Does Insurance Cover Process Addictions?

Does Insurance Cover Process Addictions?Entering treatment often means overcoming obstacles. For some people figuring out how to pay for rehab tops the list even though allowing an addiction to continue is far more costly. Financial issues may be one factor that explains one shocking statistic discovered by the Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health. Of the 23.5 million persons age 12 or older who needed treatment for an illicit drug or alcohol abuse problem in 2009, only 2.6 million, which is just 11.2%, received it at a specialty facility.

People with process addictions such as compulsive gambling or binge exercising may also be at risk for ignoring their mental and physical health because of a perception problem. Society often considers behavioral addictions to be less serious than chemical addictions. Consequently compulsive behaviors often go untreated despite the chaos they generate.

Basic Facts about Process Addictions

Most people think of drugs and alcohol when they think of addictions, but today the term increasingly applies to a broader range of behaviors. Several include the following:

  • Gambling
  • Shopping
  • Sex
  • Internet surfing
  • Falling in love
  • Exercise
  • Eating

Also known as process addictions, behavioral addictions may not pose the same obvious threat as a DUI or overdose, but they can still wreck havoc on peoples’ lives. Individuals continue to struggle with them for years despite negative consequences to their relationships, finances and careers.

According to Harvard Health Publications, the biochemical basis for this cycle is found in a cluster of nerve cells called the nucleus accumbens that lies beneath the cerebral hemispheres. When a person performs an action that satisfies a need or fulfills a desire, the neurotransmitter dopamine is released into the nucleus accumbens and produces pleasure. This creates a reward pathway. When an individual does something that activates this reward system, the brain records the experience. This makes it more likely that he or she will repeat the behavior.

This biochemical pleasure process is a key element in the development and maintenance of both substance and process addictions. People who struggle with painful emotional of psychological issues such as trauma, anxiety and depression subconsciously learn to trick the brain’s dopamine response via drugs, alcohol, or a pleasurable activity in order to cope with stress or numb difficult feelings. Repeated use of a substance or behavior teaches the brain that the best way to feel better is to take more of the substance or engage in more of that behavior. Eventually, the brain becomes hardwired for a drug or process addiction.

Process Addictions and Coverage

Not all insurance companies cover the cost of treatment for process addictions. The main reason for this is because of diagnostic difficulties. The Diagnostic Manual for Mental Disorders (DSM-IV-TR) does not actually have the word addiction in it, nor does it have a category related to addictions. Instead it has a category called “Substance-Related Disorders” that lists dependence, abuse, intoxication and withdrawal as the four subsets. This means that when people speak of being addicted to things such as sex, gambling, food, stealing, electronic media, gaming and shopping, they are speaking about an experience that does not technically exist in the realm of diagnoses.

In order to receive coverage, an individual must prove some level of problematic dependence. According to the American Society of Addiction Medicine (ASAM), several criteria that prove a service is medically necessary include the following:

  • The requested treatment services are required to diagnose or treat a suspected or identified illness or condition.
  • Scientific evidence proves that the requested treatment is effective for the condition.
  • The requested treatment is required for more than just the convenience of the requester or provider (meaning, for example, that though you might find it more comfortable to go away to rehab, unless you can prove that you need it for a medical reason, you will likely get coverage only for outpatient treatment).

Meeting the following preconditions generally results in a claim approval for residential treatment:

  • Your withdrawal symptoms can be managed at the requested level of care.
  • You are cognitively able to participate in a treatment program and have no other medical problems, which preclude your ability to participate.
  • You show evidence that you want treatment and are motivated to work toward recovery.

Most plans require that you meet at least one of the following criteria:

  • The severity of your self-harm or risk taking behaviors present a serious threat to yourself or to others and these self-harm or risk taking behaviors can’t be effectively managed outside of a 24 hour facility.
  • You have acute medical problems that make it difficult or impossible for you to stay abstinent outside of a residential environment.
  • Your addiction is causing severe problems in at least two domains of life such as school, work, family, social relationships or physical health.
  • Evidence exists that a lower level of care such as previous attempts within the last three months at a lower level of care, like an intensive outpatient program, would not help.
  • Evidence exists that without residential treatment your condition will worsen.
  • Evidence exists that residential treatment will ameliorate symptoms.
  • Current living arrangements are dysfunctional and endanger your recovery progress and there are no other clinically appropriate or available living arrangements.

Regardless of your financial situation or insurance coverage, a solution exists for paying treatment expenses. Admissions coordinators at many treatment centers offer free assistance with the process of determining benefits. Using special skills and experience, they can help you find ways to fund recovery and prioritize your health.

Recovery from Process Addictions

If you or someone you love struggles with process addictions, help is available. Admissions coordinators at our toll free, 24-hour support line can guide you to wellness. You don’t have to feel alone when help is just one phone call away. Start your recovery now.

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.