Does insurance have to cover addiction treatment the same way it covers other medical care?
From the RecoveryHome team. We write some questions from situations people often ask us about, and answer them with general information from public health sources. Been through this yourself? Your answer could help the next person who finds this page. How we write team posts
RH
RecoveryHome team Team
asked 2 days ago
Families sometimes find that their plan covers a hospital stay for a heart problem easily but fights every day of addiction treatment. Is that allowed?
RH
RecoveryHome team Team
answered 2 days ago · general information, not medical advice
Often, no. Federal parity law requires most health plans that cover mental health and substance use treatment to cover it no more restrictively than medical and surgical care. That applies to things like copays, visit limits, and how strictly prior authorization is applied. The Affordable Care Act also made substance use treatment an essential health benefit for individual and small-group plans.
If you suspect a parity problem:
- Ask your plan, in writing, for the criteria used to deny or limit your care, and how comparable medical care is handled.
- File an appeal. Most plans offer an internal appeal and then an independent external review.
- Contact your state insurance department, or for most job-based plans, the U.S. Department of Labor's Employee Benefits Security Administration.
The rules are complex and have exceptions, so this is general information, not legal advice.
Read more: Does insurance cover rehab?
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