Can your health insurance policy cover the cost of sober living care after your loved one completes a drug rehabilitation program? The short answer: maybe. It depends heavily upon the specifics of your insurance policy, the claims you file, and your willingness (or not) to follow up if your claim is denied and you believe it should have been covered.
In most cases, however, your insurance policy will not cover the entire cost of your loved one’s sober living stay unless you have premium coverage, but it should cover a portion of the cost.
If you have a copy of your health insurance policy, look it over carefully. When you think you have a fair assessment of what you can expect from your coverage, contact your insurance agent directly and ask. If the agent gives you information that you believe conflicts with the contents of your policy, read them your insurance policy. If you don’t get an answer that makes sense or more questions are raised, ask to speak with their supervisor. Make sure to take notes during the conversation, including:
Don’t stop asking questions until you have a list of everything you need to file a claim and a clear understanding of what you can expect when you do so.
NOTE: It’s your responsibility to know what your insurance policy covers, but it’s also a good idea to consider finding out what other policies cover as well. If yours isn’t as comprehensive as you would like it to be, shop around for a better option that will provide you with the coverage you need to best care for your addicted family member.
It can be easy to take your health insurance agent’s word for it when he says that no one offers coverage for preventative care or extended medical care and rehabilitation or that the amount of coverage they offer is above the state standard. Find out for yourself what your health insurance company is legally required by state law to provide in terms of minimum coverage and type of coverage when you contact your state insurance board. If your insurance company isn’t meeting these minimums, give them a call and point out the issue. If they refuse to work with you or positively address the situation, report them to the state insurance board.
At the end of the day, your health insurance company’s primary concern is their bottom line. They are a business, and they are going to work hard to avoid paying for claims that they can get away with terming as ambiguous. You may need to stand up and fight for the coverage that you are legally owed. This can mean hours of your life spent on the phone, sending letters with proof of receipt, and moving your way up the chain of responsibility at the company. In the end, your efforts may or may not pay off, but you will need to decide in advance how far you are willing to go to get coverage for sober living for your loved one.
If you find that your health insurance coverage is not adequate to meet your needs, you often have the option of financing the remainder of the bill. Learn more about how to pay for sober living when you contact us at the phone number listed above.