Can I Get Insurance for an Injury-Caused Addiction?

Can I Get Insurance for an Injury-Caused Addiction?Injury and addiction are sometimes related. Addiction may develop after an injury because drugs that may be prescribed to deal with symptoms often have high addiction potential. Conversely, addiction can also lead to an increased risk of injury because of the effects of psychoactive substances on coordination, cognition, judgment, and other physical and mental processes. Untreated addiction can lead not only to injury, but to many other health conditions, and treating it early is a wise financial decision. Unfortunately, insurance companies have not always recognized that fact. In general, insurance coverage for addiction is improving, but there is still a great deal of variance between policies.

Injury, Illness, and Workers’ Compensation

There are different types of health insurance, and coverage may vary between them. Insurance can be public or private. People injured on a job may be covered by workers’ compensation policies. If a workplace injury led to Xanax addiction, the addiction may also be covered, especially if it appears that a prescribing physician was negligent. The Workers Compensation Research Institute reports that studies find that many physicians who prescribe opioid painkillers to injured workers fail to follow guidelines designed to monitor use, abuse, and diversion of the medication. The pattern is undoubtedly similar with drugs like Xanax, which may be prescribed to treat anxiety or insomnia arising from an injury.

The Mental Health Parity and Addiction Equity Act

Private insurance policies vary in their coverage of addiction. In 2008, an important law known as the Mental Health Parity and Addiction Equity Act, (MHPAE) was passed, which improved coverage for many policy-holders. The law states that if an employer with more than fifty workers offers insurance that covers behavioral health, then coverage must be similar to what is offered for other medical conditions. The law does not, however, mandate insurers to cover addiction services, but simply restrains those who do from limiting coverage more than they do for other conditions. In most cases, if a policy covers addiction, then how the addiction developed is not relevant. Medicare offers coverage for addiction treatment, regardless of its genesis.

Combating Denied Claims

Unfortunately, people suffering from a wide variety of medical conditions have found that insurance companies often deny claims. This is equally true in the realm of addiction treatment. A 2013 article in the Cape Cod Times  notes that laws in 43 states require certain group health insurance plans to provide coverage for drug or alcohol addiction, but that many insurance companies work to find ways around the laws. The article quotes a consultant with the National Alliance for Model State Drug Laws who notes that “this is the hidden part of the war on drugs.” Often, addiction treatment providers help their patients advocate with their insurance companies and receive the coverage they are due. There are also efforts on the state level to hold insurance companies accountable.

If a health insurance company denies a claim for coverage, it can be appealed. A how-to guide produced by the Wall Street Journal suggests several strategies when doing so, including the following:

  • Learn what led to the denial. Sometimes it is something as simple as a wrong code entered on a claim form.
  • Learn your insurer’s appeals procedure. When you call to get the information, get the names of the people you speak with and take notes on the conversation. Ask for relevant documents.
  • Gather your denial letter, a copy of your plan’s benefits, and guidelines as to what the company considers to be medically necessary (which can sometimes be found online).
  • Decide whether to seek help from an advocate. Families USA provides a list of resources by state. The Patient Advocate Foundation is another source of potential help.
  • If the denial is caused by the insurance company’s decision that a treatment is not medically necessary, ask your doctor for a detailed letter supporting the need.
  • Consider utilizing a state appeals process, which is often handled through the state’s insurance regulator.

Addiction and the Affordable Care Act

The Affordable Care Act (ACA) is poised to provide insurance coverage for addiction to many who are currently without it. All insurance sold on Health Insurance Exchanges to certain newly eligible adults must include addiction treatment coverage. The White House Office of National Drug Control Policy notes that the ACA includes substance abuse treatment as one of the ten elements of essential health benefits.

We Can Help

If you have questions about addiction treatment and insurance coverage, we can help you find answers. Our toll-free helpline is staffed 24 hours a day with knowledgeable and compassionate counselors who can check your insurance coverage for you if you wish, at no cost or obligation. They can also help you identify Xanax addiction treatment options and find programs with personnel who will help advocate for you and negotiate with your insurance company. Call now and begin your journey of recovery.

Are you ready to seek treatment?

If you are ready to beat a Xanax addiction and start a new life in recovery then we can help. We have admission counselors standing by 24 hours a day to take your email, live chat request, or phone call to get you in the addiction treatment center that best fits your unique & specific needs.