Does Health Insurance Cover Drug Overdose?
Your health insurance may cover a drug overdose, depending on the services you need in response to the overdose and your specific policy. Not all health insurance policies may have the type of coverage needed to take care of all costs or services related to an overdose, although the federal government is working on ensuring that they do.
The U.S. government’s Affordable Care Act was signed into law in 2010 and is going into effect in phases through 2014. The ACA sets up a batch of essential health benefits that plans in every state must carry.
What health services would I need in response to a drug overdose?
Emergency care, hospitalization, and rehabilitation are three main types of coverage that may be necessary to treat a drug overdose. Emergency care may include life-saving measures to immediately respond to the overdose. These include the cost of an ambulance, your emergency room visit, and the services involving different types of equipment and healthcare professionals.
Additional hospitalization may also be required following the emergency services. The length of your stay would depend on the severity of your condition. The cost would also depend on the types of services required for treatment. The attention of various healthcare professionals and medication or IV fluids may be part of the treatment plan following your emergency visit.
Once your hospital stay is complete, you may still benefit from additional services that would fall under the mental health and substance abuse category of your health insurance plan. You may require an inpatient stay in a drug addiction rehabilitation facility or outpatient services related to substance abuse.
How does the Affordable Care Act ensure all these service would be covered?
While health insurance policies can severely limit or exclude the type of coverage they provide without the ACA, the U.S. Department of Health & Human Services says the ACA requires that insurance plans carry a list of at least 10 essential health benefits. This comprehensive list of services will be required for health plans in the small group and individual health insurance market.
Essential health benefits that could relate to a drug overdose include emergency services, hospitalization, and services for mental health and substance abuse disorders. The latter extends to also include behavioral health treatment, which consists of therapy or counseling from mental healthcare professionals.
Seven other essential health benefits are also covered under the ACA. These include ambulatory patient services, such as those received at a clinic or doctor’s office, newborn and maternity care, and prescription drug coverage. They also include pediatric care services, lab services, and services related to wellness and preventative care.
Would coverage still apply if the overdose was a suicide attempt?
Treatment for a drug overdose that occurred as a suicide attempt would most likely be covered by health insurance, according to the U.S. Department of Labor. Even without the full extent of the ACA in effect, health insurance plans cannot deny benefits that are linked to injuries that occurred due to a medical condition.
Mental health disorders and substance abuse disorders are recognized as medical conditions. This means the injury or harm that stemmed from a drug-related suicide attempt prompted by those disorders would qualify for coverage.
What are some other reasons behind drug overdoses?
Suicide attempts are not the only reason people may suffer a drug overdose. The Centers for Disease Control and Prevention uses the broader term of drug poisoning to describe an undesirable effect of a substance. It says drug poisonings can occur as part of an assault on another person or a homicide.
Drug overdoses, or poisonings, may also occur by accident, when the outcome was neither expected nor intended to harm or injure an individual. Drug misuse and abuse may lead to overdose, as may not obeying doctor’s orders when taking prescription medication.
Deaths due to drug overdoses of all types have been steadily on the rise in the U.S. since 1970, the CDC reports. Additional statistics say more than 27,000 people died in 2007 from unintentional drug overdoses and deaths due to drug overdoses were the second-leading cause of unintentional injury deaths that same year. The top leading cause of unintentional injury deaths was car accidents.
If I don’t play around with illegal drugs, I don’t really have to worry, right?
Drugs do not have to be illegal to lead to overdose, they only have to be misused or abused. The CDC notes that a major surge in drug overdoses that has been occurring in the U.S. since 1990 is due to the misuse and abuse of opioid painkillers.
Opioid painkillers are legal with a prescription, although they can be very dangerous or even fatal when misused and abused. Opioids are described as synthetic versions of the drug opium, with the most common examples being OxyContin and Vicodin.
More and more opioids have been prescribed over the past two decades due to a switch in pain management techniques. While opioids can help reduce and manage pain, taking too many of them can also slow down breathing to the point of death.