Insurance is one of the biggest barriers for people seeking addiction and mental health care. Fortunately, there are several insurance providers and plans that cover both a Substance Use Disorder (SUD) and a co-occurring mental health disorder. Known as ‘dual diagnosis,’ this integrated type of treatment has been ranked as the number one best practice for co-occurring disorders [1].
Understanding what dual diagnosis is, and whether your insurance plan covers it is important to get the right, effective care and avoid financial surprises — especially at a time when your health is your priority.
What Is Dual Diagnosis?
According to the National Alliance on Mental Illness, dual diagnosis is “when someone experiences a mental illness and a substance use disorder simultaneously” [2]. Dual diagnosis considers how addiction and mental health are connected. It is not a diagnosis itself, but the combination of diagnoses: an SUD such as alcohol or opioid addiction and a mental health disorder such as depression or bipolar disorder.
Treatment for dual diagnosis involves evidence-based therapies, including Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). Medication-Assisted Treatment may also be used, where medically warranted, to alleviate withdrawal symptoms and reduce the risk of relapse for SUD. Holistic practices such as meditation and yoga are also common to facilitate physical, mental, and spiritual health in dual diagnosis rehab programs.
If left untreated, both an SUD and mental health disorder can worsen. The goal of dual diagnosis treatment is to overcome addiction, manage mental health, and work toward long-term recovery.
Does Insurance Cover Dual Diagnosis?
Many commercial insurance providers cover dual diagnosis rehab programs. However, you will need to confirm that your provider is considered “in-network” at the center where you want care. You will also have to check that your specific plan is applicable to dual diagnosis.
“In-network” means that the treatment center works with your insurance provider and can cover the cost of your care (totally or partially) or can offer discounted rates and lower out-of-pocket costs.
It’s worth keeping in mind that the Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that requires insurance companies to cover mental health to the same degree as medical and surgical procedures.
Health insurance providers that offer benefits for mental health can’t impose higher financial requirements for substance use/mental health care. Nor can they impose stricter limitations for care. They must also provide equal coverage for inpatient, outpatient, intermediate, and emergency mental health care.
MHPAEA does not mean that dual diagnosis is automatically covered, nor that there won’t be additional costs.
What Is Verification of Benefits?
Verification of Benefits (VOB) is the process to confirm that your insurance provider is accepted by the treatment center offering dual diagnosis care. VOB also confirms that your insurance plan covers dual diagnosis.
VOB is conducted by the treatment center when you first call them. The admissions team will ask you for information including:
- Your full name
- Your date of birth
- A copy of your insurance card (both sides)
- Your policyholder’s information
- Your member ID and group number
- Contact details for your insurance provider
- Information about the dual diagnosis program you want
VOB should only take a few minutes, and the admissions team should be able to tell you on the call if your insurance covers dual diagnosis programs.
Paying For Dual Diagnosis Without Insurance
It’s possible to pay for dual diagnosis treatment without insurance. You may want to do so if you don’t have health insurance or if your health insurance provider is not accepted by the treatment facility (it’s out-of-network).
Paying out-of-pocket will be more expensive than using insurance. Many treatment centers offer payment plans that can make payment incremental and more manageable.
Before you decide to pay for dual diagnosis outside of insurance, speak with the admissions team at the treatment center. They may be able to suggest alternative financing options that suit you.
Insurance-Covered Care At Buena Vista Health & Recovery Center
Buena Vista Health & Recovery Centers are leading rehab facilities for addiction and co-occurring mental health disorders. We offer expert and empathetic care in a calm environment, blending evidence-based therapies and wellness activities.
We accept most commercial insurance providers. Our VOB process is transparent and we’re happy to answer any questions you have to make finances clearer. We strive to get you closer to recovery, as soon as possible.
Our centers in Chandler and Tucson, AZ span 50,000 square feet each and are fully equipped for safe, effective treatment.
Start the healthier, happier life you deserve. Call us.
Sources
[1] SAMHSA. (2009). Integrated Treatment for Co-Occurring Disorders. library.samhsa.gov.
[2] National Alliance on Mental Illness. (October 2017). Understanding Dual Diagnosis. nami.org.
