Are Inpatient Services for Addiction Expensive?
Inpatient services for addiction have dramatically varying costs determined by the facility providers and the services, staff, and amenities they provide, treatment durations, and the funding sources they allow to offset those costs.
According to a report from the National Survey of Substance Abuse Treatment Services (N-SSATS),”Treatment providers recognize that paying for treatment can be a burden to their clients.” In order to improve access and provide inpatient services for addiction, most providers are sensitive to the treatment needs of these individuals and offer alternative payment plans.
Who Needs Inpatient Services for Addiction?
Inpatient services for addiction are available for detox and rehabilitation. Some people have a short stay in an inpatient detox and transition to outpatient addiction treatment programs after medical and psychiatric stabilities are established. Others undergo the acute phase of withdrawals in an inpatient setting with a direct or in-house transition to inpatient services for addiction rehabilitation. These programs have an advantage of offering inpatient services from the moment of entry that promote treatment retention and trust between the patient and the staff that cares for them.
According to the SAMHSA, “Patients who are brittle, frail, acutely suicidal, or medically unstable or who need constant one-on-one monitoring, should receive 24-hour primary medical/psychiatric/nursing inpatient care in medically managed and monitored intensive treatment settings.” Inpatient services for addiction detox should be made available to anyone with:
- Suicidal ideations or threats
- Severe co-occurring mental health conditions that can become dangerous to the patient or others
- Chronic medical illnesses that can become complicated during detox
- A high potential for developing dangerous abstinence symptoms such as a seizure or delirium
- History of relapse or failed attempts to complete detox in other types of settings
- Lack of a safe, supportive, and drug-free environment at home
- Pregnancy, old age, or any other lack of safety in completing the detox process in an outpatient treatment setting
Why Are Inpatient Services for Addiction Expensive?
Typically, inpatient services involve an integrated set of specialized or intensive care services provided with around the clock access to a wide range of staff including clinicians, counselors, physicians, psychiatrists, and administrators working together to provide adequate support and quality treatments for their patients. Facility maintenance, housing, meals, complimentary services, recreational activities, and outreach support services add to the costs of treatment provisions.
Service providers of inpatient services for addiction are tasked with handling complicated issues that require advanced training and resources to be able to ensure the most up-to date and effective treatment practices. They have high competition with outpatient service providers for the majority of individuals needing treatment and they tend to have a wide range of appeal options that enhance their inpatient services. For those who can afford it, luxurious or private and tranquil settings are available where the durations of in-house stays can last upwards of 30 days.
Who Pays For Inpatient Services for Addiction?
Often, inpatient treatment plans will be covered by health insurance.
Some people have insurance through their employment, Medicaid, Medicare, or other programs, but, a large percentage of addicts are unemployed or underemployed and without any insurance coverage at all. According to the SAMHSA’s 2013 National Survey on Drug Use and Health (NSDUH), “Based on 2010–2013 combined data, commonly reported reasons for not receiving treatment among individuals aged 12 or older who needed but did not receive illicit drug or alcohol use treatment, felt a need for treatment, and made an effort to receive treatment, were:
1) no health coverage/could not afford cost (37.3 percent)
2) not ready to stop using (24.5 percent)
3) did not know where to go for treatment (9.0 percent)
4) had health coverage but it did not cover treatment or did not cover cost (8.2 percent)
5) no transportation or inconvenient hours (8.0 percent)
Some providers are publicly funded meaning they rely on forged partnerships to provide substantial funding from public sectors to offset the costs for treatment. The most common forms of public funding involve state block grants, Medicaid or Medicare for those over the age of 65, federally funded programs, and nonprofit agency support. These centers may be able to offer inpatient services for addiction through insurance or programs at zero cost to patient or based on income with a sliding scale fee.
In fact, many centers, private, non-profit, and for-profit, offset costs for those who need it via public funding assistance. According to the National Survey of Substance Abuse Treatment Services (N-SSATS): 2013, “Treatment at no charge for persons who cannot afford to pay was offered by 48 percent of all facilities, ranging from 20 percent of private for-profit facilities to 81 percent of facilities operated by tribal governments.”
Insurance and the Affordable Care Act
Effective in 2014, provisions of theAffordable Care Actexpanded benefit coverage for mental health and substance abuse treatment services. Under the act, “all new small group and individual market plans will be required to cover ten Essential Health Benefit categories, including mental health and substance use disorder services, and will be required to cover them at parity with medical and surgical benefits.”
Parity simply means legally recognizing mental health conditions and substance use disorders as equal to physical illnesses and the Affordable Care Act provides the measures necessary to obtain these services with equally comparable costs. It also provides for subsidies based on income levels for those who are ineligible for Medicaid or Medicare to have the coverage they need for healthcare services.