In most cases, health care plans are a pretty simple and straightforward affair. When a customer walks into the office of an insurance agency they are clearly explained about the features of the particular insurance plan that they wish to buy. From that point on, a customer and his or her family sign up for the health care plan and continue to pay a preplanned monthly premium. The amount of these premiums, the options that each healthcare plan provides as well as any other benefits vary from provider to provider.
Typically in most cases, these sorts of health plans are supposed to cover everything that’s related to the costs that a family or an individual has to endure in terms of health expenses. This is where the various offers and packages offered by insurance health plans become so important. There are different levels of coverage such as bronze, silver, gold, and in some cases, platinum. As you can probably guess, these different levels of coverage offer differing variations of coverage in different sets of circumstances.
Each of these programs has different features that are specifically designed for different people. For example, it is true the bronze program would allow people to pay the lowest monthly premium but they also come with some restrictions in terms of health coverage. If you’ve signed up with the bronze package then you may have to receive care at only specific treatment facilities. This is where the question of mental health and drug rehabilitation becomes so important. Most of these health insurance plans refer to drug rehabilitation as “specialty service”. It may also be possible that your insurance may not cover substance related issues at all. While it may differ from provider to provider, chances are that you will have to gain a referral before using your insurance for these specialty services, if your provider does indeed offer these services.
The most significant laws related to drug addiction treatment as well as substance abuse are the Parity Laws. It doesn’t matter what kind of health insurance you use, your treatment will depend almost entirely on these Parity Laws. These laws exist at both state and federal law. Hence, it is important to understand them on those different levels.
Federal Parity Law
Until almost a decade ago, there was extremely minute coverage for addiction treatment in any insurance policy. The policies that did offer the treatment required extensive premium payments. There was little or no legislation that was done regarding regulating this particular situation until 3rd October, 2008 when then President George Bush Jr. signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The “Parity Law” as it has become known since then made it mandatory for large employers and companies to offer group health insurance for addiction treatment as well as alcohol, mental health in addition to other sort of medical and surgical treatment.
However, there’s a reason behind the term “parity” in the law. The core purpose of this legislation is not to create a more concrete method for health insurance to be used in terms of addiction treatment but to create a stronger correlation between overall health and mental health.
Another thing worth noting is that this law does not apply to employers that have less than 50 employees. The definition of a “large” employer as stated in the law is a company that employs 50 or more employees. More than that, this law does not apply to any individual plans either. In addition to these small employers’ exclusions, it does not apply to Medicare and Medicaid either. While this is generally the norm, there may be a few exceptions which would depend squarely on two factors i.e. each individual’s immediate need for addiction treatment as well as how the law is applied.
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State Parity Laws
Most of the states have had similar laws like the federal parity laws before the federal law’s passing. It didn’t matter if you were using a local or branded insurance policy, the laws still applied in equal measure on all the health insurance plans. The only variation arises when you’re talking about the rich and powerful companies that prefer to have their own insurance plans. This usually refers to companies that have the means to pay the benefits with their own funds rather than let their employees rely solely on the insurance agency’s funds.
Companies that choose to pursue this method have the benefit of not being mandated by the state or federal laws. This is where the situation gets a little tricky. While all companies, rich or modest, are bound to follow the parity law, they can choose not to cover the drug rehabs costs of their employees if they choose not to. While most companies who do follow this practice opt to provide partial coverage, there isn’t any legal action that can be taken against them if they choose to not provide any sort of coverage at all.
It doesn’t matter which plan you end up using, there are always certain things that you should always be vary of. One such thing that you need to be fully aware of is known as the “Non-Quantitative Treatment Limitation” (NTQLs). The reason why NTQL is so important is because unless your plan is exempt from following the Parity Laws, your drug rehab should be counted the same as the coverage for any other surgical and medical condition.
NTQL are primarily a feature that is associated with insurance health plans meant specifically to ensure equal care for mental health and drug rehab users on par with any other health requirement. The NTQL are not expressed in any numerical form, hence the use of the term “Non-quantitative”. Rather they cover specific aspects of your drug rehab treatment such as the names of prescriptive drugs that are covered by your plan or the fees that can be paid for other services within your rehab such as counseling, a refusal to cover the payment if you fail to complete the rehab as well as overseeing your overall progress at the facility where you undertaken the drug rehab.
This feature is used by many insurance providers to ensure that they keep a watchful eye over you and make sure that their money is being spent on something useful. The insistence that they’ll only cover your treatment costs if you complete the payment is a way to ensure that you complete the program and do not relapse in the middle. It has been both praised for the psychological role it plays in patients completing their rehab period and criticized for how it can reduce rehab into an obligatory get together for several others. Research has shown over the years that the success ratio of programs with NTQL is 50% which is fairly high for insurance plans that cover drug rehab.
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