Every new health insurance plan that complies with the Affordable Care Act (ACA) covers services for mental health and substance abuse disorders, including behavioral health, this sort of treatment is part of the 10 essential health benefits.
Mental and Behavioral Health Services
All Qualified Health Plans Must Include:
-Inpatient services for mental and behavioral health
-Behavioral health treatment, i.e. counseling and psychotherapy
-Substance abuse treatment or substance use disorder services
An individual’s behavioral health benefits primarily depend on his or her state and the health insurance plan you selected. The full coverage of each plan which includes behavioral health benefits are outlined in the Summary of Benefits for easy comparison.
Pre-existing Mental and Behavioral Health Conditions
-These services are covered and there are no dollar limits.
-The Qualified Health plans (QHP) cannot deny coverage nor charge more simply because you have any pre-existing condition. This includes mental health as well as substance use disorder conditions.
-Coverage for all pre-existing condition treatments start the same day your coverage takes effect.
-The QHP cannot put yearly or lifetime spending limits on any essential health benefit coverage. This includes mental health and substance use disorder services.
Parity Protections for Mental Health Services
The 2008 Affordable Care Act and Mental Health Parity and Addiction Equity Act require all QHP plans to provide parity protections. This entails mental health and substance abuse services to be made comparable to standard medical care and surgical services, thus balancing the plan treatments with the stipulation for standard medical rehab for the said situations.
This generally implies that limits cannot be made more restrictive on mental and health substance abuse treatments than medical and surgical benefits. Coverage must be of the same extent in terms of:
Financial – pertains to deductibles, co-insurance, co-payments, and out-of-pocket limits
Treatment – pertains to the number of days or visits that are covered
Care Management – pertains to instances like having to get authorization prior to availing a certain treatment
How Do You Get A Person Into Rehab?
If a loved one or someone you care about is addicted to drugs or alcohol, you may be thinking of ho you can possibly get them much-needed help. Though one cannot force any person into rehab, the best you can do is encourage them to make the decision on their own. Hence, it is critical to proceed with a well-planned approach revolving around care and respect to achieve the ideal outcome.
Staging an Intervention
You may be considering staging an intervention with the goal of helping your loved one, and it would be a wise move to have a professional interventionist to provide their expertise. Interventionists are trained and highly equipped, whereby their knowledge on mental health, addiction, and intervention planning serves as guidance. Their role is critical to the success of your intervention, and he or she can likewise minimize any tension as a mediator. Make certain that you share your loved one’s insurance information with the interventionist during the planning process. This allows you the opportunity to select a treatment facility that accepts the individuals insurance to cover rehabilitation costs.
STAGE 1: Plan Your Intervention
Intervention requires careful planning and consideration of various aspects down to the tiniest detail. This involves deciding where it will take place, who will be present, the consequences your loved one can face if they don’t get help. The ideal time would be when the addicted individual is sober, surrounded with his or her closest friends and relatives, but none of the people they used drugs with. Planning also includes designating the rehab facility and transportation made readily available in the anticipation of success.
STAGE 2: Express How Their Addiction Affects You
Respect must be maintained even for people struggling with addiction, and can be observed by holding your intervention in a private place. Never be accusatory, critical or judgmental when speaking. The goal is to reach out and not push them further away. Each person who’s attended should tell how their loved one’s addiction has affected them and what they feel about the unhealthy behavior. “I” statements will keep your words at the safe side rather than using “you” where your genuine concern comes out otherwise.
STAGE 3: Getting Your Loved One to Rehab
If your loved one agrees to go to rehab, act quickly and take them directly to the facility. Their bags must be packed and waiting for you to head towards rehab when the intervention is deemed successful. Don’t make any stops along the way, since any delay only gives your loved one the slightest moment in time to reconsider.
STAGE 4: Show Full Support Towards Recovery
Upon agreeing to get treatment, do everything on your end to show your support for your loved one’s recovery. Do so while keeping the guidelines set by treatment specialists in mind. However, support is not something you’d freely give in case your loved one drops out of treatment. If this does happen, be firm and stick with the consequences you laid out during the initial planning stage. For instance, if you promised to stop providing the addicted individual with money or a place to live if they refuse to get treatment, then you need to keep your word and really withdraw those things. This can be the hardest part, but this could be the only way to help them get back on track with the treatment. Hopefully, they will complete the program and rejoin society by successfully kicking their habit.