Problems with Insurance Covered for Addiction Treatment

Problems with Insurance Covered for Addiction Treatment

Problems with Insurance Covered for Addiction Treatment

Table of Contents

Insurance Coverage Issues

Addiction is a diagnosable medical condition. However, the stigma associated with addiction can lead to insurance coverage issues for medical care and rehabilitation. Some health plans have financial incentives to deny treatment, and they may word health policies to misrepresent what is covered under the insurance plan.1 This runaround leads to people jumping through hoops to try to get coverage, which can be very difficult for someone who is already dealing with addiction. It’s common to face rejected claims, delays, or only being offered treatment far from home in this situation. Lack of insurance coverage is a common reason people won’t seek treatment, simply because their insurance plan doesn’t provide them with the means to afford care. When it comes to problems like addiction, these are serious issues that can significantly impact the lives of those struggling, as well as the people who care about them. Everyone deserves to get the help that they need.

Coverage is Not for Quality Addiction Treatment Programs

Often, the medical care offered for addiction treatment through an insurance plan doesn’t provide the attentive and comprehensive care needed to fully recover and rehabilitate. Traditional insurance plans frequently only give access to one size fits all treatment programs for addiction. Everyone has different things that cause and trigger addiction, so while a specific type of program and treatment could be beneficial for some, it doesn’t take into account the wide variety of issues that are causing the addiction. Other underlying factors to addiction could be:


  • Mental health issues
  • Past trauma
  • Extreme amounts of stress in someone’s daily life

These underlying issues can only be discovered and thoroughly worked through in a comprehensive therapy and treatment program.

Insurance Plan Cost Controls

Insurance plans may not provide quality addiction treatment because they try to keep their costs low to increase their profits. This treatment gap leads to understaffed centers and a lack of medical resources such as medication-assisted treatment. Understaffed treatment centers with a lack of resources lead to people not getting the attentive and in-depth care they need to recover properly. This gap essentially creates a cycle of people going to treatment centers, not receiving proper treatment, and ultimately ending up relapsing and needing treatment once again. This practice of not providing complete treatment has been coined “The Florida Shuffle.”2


Essentially, there are claims to government insurance programs for addiction treatment without intending to help someone recovery. This keeps people going through this cycle to increase profits. Nobody should be profiteering off something as serious as addiction treatment. Everyone deserves to get proper healthcare and the help that they need to recover.

Insurance-Covered Programs Reliance on Dated Medicine and Information

Dominated By 12-Step Programs

Insurance-covered programs for addiction are dominated by 12-step programs such as AA and NA. While 12-step programs can be useful, they aren’t right for everyone. The typical 12-step programs are deeply religious-based, which isn’t appropriate for many who don’t share those beliefs. This lack of connection leaves people feeling alienated and ultimately leads to people leaving the program and not getting help.

Don't Use the Disease Model of Addiction

The disease model of addiction classifies substance abuse as a disease because it is a chemical and biological issue that is:

  • Primary
  • Progressive
  • Chronic
  • Potentially fatal if left untreated

The disease model of addiction supports the idea that someone can have a genetic predisposition to substance abuse that environmental conditions can exacerbate. In recent years, the medical community has embraced the disease model of addiction due to clinical studies showing that many genes can be transferred from generation to generation, causing a predisposition to addiction.3

Even though the medical community has embraced the disease model of addiction, most insurance companies have not. Not recognizing a predisposition to substance abuse makes it harder to receive the treatment needed to recover and maintain sobriety. This lack of treatment can keep people on the previously mentioned cycle of rehabilitation, recovery, and relapse.

Abstinence-Only Programs

Abstinence-only programs are generally the most common in treating addiction, especially treatment programs offered through insurance plans. While these programs work for some, they aren’t the right treatment plan for everyone, as everyone has different needs. One of the main flaws with abstinence-only programs is they don’t respond well to relapse. People who relapse often feel chastised for their mistake, and some programs may even kick people out for relapsing. This denial can lead to someone feeling like they have run out of options for treatment.

These programs can also lead to a sense of powerlessness. The first step in a 12-step program is the individual admitting that they are powerless to their addiction.4 This statement may make some people feeling like a relapse is inevitable, especially if addiction is something they’re powerless to anyway. Alternatives to this approach try to make people feel empowered by education and treatment of their addiction. A more empowered system can make someone feel like this is something they can learn and grow from, encouraging them to keep going in the program.

Insurance-Covered Programs Don't Provide In-Home and Private Facility Programs

The struggle with addiction can be challenging, and it can result in self-conscious feelings since there is a stigma surrounding addiction. The lack of privacy in insurance-covered programs can lead some people not to enter treatment. While going to general treatment centers can work for some, it can make others feel very uncomfortable being in a new environment surrounded by many other people. A private facility or in-home program can provide more comfort and allow work on rehabilitation in an environment they’re comfortable in.

People may also be concerned about leaving their work responsibilities behind when entering a treatment program. Typical programs offered through insurance cut people off from their work responsibilities when they enter the treatment program. While it can help some get away from these responsibilities, it can stress some people out more to feel disconnected in that way. An increase in stress levels can lead to the treatment program not working as well for that individual.

Bespoke Medicine is the Answer

Bespoke medicine is a subscription-based medical plan focused on providing complete proper healthcare. There are no delays and no hoops to jump through. If you need medical care, a bespoke medical plan will make sure you get help at the moment it’s needed.

Bespoke medicine will provide you with the best care and the best medical staff. Medical professionals who work in bespoke medicine focus on the patient and do everything possible to provide the best healthcare. This work includes diagnostic testing and a wide range of treatment options. Bespoke medicine uses cutting-edge medicine and individualized care to make sure you get the best treatment possible based on your needs.

In-home addiction treatment is also offered as an option through bespoke medicine. This option provides privacy and the ability to rehabilitate in the comfort of your own home. Personalized treatment also allows for executives to continue work while they are in treatment. This freedom can help ease any concerns about having to leave work while getting treatment. Every treatment plan is tailored to the individual to meet their specific needs. This personalized attention is why bespoke medicine is the best option for addiction treatment.