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Can I Get Insurance Coverage for an Injury-Caused Addiction?

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Can I Get Insurance Coverage for an Injury-Caused Addiction?

Addictions, known clinically as substance use disorders, are chronic diseases covered by many health insurance plans. Health insurers that offer coverage for substance use should pay for care regardless of the reason behind the addiction.

Injury-caused Addictions and Worker’s Compensation

Pain reliever addictions caused by an on-the-job injury are a significant part of the overall epidemic of pain reliever addictions. Business leaders and workers’ compensation insurers note that costs for pain relievers make up a greater percentage of claims now than in years before and much of the cost is due to injury-caused addictions, according to a May 2013 article in Psychology Today. Workers’ compensation plans do cover the cost of addiction treatment; many experts note that treating the addiction is cheaper than covering the long-term prescription drug bill for an addicted worker.

Experts following the trend say back injuries are the most common injury to lead to addiction, according to a May 2013 article in Insurance Journal. The U.S. Centers for Disease Control and Prevention (CDC) considers the misuse and abuse of opioid pain relievers, such as hydrocodone, methadone, oxycodone, and oxymorphone, to be an epidemic.  People who take high doses of these drugs are in danger of dying or slipping into a coma.

CDC physicians warn that U.S. physicians are prescribing opioid pain relievers for long-term use instead of reserving the drugs for limited cases on a short-term basis. The Insurance Journal article notes that 16% of people prescribed an opioid pain reliever for a work-related back injury were still taking the drugs a year later and 42% of people have prescribed the drugs in the first year.

Can I Get Insurance Coverage for an Injury-Caused Addiction?

Affordable Care Act and Addiction Treatment

With the passage of the Affordable Care Act, more people should have access to health insurance that covers substance use disorders, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Health insurers who offer plans on the Health Insurance Marketplace are required to cover mental health disorders and addiction treatments at the same level as they cover physical disorders.

Coverage for treatments includes counseling and psychotherapy, according to healthcare.gov. Beginning in 2014, health plans cannot refuse coverage for pre-existing conditions; previously some insurers considered an addiction a pre-existing condition and denied coverage for addiction treatments for new members. Also, due to the Mental Health Parity and Addiction Equity Act of 2008, all health insurers that cover substance use disorders must cover treatments at the same level as physical medical conditions. Mental health and substance use parity means copayments, deductibles, out-of-pocket maximums, and other costs are the same for physical and mental treatments.

Addiction Treatments for Injury-Caused Addiction

When it comes to substance use disorders, health insurers that offer behavioral health benefits make no distinction between an injury-based addiction and an illicit drug addiction. The medical profession understands more about the physiology of addiction now than ever before and addictions are considered chronic diseases, according to the National Institute on Drug Abuse (NIDA). Addiction treatment centers offer effective programs that help people fight their addictions and learn the skills necessary for maintaining a long-term recovery.

Organizations such as the NIDA also promote the importance of treating a person’s mental health issues at the same time as an addiction. Now that many health insurers are required to offer the same level of benefits for mental health and physical health, there are more options for people who need help for co-occurring disorders. Also in 2014, most individual and small group health plans will cover mental health and substance use disorder treatments.

Need Help Finding Addiction Treatment?

There is hope for a person struggling with a pain reliever addiction due to an injury. Many scientifically based treatments are available to offer people the best outcomes possible.

When a person wants to stop taking an addictive substance and needs medical help, it is important to seek care. Individuals with health insurance can call a customer service representative to find out where to receive care and to understand the types of services covered. If a person does not have insurance, a local hospital or 12-step support program may be able to recommend community based services that help people afford detoxification services.

The physical symptoms of addiction are only one part of the problem. Do not suffer alone with the psychological and spiritual challenges of addiction. If you or a loved one is looking for a program that offers addiction treatment, please call our toll-free number. Our admissions coordinators are available 24 hours a day, seven days a week. Don’t wait; call today.

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