Guide To Health Insurance.org

Although there are some federal protections regarding substance abuse and health
insurance coverage, each of the 50 states also has its own laws and guidelines
related to this issue. On the federal level, the Health Insurance Portability
& Accountability Act of 1996 (HIPAA) guarantees certain protections for individuals, which include privacy and confidentiality of records pertaining to medical conditions and treatment. The State Department of Insurance should be consulted as to what services are provided, and which are excluded from a particular plan.

Unfortunately, there is a disproportionate number of children and teens who use drugs and alcohol, and who require treatment from problems relating to these addiction. Essentially, many of the guidelines remain the same, whether the person is seeking treatment for a illness-related or substance abuse problem.

Seeking Substance Abuse Treatment

If a person seeks treatment for a substance abuse problem, he or she (or the child's guardian) should follow certain steps in obtaining coverage:

• Determine whether a referral is necessary from the primary care physician before seeing a specialist.
  
  
• Check out limits on annual deductibles and determine whether there is a limit on the number of visits (for appointments with a substance abuse counselor, for example).
  
  
• Research the hospitals where it is permissible to go under the insurance plan.
  
  
• Learn whether certain diagnoses or conditions are excluded from the coverage.
  
  
• Ask whether there is an annual limit on co-pays or total dollars spent.

Short-Term Investment, Long-Term Results

Studies have shown that, if alcohol and other substance abuse problems are addressed and treated (which is more likely if the individual has comprehensive insurance coverage), this will decrease the amount of money spent on other medical bills and usage. In other words, if an alcoholic is seeking and receiving treatment for his addiction, he is less likely to call in sick to work. Fewer missed days means higher productivity for employers. This translates into increased efficiency as a national workforce. The results from one study of the California Department of Alcohol and Drug Programs were particularly impressive, finding that:

"...a 17 percent increase in health status and significant decreases in health care utilization after treatment. Hospitalizations from physical health problems dropped 36 percent, drug overdose hospitalizations dropped 58 percent, mental health hospitalizations dropped 44 percent, emergency room visits dropped 38 percent, and the total number of hospital days dropped by 25 percent."

It is apparent that short-term investment in substance abuse treatment for individuals who suffer from addiction problems, yields lower health care costs for all of us.