why different treatment cost depends on insurance

The types and durations of services you receive will significantly determine the cost of treatment; these largely depend on personal factors such as your history of addiction, the type of drug (s) used, your insurance coverage, whether your facility is an in-network rehab, and more.

Full Answer

Why is it important to understand your costs and key terms?

It’s important to understand your costs and key health insurance terms, so you’ll know what services your plan will pay for and how much each visit or medicine will cost. Deductible: The amount you owe for covered health care services before your health insurance or plan begins to pay.

Why is insurance so expensive?

Other considerations that can affect why insurance is so expensive include whether they use actual cash value or replacement cost for claims settlement if exclusions or special limits exist, and what risks are covered. Some insurance companies offer various perks or advantages.

How does health insurance affect your budget?

Health insurance can be like that. If you look only at your monthly payment, you may find that other costs have a big impact on your household budget. It’s useful to think about your total yearly health insurance costs.

How much does it cost to see a therapist?

In the U.S., the fee for a single session frequently falls between $100 and $200, but many providers will offer lower fees, while some charge more. The ultimate cost to a client also depends on whether health insurance is involved. Is therapy covered by insurance?

Why does it cost more with insurance?

The state's natural disasters, theft/vandalism rates and dense population contribute to these higher insurance costs. California drivers can take several steps to lower their premiums, like comparing quotes from several providers and searching for discounts.

What factors affect the cost of health insurance?

Five factors can affect a plan's monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents. FYI Your health, medical history, or gender can't affect your premium.

How does insurance make healthcare more expensive?

Health insurance gets expensive because health insurance covers expensive treatments. Treatments are expensive because once you have health insurance you don't care how expensive the treatments are. After you satisfy the annual deductible, additional services cost substantially less.

What are some of the different cost factors in healthcare?

To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity.

What are 5 factors that determine the cost of insurance premiums?

Below are the 15 rating factors most often used by car insurance companies, along with some associated costs by insurer.Age. Age is a very significant rating factor, especially for young drivers. ... Driving history. ... Credit score. ... Years of driving experience. ... Location. ... Gender. ... Insurance history. ... Annual mileage.More items...

Why are insurance premiums different for everyone?

Because of differences in those and other features, such as plans' administrative costs and the populations they cover, plans with the same actuarial value may charge different premiums.

Who is to blame for high healthcare costs?

U.S. residents mostly blame the health care industry for high health care costs, with at least 70% of respondents to the Kaiser Family Foundation's (KFF) latest Health Tracking Poll saying drug companies, health insurers, and hospitals are at fault for rising costs.

Why is health insurance so complicated?

They're really pre-paid health care plans. They cover routine check- ups, less serious illnesses, and recurring expenses like prescription medications in addition to protecting you from a health disaster. All of this has made healthcare much more expensive and complex than any other form of insurance.

Why is expensive healthcare a problem?

High costs inflate the earnings of many providers and make the industry unnecessarily large. The cost of employer-provided health insurance, largely invisible to employees, not only holds down wages but also destroys jobs, especially for less skilled workers, and replaces good jobs with worse jobs at lower wages.

What are the three factors due to which health care costs keep rising?

Reasons for Rising Costs of Healthcare Scarcity of experts who are qualified to use advanced medical equipment and robotics. Patients opting for higher category hospital rooms and extended hospital stay, depending on the health condition of the patient. Shortage of specialist doctors and surgeons in a particular field.

Why is healthcare cost important?

Protection from high medical costs Health insurance provides important financial protection in case you have a serious accident or sickness. People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.

What are some of the factors that have led to increasing health care costs?

Five factors contribute to the rise in health care costs in the US: (1) more people; (2) an aging population; (3) changes in disease prevalence or incidence; (4) increases in how often people use health care services; and (5) increases in the price and intensity of services.

How can I estimate treatment costs?

The cost of treatment can vary widely—it depends on the provider, the setting, the services offered, and your specific needs. Treatment providers should be able to help you understand:

How much does it cost to do a health assessment?

Consider paying for one session with a health professional who can conduct an assessment and recommend next steps. This may cost up to a few hundred dollars.

What does sliding fee mean in therapy?

Look for therapists or programs that offer payment assistance or a sliding fee—these terms mean that the cost of treatment can be adjusted to meet the person's ability to pay. This makes the same treatment available at a reduced cost.

Does health insurance cover alcohol?

Most health insurance covers some alcohol or drug treatment. Insurers may call this "behavioral health" coverage. You can contact the insurance company (call the number on the insurance card) or review the schedule of benefits to learn: Number of inpatient days and outpatient sessions. Which medications, if any.

Does Medicaid cover substance abuse?

In most states, Medicaid will cover some form of addiction treatment. Contact your local or State health departments to inquire about treatment services. Start with this Directory of Local Health Departments. (link is external) . If you need additional options, try contacting your State agency for substance abuse services.

Is the most expensive option always the cheapest?

Keep in mind that the most expensive option is not always the best —but neither is the cheapest. Look for a balance between cost and quality when weighing your options. The Navigator will show you how to spot signs of higher-quality care.

