Tips for Getting Addiction Treatment Covered by Health Insurance

heatlhcare addiction treatmentGateway Alcohol & Drug Treatment urges Illinois residents—even if denied health benefits for alcohol or drug rehab in the past—to check their current healthcare plan to determine if substance abuse treatment is covered by insurance. Now that federal parity laws, Illinois Parity, and The Patient Protection and Affordable Care Act have all taken effect, many health plans include the same coverage benefits for treatment of mental health/substance use disorders (MH/SUD) as they do for general medical and surgical treatment.

“There are thousands of Illinois residents who need care for addiction issues and now more than ever they have access to treatment through their health insurance. Our goal is to help people understand their treatment options and their insurance benefits” says Michael Darcy, President & CEO, Gateway Alcohol & Drug Treatment.

Here are the top five tips Gateway provides to those seeking coverage for drug or alcohol rehab their health
plans:

1. Know Your Illinois Parity Rights: In the state of Illinois, unless an insurance plan is exempt, large employer plans are required in each calendar year to cover the following for substance use disorders:

2Understand What Insurance Plans Must Follow Federal Parity Laws:

  • Health plans sponsored by private and public sector employers with 51 or more employees including self-insured and fully insured arrangements.
  • All insurance plans sold inside and outside the state exchanges, which are available to individuals and smaller companies with 50 or fewer employees.
  • Some state and local government health plans.

3. Understand What Health Insurance Plans Do Not Have to Follow Federal Parity Laws:

  • Medicare
  • Individual plans not purchased through the health insurance marketplaces
  • Group plans with 50 or fewer employees.
  • Plans who received an exemption based on increase of costs related to parity.

4. Look for a Reputable Treatment Center: Substance Abuse Treatment is a specialty service and it’s important your Financial Counselor is an accomplished expert who can work on your behalf to gain the most from your insurance coverage.

5. Don’t Take No for an Initial Denial: If your health plan meets the criteria of state and federal parity, it’s important to realize an initial denial does not always mean no coverage is available. Knowledgeable Financial counselors may be able to obtain insurance coverage for treatment by exploring different avenues with your insurance company.

“Substance use is a treatable healthcare disorder – and people should know it is covered by insurance, similar to diabetes, hypertension and cancer.” says Michael Darcy.

To learn more about treatment options or insurance coverage for treatment related to alcohol or drug abuse, call Gateway at 877-505-HOPE (4673).

The Affordable Care Act Opens Doors to Addiction Recovery

By Dr. John Larson

JohnLarson_Gateway Alchol and Drug Treatment Centers

Dr. John Larson
Corporate Medical Director
Gateway Treatment Centers

In predicting the types of medical problems we may experience in the future, we tend to underestimate the likelihood substance abuse will occur in our own life or the life of a close family member.

Studies have shown that approximately 10% of Americans need substance abuse treatment each year but only 1% receives it. And while the reasons vary, financial constraints are frequently a barrier that prevents people from getting the kind of help they need.

Prior to the passage of the Affordable Care Act, millions of Americans who had insurance and tried to get treatment for themselves or a family member discovered alcohol and drug abuse was not covered by their health insurance. But things are different today.

Now, the Affordable Care Act requires health insurance carriers to provide the same benefits for psychiatric and substance abuse as they do for other medical conditions.

Unfortunately, too many people still assume treatment for addiction issues is not covered by their health insurance, and the reality is they have the type of coverage benefits they need and can engage in treatment right away.

With the financial barrier removed, there’s hope for more families to end the relentless cycle of substance abuse.

Not enough hours in a day to iron out what’s covered by insurance? Gateway Alcohol & Drug Treatment will do the work for you. Call 877-505-HOPE (4673) to learn more about your insurance coverage options for substance abuse treatment.

The Irony of Drug and Alcohol Addiction

alcohol addiction substance abuseNearly one in 10 American adults and teens has a drug or alcohol abuse problem; and sadly, only one in 10 Americans who need help with substance abuse issues will seek professional treatment.

Prolonged exposure to alcohol and drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit using by sheer force of will. But that doesn’t mean someone with addiction issues is a helpless victim.

The good news is: Brain changes associated with addiction can be treated and reversed through engaging in therapy and other treatments, taking appropriate medication as prescribed, and leading a healthy, sober lifestyle.

Click to View Gateway's Roadmap to Understanding Substance Abuse: A Guide for Parents and Families

Click to View Gateway’s Roadmap to Understanding Substance Abuse: A Guide for Parents and Families

So, if addiction can be successfully treated, why are roughly 90 percent of Americans ignoring their issues with alcohol and/or drug dependency? Tragically, that’s the irony of addiction.

There are major hurdles to overcome before people acknowledge they are ready for substance abuse treatment. Denial, stigma, aversion to change, understanding treatment options, and cost of care are just a few.

But there is hope. The Affordable Care Act now makes substance abuse treatment accessible to more people through their insurance benefits. And effective outpatient treatment allows adults to continue working while receiving treatment.

For more information, visit RecoverGateway.org/Roadmap to get a free copy of our new family and parent guide, “Roadmap to Understanding Substance Abuse.”

