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A Guide to Navigating the Indiana Drug Addiction Treatment Insurance Process


In Indiana, seeking drug addiction treatment is an essential initiative to leading a sober, healthy and prosperous life. The health insurance plan people struggling with addiction have will determine what cost he/she will have to incur while seeking treatment.

Your health insurance plan can lighten some of the burden on your wallet. In Indiana, many of the insurance plans include payment options through deductibles, coinsurance, premiums and co-pays. It is very important that people seeking treatment have a good understanding of what their plans offer.

In this article, we will look at the details how you can navigate insurance to seek drug addiction treatment in Indiana.

Insurance Coverage

There is no doubt that navigating insurance for addiction treatment purposes is a complex process. As for the amount coverage, the insurance providers look at the coverage amount and insurance deductibles your plan includes and then decide the variable amount they will cover in the overall drug addiction treatment cost.

Due to this reason, you will find more variable coverage amounts instead of a particular percentage by the insurance providers. Moreover, other coverage will widely vary, such as the length of days one can stay at the rehab, the levels of care a patient can access (outpatient vs. inpatient), stages of treatment (continuing care, on-going vs. detoxification), contacted providers (individual insurance policy of facilities, out-of-network status vs. in-network) etc.

How to Approach Your Insurance Provider for Drug Addiction Treatment

Once you decide to pursue treatment for your drug addiction, a good first step is to call the addiction treatment provider you wish to attend. At Avenues Recovery Indiana, a member of our highly trained admissions department will be able to guide you through the nuances of your plan. They will explain the the details of your coverage in simple terms and even initiate contact with your insurance provider. During such a conversation, ask questions concerning your treatment options, how much coverage you can accept, your eligibility status etc.

Before you do that though, remember to keep your membership identification and insurance card ready in case you need some reference. Clarify every terminology you hear while being given information of the coverage, ask questions unhesitatingly, and be sure to cover everything include the levels of treatment and such details. Educating yourself in the process is crucial and we will help guide you through every step.

Things to Discuss with Your Insurance Provider

Talk about Your Plan

There are several plan types that a health insurance includes. A good idea is to find out about these when consulting your insurance company. Some of the most common plans include:

  • Medicare– these plans do not have a uniform nature and vary by a far measure in coverage. The coverage in this plan depends on what you have, such as medicare supplement insurance policies, additional prescription drug coverage, medicare advantage or original medicare.
  • Medicaid– these plans too differ in nature. The scope, duration, amount and type of services you can avail depend on the state you’re living in. You see, individual states administer and also establish their unique Medicaid programs, hence they designs the specifics too under the light of broad federal guidelines. Some states choose to make a couple of services mandatory while others essential in addition to offering optional benefits.   
  • PPO- this is short for Preferred Provider Organization. If you have this health plan in your insurance, then you will pay less if you opt for providers in your plan’s network. However, if you choose a provider, hospital or doctor beyond your network and no referral then you will have to bear an additional cost.
  • HMO-short for health maintenance organization, this plan limits your coverage, from doctor to care facilities under HMO’s contract or employment. HMO prioritizes wellness and prevention and a notable feature of it is the integrated care provision. In this plan, you will also get no coverage for an out-of-network care unless there’s a dire need for it. Not only this though, under this plan you will also have to living in a service area for earning service eligibility.
  • EPO– Exclusive provider organization in which you can only avail services if you use a hospital, specialists or doctor’s in your plan’s network.
  • If you are speaking to your insurance provider’s rep directly, ask them to point out a search radius to help you locate eligible providers. The best option in this is to begin searching in your current state or the neighboring ones. Be sure to steer clear of addiction tourism, which is a practice where the patients have to leave their home states for seeking treatment.
  • Ask the representative to outline all the details of your coverage, including contracted providers, clinical care levels, treatment stages and lengths of stay at the rehab facility.
  • Discuss the maximum expense out of your pocket during the drug addiction treatment. Find out about co-pays and costs the various treatment options will curtail.
  • Talk about what you need to gain insurance coverage. Some examples may include referral, pre-approval or prior authorization.
  • Request from the representative to email you a list of in-network treatment providers
  • Ask them to provide you the criteria of the provider company, regarding medical necessity for your treatment coverage.

