the federal government made rehab treatment more accessible through this stipulation. Most insurance policies used to consider substance addiction as a pre-existing ailment, they get to deny a person insurance coverage before.
Things have changed and this idea of considering addiction as a pre-existing disease is no longer acceptable. Even the treatment of mental health illnesses, which is often linked to most cases of SUD, is already part of the insurance benefits. Regardless if a person’s condition is mild, moderate, or severe, rehab treatment can be covered by insurance.
Treatment for addiction to Tramadol, an opioid pain medication, is not exempted from any insurance benefits. Every insurance policy contains specific limitations that must be identified before enrolling in a rehab facility. It is best to reach the insurance provider and discuss these points to avoid paying for unexpected costs.
What Are Covered By Insurance For Tramadol Rehab?
Insurance coverage depends on the type of plan that a person owns. A basic policy may cover a portion of the cost of certain services, leaving the patient with deductibles and out-of-pocket payments, while a premium policy can cover most or all of the cost of the services. However, a premium policy is typically more expensive than a basic policy.
Many factors affect the amount of out-of-pocket pay a patient must shoulder during rehab treatment. But when it comes to the services included in the insurance coverage, here is a list of them:
- Health screening
- Detox care, including medications
- Inpatient and outpatient services
- Therapy and counseling services
- Recovery maintenance
At present, addiction is now considered a medical ailment more than a behavioral problem which is why its treatment is covered by health insurance. However, coverage does not always equate with free treatment.
For instance, most insurance providers would advise basic policy owners to consider outpatient care instead of inpatient treatment. This is because the latter is typically more expensive than the former. However, medical advice must still be given top priority in deciding the treatment plan that works best for the patient’s needs.
What Are The Types Of Insurance Plans For Tramadol Rehab
There are three commonly used health insurance plans among patients seeking treatment for their Tramadol addiction. Here are the details on how each plan works.
Health Maintenance Organization (HMO)
Having an HMO policy means a person is limited to availing medical and behavioral services in a specific network partnered by the insurance provider. The main advantage is that it comes at an affordable cost. On top of that, there is a wide variety of physicians and in-network rehab facilities to choose from so the search for a healthcare team can be done easily.
However, choosing to avail of medical services outside the network may strip the patient from enjoying their insurance policy. For instance, when a person’s condition requires a specialist who is out of network, the services must be personally paid by the patient. A referral from an in-network physician is also required.
Preferred Provider Organization (PPO)
A PPO policy is the opposite of an HMO. A person who owns this type of plan can enjoy the insurance benefits of availing medical services within or outside the network partnered by the insurance provider. If a person chooses an in-network healthcare service, the insurance provider will pay less for the cost of the treatment. In addition, referrals are not needed.
However, having a PPO plan can be expensive. A person must pay a higher monthly cost compared to HMO. Plus, it has lower copays for the cost of treatment. This leaves the policy owner a potential out-of-pocket pay and high deductibles, depending on the treatment plan designed for them.
Point of Sale (POS)
POS plans are like a combination of the two previously mentioned plans, although it is more closely related to HMO. In this case, patients are restricted to avail of medical services within the network partnered by the insurance provider. However, this plan can cover out-of-network costs when necessary.
When a person owns a POS and prefers to use it for their rehab care, it is important to be clear about the specifications of their policy from their insurance provider since every company has varying terms and conditions when it comes to this type of insurance plan.
How Does Dual Insurance Coverage Work
Dual insurance coverage means a person gets the chance to enjoy the benefits of two insurance policies from different providers for the cost of their rehab treatment. This happens with any of the following cases:
- Married people can enjoy their health insurance benefits and that from their spouse.
- Individuals under the age of 26 can enjoy their health insurance benefits from the coverage of their parents.
- Individuals under the age of 26 and whose parents have divorced may enjoy health insurance benefits from each of their parents.
- Individuals over the age of 65 can enjoy their health insurance plan and Medicaid.
Dual insurance coverage allows a patient to have a primary and a secondary plan. The secondary plan will automatically pay for the costs not covered by the primary plan, which initially pays for the cost of the treatment. This could sound great, but; this system still does not guarantee that a person will not pay anything out-of-pocket.
How To Qualify For Medicaid Insurance
Children below the age of 18 and adults above 65 years old are automatically qualified for Medicaid. But those who cannot afford to buy an insurance plan can qualify for the benefits of this program as long as their income falls within their state’s poverty threshold.
It would be best to visit the nearest Medicaid Health home to find out the specific qualifications for this since there are variations in some state policies.