CMS Announces $840 Million Initiative To Improve Patient Care and Lower Costs

The Centers for Medicare & Medicaid Services (CMS) launched a new innovative model to support clinicians in achieving large-scale health care transformation. The Transforming Clinical Practice Initiative will provide up to $840 million over the next 4 years to support 150,000 clinicians in sharing, adapting, and further developing comprehensive quality improvement strategies, which are expected to lead to greater improvements in patient health and reduction in health care costs.

This effort is especially significant to the behavioral health community. With implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, more than 60 million Americans will gain access to new or expanded coverage for mental health and substance abuse services. As the health system broadens, the behavioral health field has a responsibility to lead in setting comprehensive goals to develop the workforce, improve quality, and provide effective services to individuals with behavioral health conditions.

An opportunity such as this is an incentive for the behavioral health community to integrate with and leverage funding that will transform health care delivery.

Michael-Darcy-Gateway-Alcohol-and-Drug-Treatment“I am glad to see that SAMSHA is investing in improving clinical practices. The development and improvement of clinician practices will have an immediate impact on improving quality of care.

At Gateway Alcohol & Drug Treatment Centers we track engagement, retention and continuity of care by practitioner and work with our practitioners to improve their outcomes in these areas.”

Michael Darcy
President/CEO
Gateway Alcohol & Drug Treatment

How To Apply

Beginning October 23, 2014, CMS will begin accepting applications for the following funding opportunity announcements:

Potential applicants are highly encouraged to submit nonbinding Letters of Intent to apply by November 20, 2014. The application period for both funding opportunity announcements is October 23, 2014, through January 6, 2015. The funding opportunity announcements and detailed application instructions are located on Grants.gov.

Gateway CEO Rallies Alcohol & Drug Rehab Industry to Reach More Patients

drug rehab, industry, iadda, Gateway Treatment Centers

Michael Darcy, President & CEO, Gateway Foundation Alcohol & Drug Treatment, speaking at IADDA’s annual meeting on Sept. 4, 2014, at Hilton in Lisle, Ill.

Michael Darcy, President & CEO, Gateway Foundation Alcohol & Drug Treatment, urged members of the alcohol and drug rehab industry attending IADDA’s annual conference at Hilton in Lisle, Ill., on Sept. 4 2014, to focus on attracting consumers who need treatment for substance abuse  with private pay insurance. Inspired by Gateway’s own successful model of treating the insured population, Darcy explained to a packed ballroom of industry leaders that treating the insured population will help the industry fulfill its collective mission of supporting individuals who can’t afford alcohol and drug rehab.

“More than 80 percent of Americans have private health insurance. And, with the Affordable Care Act in effect, the majority of Americans now have access to treatment for substance abuse issues through their health insurance benefits. With state budgets in flux, treating the insured population will ensure future viability of the alcohol and drug rehab industry so those who may not be able to afford treatment will have access to help when they need it,” says Michael Darcy, President & CEO, Gateway Foundation Alcohol & Drug Treatment.

As the soon-to-retire leader of one of the largest substance abuse treatment organization in the U.S., Darcy has dedicated his career to evolving treatment and expanding accessibility and recovery support throughout Illinois and beyond. Since 1968, Gateway Foundation has steadily improved its expertise and capacity, growing capabilities to treat more than 9,000 individuals daily through successful programs and treatment centers spanning five states.

“In the long run, it is best for the consumer and society at-large if America has a vibrant substance abuse treatment industry that works seamlessly with health care professionals, hospitals and insurance carriers on behalf of patients in the primary healthcare arena,” explains Darcy.

For more information about Gateway Treatment Centers and its executive leadership, please visit RecoverGateway.org.

Did You Know? Insurance Carriers and Medicaid Now Cover Drug Treatment

insurance drug treatmentSince the Affordable Care Act (“Obamacare”) went into effect on Jan. 1 2014, all insurance carriers and Medicaid are required to cover the costs associated with treatment for substance use disorders on their insureds’ behalf. As a result, a significant financial barrier for treatment is now lifted for millions of Americans who deserve the chance to get life back on track.

If you know individuals who have been denied insurance benefits for substance abuse and mental health treatment in the past, please let them know the financial hurdle standing in the way of their recovery is no longer an issue.

Gateway Treatment Centers: More Convenient and Better Than Ever

While your life has experienced positive growth, so has Gateway! It was a very busy 2013, opening two new, state-of-the-art Gateway outpatient treatment centers and completing a major makeover at our Lake Villa residential treatment center.

Gateway Chicago River North: To better serve the needs of the Chicago area, a Gateway center specializing in Adult Outpatient Treatment is now located in Chicago’s River North district near the Merchandise Mart.

Gateway Swansea: In the St. Louis Metro East area, we relocated to Swansea from Belleville, IL. The center provides Outpatient Treatment for adults and adolescents in addition to family counseling and medication assisted treatment as part of an integrated approach to treatment.

Gateway Lake Villa: Last but not least, our Lake Villa residential center underwent major cosmetic renovations to provide a more comfortable, relaxed atmosphere for recovery. The renovated public spaces, corridors and guest rooms feature a soothing, natural palette. Lunge area updates included access to areas dedicated to studying, meditating and DIY laundry.

For more information about the programs offered at Gateway Alcohol and Drug Treatment Centers, call 877-505-HOPE (4673).

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