Asking for Additional Resources

When you’re about to have a word with your insurance company’s representative, it is important to know of the additional resources you can ask about. There are situations in which a patient can directly contact their insurance company.

This happens when they’ve got a desired provider or treatment facility to ask about concerning their coverage status. If for some reason your desired provider or facility has no coverage under your plan, or is out-of-network, then perhaps the insurance company can provide you with in-network comparable options. Who knows, they might suit you quite well too.

There are many insurance companies that now employ behavioral health advocates. These advocates are a supremely helpful resource in helping patients find suitable treatment providers.

Look for Eligible Addiction Treatment Insurance Providers in Your Vicinity

If you’re in Indiana State, you can use several resources for locating eligible drug addiction treatment providers near you. For example, the Addiction Resource hub is a helpful source that collects vital information on eligible providers, using the in-network provider list your insurance company will give.

Indiana Addiction Treatment Insurance Coverage- How to Make Appeals

There is doubt about one relevant fact here and that is that subsequent appeals increase the chances of success. In fact, as per the stats, nearly twenty percent of denial of coverage cases turns into success for the covered individuals.

You first levels appeals to insurance providers may not win you success and officially, an appeal has to get denial first before it makes a person eligible for appealing for treatment or services on a higher level. For this very reason, you should keep handy all correspondence with your insurance provider, coverage information and the representatives with whom you discuss and earn support for your appeals claim.

When you all the vital information at hand, it makes referencing easy during all your communications with the plan. You can make two types of appeals:

  • Eternal appeals are those that include judicial hearings, arbitration hearings, accreditation audits, regulator complaints and external review appeals.
  • Internal appeals typically refer to the first and second level appeals. In these you will find grievance/administrative procedure appeals, standard/expedited clinical utilization management appeals, parity appeals etc.

How To File Your Appeal

Before you file an appeal, there are some essential steps to follow. These include:

  • Seeking a medical necessity statement from your healthcare provider
  • Do not forget to get a copy of the SPD (Summary Plan Description), conditions and terms, plan terms, plan coverage and benefits documentation and medical necessity criteria. It is also crucial to get hold of a copy of the clinical guidelines that will determine the benefits for substance use disorder and mental health conditions.
  • Collect all the appropriate medical records for submission.
  • Plan what type of appeal you are going to file, such as i) administrative appeals that address whether the insurance policy plan will cover the recommended plan and ii) clinical appeals or medical necessity that will address the terms of care, such as level of care and length of stay.
  • In case you get an internal denial, it would be a good step to file a complaint with your local state insurance commissioner. Doing so will leverage all your legal safeguards.
  • Your insurance company will typically allow you one or two internal appeals. If you get a denial during the internal process, you may then appeal to an external third party. The law binds your health insurance company to explain to you how you must initiate your next steps of making an internal appeal.
  • You must also a write a personal summary letter, including all the defense and medical necessity of care coverage

Final Thoughts

By using health insurance for your Indiana drug addiction treatment, you can make the process more affordable for you. This is because of the scheduled regular payments that the providers make and the coverage of various cost amounts that are a part of behavioral healthcare. Indiana has a range of health insurance providers to choose from and soon you will be on the road to recovery with their support.

Helpful Tip

It is not uncommon to find insurance companies and healthcare providers at conflict in terms of coverage. Hence, before you file your appeal, it is good to verify if your provider has had a direct conversation with their peers and the insurance medical director regulating the denial.

At Avenues Recovery Indiana, we will do everything possible to make sure you or your loved one can access the coverage you deserve. We are firm in our belief that financial difficulty should never be an obstacle to starting on the path of recovery.

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Brooke Abner,

Motivational Coach