How to Find Affordable Care if You Need Treatment for Opioid Addiction

If you receive an unpleasant diagnosis from your doctor, you might feel it necessary to ask: What’s this going to cost?

No one wants to miss out on medical care they need. But the financial burden can be enough to make a patient hesitate.

Those seeking care for addiction recovery face the same challenge. The sharp increase in deaths from opioid overdoses is well-documented, but the cost of addiction treatment is less often discussed.

It’s a relevant concern for both those who have insurance and those who don’t, said Harry Nelson, chair of the Behavioral Health Association of Providers and author of the upcoming book, “The United States of Opioids: A Prescription for Liberating a Nation in Pain.” According to Nelson, that’s because there are so many options available, and many treatment approaches are relatively new.

“The numbers are all over the place,” he said of treatment program prices. “I know programs that charge $80,000 per month and programs where people spend $5,000 per month.”

If you’re considering getting treatment for drug addiction, or if you’re trying to help someone else, it can be hard to figure out the financial obstacles you’ll face.

Here’s what you’ll want to know before making the first phone call.

How Insurance Works

If you have insurance, call your carrier to ask about covered facilities and services in your area. The Affordable Care Act requires that all health insurance plans in HealthCare.gov’s Health Insurance Marketplace cover treatment for substance abuse disorders.

Look under “behavioral health benefits” if you’re examining your plan or comparing plans in the Marketplace. Benefits vary by state and insurance plan, but one thing’s for sure: Marketplace plans cannot deny you coverage or charge you more because you already have a mental health or substance use disorder.  

Medicare plans also cover mental health and substance use treatment.

If you don’t have insurance, the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline is a free and confidential resource that offers treatment referral services in English and Spanish. Just call 800-662-HELP (4357).

A hotline specialist can help you identify intake centers or state-funded services near you. If you don’t have insurance, SAMHSA will refer you to your state office or facilities that offer a sliding fee scale.

If you’d rather search online, you can enter your location into the SAMHSA treatment services locator. Search results identify each facility’s accreditations and certifications, as well as which payment, insurance or other funding is accepted.

What to Look for in an Addiction Treatment Center

Dr. Michael Strolla, a Tampa Bay-based psychiatrist and medical director of two substance abuse treatment facilities, said that advertisements promising to cure you in a certain amount of time shouldn’t be trusted. Not only is there no cure for addiction, but each patient must be considered individually.

“When someone walks in the door, I never give them a time frame,” he said. “If a place is doing therapy and treatment right, they take it one day at a time.”

“Recovery from addiction requires learning a ton of skills,” said Dr. Paul Earley, president-elect of the American Society of Addiction Medicine (ASAM). He compared a recovering addict to someone who has been diagnosed with diabetes and must learn to monitor their diet. A facility should highlight that patients will learn coping skills and use words like “recovery” or “remission” instead of talking about “curing” addiction, Earley said.

Earley and Nelson both stressed the importance of asking about the science-based approaches to addiction and the outcomes for those who have completed a facility or doctor’s treatment options.

Strolla recommends reading about facilities that are covered by your insurance. Read reviews, but take those reviews with a grain of salt — the same as you would with any business review. A facility or doctor who tries to force you into a particular treatment path is a major red flag, he said.

Earley agreed. “One type of approach never works with anybody,” he explained. “If someone says, ‘We have an approach that works for everyone and no one does it like we do,’ that’s not in contact with reality.”

One factor you’re almost guaranteed to discuss in initial consultations is the use of medications. All the research on the three types of FDA-approved medications for opioid addiction says these medications are “the single most important thing in the early process of attaining remission,” Earley said.

He said that while there may be exceptions for some patients, “almost all people with [opioid use] disorder should be on some type of medication at least at first — and sometimes forever.”

Strolla noted that these medications can be very inexpensive and that doctors use formularies — a list of medications and their prices — to determine a course of treatment for a patient.

“I know people for whom medication assisted treatment (MAT) has been a lifesaver, and for some it’s a huge challenge,” Nelson said. “It’s not one size fits all.” He advises patients to step back and get more information if they’re feeling pressured to take a particular course of treatment.

Remission from drug use should be the first focus of a treatment program, Earley said. But that effort should be integrated with ongoing mental health treatment for any underlying issues like depression or trauma.

Nonprofit or For-Profit? Inpatient or Outpatient?

Some nonprofit treatment facilities funded by the state provide a brief three- to five-day detoxification program before referring the person to outpatient services. Others will allow patients to receive residential care for several months when needed.

Strolla has found that patients at nonprofit facilities typically lack the financial means to get treatment otherwise; they may be homeless or in transition. A nonprofit service won’t turn someone away because they don’t have money to pay for treatment, so long as they have space available.

Private facilities, on the other hand, can provide longer and more thorough care than many state-funded services will be able to. The initial detoxification period of treatment may be longer, depending on the individual.

Private facilities were once cash-only operations. “Not everyone has the funds available to pay for that kind of treatment, and we were losing people who couldn’t afford it,” Strolla said.

As private facilities have started working with insurance companies, “[we’ve] saved countless lives,” he said. Patients who once had to choose between draining their bank accounts or not getting treatment at all can now use their insurance to get treatment.

Earley said that a facility’s status as for-profit or nonprofit should not be the sole deciding factor when considering treatment.

If you’re concerned about costs, Nelson advised starting your research with local nonprofit facilities.

“There’s this model of going far away to get treatment,” Nelson said. “It’s important to get out of the specific environment and peer group that keeps [a person] in access to drugs and continued use, but they can find really good lower-cost options” without traversing the country, he said.

Some people may find a combination of inpatient and outpatient treatment may work for them, which can come with a lower price tag. “Local recovery groups like Narcotics Anonymous and free counseling groups aren’t a substitute for treatment itself, but they’re an important part of the puzzle,” Nelson said. “When we start thinking about what treatment and recovery look like, we don’t have to assume it has to happen in a faraway, super-expensive center.”

Don’t Wait to Get Help for Opioid Addiction

Earley said that it’s important to do your homework and to be vocal if a program isn’t working for you. He also recommends getting an independent addiction medicine evaluation from a board-certified addiction medicine physician or psychiatrist, who will make sure you’re getting a complete approach.

“I get that if you’re not walking around with an IV pole and a hospital gown, it’s hard to conceptualize how dire [your situation] may be,” Strolla said.

But don’t try to figure it out on your own, he insisted. “Don’t be afraid to ask questions. Do what you need to do, and don’t hold back. There’s no guarantee you’re going to survive.”

If you’re concerned about your own health or someone you care about and don’t know where to start, call the SAMHSA helpline today. The National Suicide Prevention Lifeline (1-800-273-TALK) also offers free counseling to those struggling with drug addiction.

Lisa Rowan is a senior writer at The Penny Hoarder.