Are there other options for people with limited financial resources?

For people with limited financial resources to pay for alcohol treatment , here are a few suggestions:

Why are hospitals not accountable for their costs?

The first one is that one hospital may have different costs than the other one, and hospitals are generally not very much accountable for their costs because there's no transparency. No one really has any idea what the hospital spends on. In fact, for most nonprofit hospitals, they don't even have their annual report on their Web site as a for-profit hospital would have to have. So that's one reason.

Who said same surgery, different cost?

Same Surgery, Different Cost: Insurance Explained Princeton economist Uwe Reinhardt argues that health care should be looked at from an unemotional, economic perspective. Reinhardt explains the practice of price discrimination, the process by which the cost of care is negotiated between hospitals and insurance companies.

How much does an MRI cost?

If you need an MRI, for example, one hospital might charge your insurance company $2,500. At a hospital just across town, the same procedure could cost $1,000 less. This hour, we will explain that cost chasm and how a health care bill in Congress might try to fix the problem.

How can we get hospitals in our neighborhood?

The same as getting hospitals in your neighborhood, the only way you can do this is through the political process. It used to be called health planning. It was actually President Gerald Ford who passed and signed a law that we should have regional health planning where you couldn't just do what we have now, all the inner-city hospitals moved to the suburbs, on big campuses and became quite luxurious, while the inner city was left with one hospital, and even it was underfunded. We see that throughout New Jersey, by the way. People are moving out of the cities into the suburbs. Chicago is famous for that.

What is price discrimination?

REINHARDT: But the other reason is that there is, what we economists call, price discrimination, which means different payers are charged different prices for the same thing.

Why are consultants multimillionaires?

And then, you have many physicians have consultants who do their billing, and these consultants are multi, multimillionaires because they have computers that understand the contract - the insurance contract the patient has. And they can cut what is called a clean bill, a bill the insurer cannot reject. And I really feel sorry for physicians who have to deal with maybe 20 different insurance carriers, each with different claims forms, each with different rules.

Who is the economist who argues that health care should be looked at from an unemotional, economic perspective?

Princeton economist Uwe Reinhardt argues that health care should be looked at from an unemotional, economic perspective. Reinhardt explains the practice of price discrimination, the process by which the cost of care is negotiated between hospitals and insurance companies.

What is copayment and coinsurance?

Copayments and coinsurance: What you pay (a dollar amount or percentage of costs) when you get care after your insurance company starts paying.

Is it useful to think about your total yearly health insurance costs?

It’s useful to think about your total yearly health insurance costs.

Is a higher premium better for health insurance?

If you expect to use regular care, or a lot of care, a plan with a higher premium may be a better overall deal. Plans with higher premiums usually have lower deductibles, copayments, coinsurance, and out-of-pocket limits.

Do you pay a premium for preventive care?

If you don’t expect to use much care during the year, or if you have insurance mainly for protection against really high bills and for preventive care, looking mostly at your monthly premium may be right for you. You’ll pay a low premium but face high costs when you use care.

How long does it take for insurance to approve a higher level of care?

One must keep in mind that when considering the level of care to be billed, insurance companies will only approve the higher levels of care (Inpatient, Residential) for a limited amount of time, often less than ten days (though it varies by insurance policy).

What is residential treatment?

Residential treatment is broadly defined as mental, behavioral health or substance abuse treatment that occurs in a residential (overnight) treatment center where the treatment provider is responsible for clinical services, safety, housing, and meals.

What is a clinical treatment program without housing?

Clinical treatment programs without housing have several different designations. Outpatient or “day” programs offer a combination of individual therapy, group therapy and other activities (arts, yoga, exercise, writing, experiential activities, etc.) while the patient or client lives off-site. These programs are generally described as “intensive outpatient,” “outpatient,” “day treatment” or “partial day treatment” depending on the number of days of treatment per week and the number of hours of treatment per day. These non-housing programs are most accurately described by insurance company designations such as “Partial Hospitalization,” “Intensive Outpatient Treatment” or “Outpatient Treatment” as will be explained below.

What is acute inpatient psychiatric care?

Acute Inpatient Hospitalization – Acute inpatient psychiatric hospitalization is defined as treatment in a hospital psychiatric unit that includes 24-hour nursing and daily active treatment under the direction of a psychiatrist and certified by The Joint Commission (JCAHO) or the National Integrated Accreditation for Healthcare Organizations (NIAHO) as a hospital. Acute psychiatric treatment is appropriate in an inpatient setting when required to stabilize Covered Individuals who are in acute distress and return them to a level of functioning in which a lesser level of intense treatment can be provided. A need for acute inpatient care occurs when the Covered Individual requires 24-hour nursing care, close observation, assessment, treatment and a structured therapeutic environment that is available only in an acute inpatient setting.

How long does partial hospitalization take?

Covered Individuals must attend a minimum of 6 hours per day when participating in a partial hospitalization program. Covered Individuals are not cared for on a 24-hour per day basis, and typically leave the program each evening and/or weekends. Partial hospitalization treatment is provided by a multidisciplinary treatment team, which includes a psychiatrist. Partial hospitalization is an alternative to acute inpatient hospital care and offers intensive, coordinated, multidisciplinary clinical services for Covered Individuals that are able to function in the community at a minimally appropriate level and do not present an imminent potential for harm to themselves or others.

