Does health insurance cover drug and alcohol addiction?
It's a sad fact that more and more Australians are becoming addicted to alcohol and drugs every year. Fortunately, the public health system, together with private health funds, is providing some financial assistance for addicts. This guide looks at what is currently available, how much it costs and the drawbacks involved in seeking treatment.
What is drug and alcohol rehabilitation?
Drug and alcohol rehabilitation is aimed at helping those with a substance abuse problem to find ways to reduce and ultimately cease their use of drugs and alcohol. The treatment and support options are largely funded by state and federal governments and run by non-government organisations and charities (although some private drug and alcohol treatment options do exist).
Treatment for drug and alcohol addiction aims to help break the addiction cycle, cope with withdrawal symptoms and deal with any relapses (several attempts are often needed for such treatment to be successful).
Compare health insurance for drug and alcohol treatments
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|Top Hospital Gold||
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|Gold Top Hospital||
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*Price based on a single policy for a Sydney resident.
What can you claim with private health insurance?
Some rehabilitation programs are covered by Medicare, but if you wish to be treated privately, you will need to have appropriate private health cover. Private health insurance will cover some of your expenses including:
Private health insurance can cover in-hospital accommodation as a public or private patient and some of the associated medical fees. You will need a private hospital policy that includes cover for psychiatric services and drug and alcohol rehabilitation programs such as:
- In-patient stays
- Overnight stays
- Day or evening programs
You may have to pay some out-of-pocket expenses for services where the provider charges more than the MBS fee. You will also have to serve a waiting period before being covered, but this is only 2 months compared to the usual 12-month waiting period for in-hospital treatment.
Outpatient services are not covered by private health insurance hospital cover, so if you wish to be covered for psychiatric treatments or rehabilitation without being admitted to hospital, you will need to take out private health insurance extras (ancillary) cover that includes these treatments. Medicare will pay for some of these outpatient services such as GP visits and specialist consultations, and your extras cover will pay an amount towards the difference.
Again, there may be a gap that you will have to pay between what is charged and what your fund will cover. Some medications you are given may not be subsidised by the Pharmaceutical Benefits Scheme (PBS), so you will need to ensure your extras pharmacy cover includes non-PBS medications.
When looking for private health cover for psychiatric services or rehabilitation programs, it’s very important to compare health funds thoroughly, as levels of cover vary widely amongst fund and some do not provide cover at all or restrict the benefit amounts payable.
Can you get help through the public system?
If you aren’t able to afford private health cover, the public health system may be able to help. Medicare covers up to 10 allied mental health services per year offered through the Better Access Initiative. Your GP can help you determine eligibility requirements and provide you with a referral to the appropriate service.
If you choose to see your own psychiatrist, make sure they have a Medicare Provider Number or it will be at your own expense. Even if they do, there may be a gap to pay if the psychiatrist charges more than the MBS fee. You can also refer yourself for treatment and contact a treatment provider directly, but be aware that there can be substantial waiting periods for publicly funded rehabilitation programs due to high demand and limited resources.
The cost of going to a treatment centre
While treatment is largely free in public rehabilitation programs, waiting lists can be long. Addicts who have access to funds often choose to attend a private clinic to obtain faster treatment. The costs can be prohibitive, with a bed in a private clinic costing anywhere between $3,000 and $4,000 a week.
The bottom line is, if you don’t have the funds, you’ll have to wait for treatment through the public health system, and if you do have the money, private rehabilitation will cost you an arm and a leg. Taking out private health cover well before you seek treatment for your addiction (at least two months in advance) may be the best course of action in order to receive timely, affordable assistance.
What treatment options are available to addicts?
There are many treatment options available to addicts, which can be used separately or in combination:
- Withdrawal or detoxification. Ceasing drug and alcohol use, while minimising side-effects and the risk of harm.
- Pharmacotherapy. Substitution of a harmful drug with medication to reduce cravings and the risk of overdose.
- Counselling. Different approaches include talking through your problems and learning how to change the way you think and deal with difficult situations.
- Rehabilitation programs. A long-term approach to achieving a drug and alcohol-free lifestyle, with no further medication provided once withdrawal is successfully completed.
- Complementary therapies. Treatments such as relaxation therapies and natural remedies, which can be useful in managing withdrawal symptoms.
- Peer support. Support programs established by those with personal experience of drug and alcohol abuse such as Alcoholics Anonymous and Narcotics Anonymous.
- Social support. Services to help former addicts access housing and financial, legal, general health, dental and other assistance.
- Family support. Services supporting those affected by a family member's substance abuse, providing understanding and information on how best to help during treatment.
As well as your GP or psychiatrist, there are other avenues of help available to addicts. These include counselling services such as beyondblue, Lifeline and various other drug and alcohol online and telephone counselling services. There are also a number of useful websites where you can get further information and advice, including DrugInfo and the Australian Drug Information Network (ADIN).
If you aren’t sure whether you need help for an addiction, the simple question to ask yourself is whether your alcohol or other drug use is affecting your health, family, relationships, work, school, financial or other life situation. If the answer is yes, then you should seek help.
Organisations that can help
The following organisations can provide further assistance and advice regarding drug and alcohol addiction:
- Counselling Online. 24-hour free drug and alcohol counselling on 1800 888 236.
- Family Drug Support Online. 24-hour support for families and friends of drug and alcohol users on 1300 368 186.
- Alcoholics Anonymous. Help for alcohol addiction on 1300 222 222.
- DrugInfo. Drug-related information, help and support on 1300 85 85.
- Cannabis Information and Helpline. Help and advice on 1800 30 40 50.
- Family Drug Help. 24-hour support for families of addicts on 1300 660 068.
- Adverse Medicine Events Line. Prescription drug helpline on 1300 134 237 (not for emergencies).
- Medicines Line. Information on medicines on 1300 MEDICINE or 1300 633 424.
- Alcohol and Drug Information Service (ADIS). Sydney on 02 9361 8000 and regional NSW on 1800 422 599, Queensland on 1800 177 833, Perth on 08 9442 5000 and regional WA on 1800 198 024, South Australia on 1300 131 340, ACT on 02 6207 9977, Tasmania on 1800 811 994 and Northern Territory on 1800 131 350.