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INSURANCE vs CASH SUBOXONE: The Great Debate

With so many treatment options out there...its hard to know where to begin - especially if your in the market for outpatient services. One of the biggest (and most controversial) topics in the news today seems to revolve around "cash" clinics vs insurance based. With over 8 years of experience working in both "insurance" and "cash" based clinics, here's some insight into the major differences that we see...

 

Insurance Based (licensed programs)

What does insurance/licensed facility even mean? Well...in a nut shell, it means that the particular program has gone through extensive state licensing requirements and with that, means they can accept your insurance to cover the cost of the appointments.

 

Pros:

* They bill your insurance for the appointments, meaning all you pay is a co-pay

* They are state regulated - which means someone is monitoring and making sure they are meeting a certain standard of care

*They generally have a wide variety of on-site services including psychiatry, groups, individual counseling etc.

*They generally tend to have more open availability as far as scheduling appointments and always have open spots to accept new clients

 

Cons:

*These programs as designed in a "one shoe fits all" mentality (in their defense - they have to be since they are basically employed by the insurance companies)

*Multiple day per week requirements (usually)

*If you have a co-pay, this can add up. If your co-pay is $20 and your going to the clinic twice per week for a month, you end up paying $160 just in co-pays. Not to mention the time and gas money to get there.

*Failure to follow the program requirements can result in discharge (i.e you cant attend twice weekly counseling/group appointments)

 

Overall: these programs are great for those coming directly out of detox's or for those that need some serious accountability in their lives. These types of programs are helpful at setting the foundation for true maintance treatment later because they teach you the true foundations of recovery. However, if you have kids, a job or any other type of responsibilities, it can be difficult to manage the time to meet the criteria and stay compliant with the program.

 

 

 

 

Cash Based (private programs) 

Ahhh...the most controversial topic in the opiate epidemic (aside from deciding if we should blame the doctors or big Pharma for our current situation, of course). These programs range from flat out illegal and negligent to superb care that is so individualized that its practically impossible NOT to succeed.

 

Pros:

* Be seen as little as once per month - great if you work full time or have other responsibilities that prevent more intensive treatment and are considered stable

*Completely customized treatment - since they don't bill your insurance, no one can dictate the type of care you receive (this can also be a very bad thing - keep reading, we will get to that)

*Flexibility - cant make it to an appointment because you got called out of town for work or a family emergency? No worries. Most of the time they will simply reschedule you and not discharge.

 

Cons:

*As I said earlier - these programs answer to NO ONE. Which means there is no standard of care being monitored. That means that your doctor could be doing a million illegal things or not worried about your best interest (and just your almighty dollar)

*Expensive - these programs can range anywhere from $200-$400 per month - and that doesn't include the cost of medications, drug testing and counseling services (most clinics do assist in getting medication coverage and finding in network counseling but not always)

*Most clinics don't run 7 days per week (and if they do - your a number to them) This can be a challenge for scheduling at times. If you cant make your appointment on Monday - they may not be open again until Friday.

*Not much accountability, which makes these programs not very efficient at managing those whom are still at high risk of relapse - some clinics will see you more often, but that of course costs more money.

 

Overall: These programs can not only be costly, but also downright bad for you if the doctor/clinic is running like a "pill mill". On the other hand, you simply cannot compete with the customizable treatment you can get - if you can afford it. Realistically, most people that haven't hit a true "rock bottom" - still working, raising children etc., really cant manage an outpatient insurance based program so they end up having to pay out of pocket.

 

We have seen both insurance and cash based programs do incredible things for individuals and just like people, there is no ability to say which track is the best or most beneficial. Each person is unique and with that comes a unique set of needs. If you are concerned that perhaps the place you are at is not the best fit for you, but you have no idea where to start to look for something new, find a place that offers free referral resources or a counseling office (like TCI) that works with MAT populations. They often have the "goods" on the local programs and would be able to direct you to a solid start.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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