How much does the third program cost for Kathy?

The second program will not adjust their price, but they reimburse Kathy with all insurance proceeds. The third program will charge $28,000 and keep insurance proceeds. In this case, determining which program will have the least financial impact depends on the amount Kathy’s insurance will reimburse. If Kathy receives at least $7000 ...

What is the highest level of care in a hospital?

In the first category (with housing), the highest level of care is “Inpatient” which involves treatment in a hospital setting within a locked unit or an unlocked unit where housing and meals are provided. Inpatient treatment may involve emergency stabilization on a locked ward; this level of service is usually limited and is not a long-term treatment plan.

How does treatment cost vary?

Treatment costs vary and are based on many personal and provider factors. The types and durations of services you receive will significantly determine the cost of treatment; these large ly depend on personal factors such as your history of addiction, the type of drug (s) used, your insurance coverage, whether your facility is an in-network rehab, and more.

How to determine cost of treatment?

The cost of treatment is determined by several components based on your specific needs, your insurance provider, and your chosen treatment facility. More specifically, the cost of treatment is often defined by some of the following factors: 2 1 Length of stay and range of services provided. 2 The intensity of services rendered. 3 Location of the treatment facility. 4 Specific client characteristics (i.e., pregnancy, significant medical issues, or mental health problems). 5 Cost of resources.

What Impacts the Cost of Rehab?

The cost of treatment is determined by several components based on your specific needs, your insurance provider, and your chosen treatment facility. More specifically, the cost of treatment is often defined by some of the following factors: 2

How is rehab cost determined?

The cost of rehab is also determined by the amenities offered by the specific substance abuse treatment facility. Every service and amenity can come with a cost.

What is the least restrictive type of substance abuse treatment?

Outpatient rehab is the least restrictive type of substance abuse treatment and costs less than medical detox and inpatient re hab. 1 In outpatient rehab, you go home every night. Treatment is conducted on an out patient basis and can consist of things such as individual therapy, support groups, and group therapy.

What is the most intensive treatment for substance abuse?

From most intensive to least intensive, some substance abuse treatment options are as follows: 1. Drug Detox. Detoxification, also known as withdrawal management or medical withdrawal, ...

How much does substance abuse cost the United States?

Current studies report that substance abuse in the United States costs the country more than $600 billion dollars a year — and substance abuse treatment can reduce that cost. 4.

What is coinsurance in health insurance?

Coinsurance: Your share of the cost for a covered health care service, usually calculated as a percentage (like 20%) of the allowed amount for the service. Premium: The amount you pay for your health insurance or plan each month.

What is deductible medical insurance?

Deductible: The amount you owe for covered health care services before your health insurance or plan begins to pay. Copayment: An amount you pay as your share of the cost for a medical service or item, like a doctor's visit.

What is a network in insurance?

Network: The doctors, hospitals, and suppliers your health insurer has contracted with to deliver health care services to their members.

When there is a general increase among all insurance companies, the rates may increase by the same amount?

When there is a general increase among all insurance companies, the rates may increase by the same amount no matter which company you use. If one insurance company finds that they weren't charging enough premium, they may have to increase prices more than the rest.

What happens when you have multiple insurance policies?

When an insurance company insures multiple policies for you, or even for several of your family members, there is a greater chance that the price of your insurance may be negotiated.

How to find the lowest insurance price?

If you are insured with an agent who only represents one insurance company, they may not have access to other insurance products to offer you. In this situation, shopping around may be the only way to determine if you are paying a fair price on your insurance.

Why do insurance companies use credit scores?

Companies are using insurance credit scoring more often because statistics have shown that people with good credit scores have fewer claims. 1  When people have fewer claims, they can pay less money for their insurance. ...

Do you know what discounts you can get with insurance?

You would think all the possible discounts are taken care of and properly applied when you sign up for an insurance policy. But each insurance company is different. There is no way for you to know what discounts you may be able to get unless you ask.

Does insurance give discounts for sewer backup?

For instance, an insurance company may give a discount for installing a water backup valve—a good tool that helps prevent claims from sewer water backup. When switching from one insurance company to another, you may miss getting your additional discount for this water damage prevention if you don't mention this specifically.

Can you shop around for insurance?

However, if you deal with a broker or agent who represents several insurance companies, they can shop around on your behalf to negotiate a lower price. Since insurance is so expensive, comparing prices among several companies is worth the effort. Check your rates with the five tips above before you pay too much for your insurance.

How Can I Estimate Treatment Costs?

• The cost of treatment can vary widely—it depends on the provider, the setting, the services offered, and your specific needs. Treatment providers should be able to help you understand: 1. Costs for a typical course of treatment—and how long it might last. 2. Accepted health insurance plans. 3. Services usually covered by insurance versus those bill...

See more on alcoholtreatment.niaaa.nih.gov

What About Health Insurance?

Are There Other Options For People with Limited Financial Resources?