Navigating the Healthcare System When Facing Addiction

Find the resources you need to overcome substance use disorder.

Woman sits at kitchen table looking over paperwork while she talks to her insurance company on the phone

Updated on September 22, 2023.

Navigating the healthcare system can be a confusing and daunting task, especially when you or someone you love is dealing with substance use disorder or addiction. But becoming familiar with how to access prevention, treatment, and recovery services can go a long way towards making the journey seem more manageable. Knowing who to call—and when—is particularly crucial.

With that in mind, here are issues and resources to consider when you're coordinating care.

Dealing with insurance

You might assume that even if you have insurance, you won’t be able to access the right treatments for you—but that’s not necessarily the case. Thanks to the Mental Health Parity and Addiction Equity Act of 2008, private health insurance plans are required to offer substance use disorder and mental health services, with equal coverage for mental health treatment compared to treatment for other health conditions.

Still, each insurance policy and plan will approach this a bit differently, with different treatments available and different co-payments or out-of-pocket payments required. To find out what your coverage includes, call your insurance provider before receiving treatment. This way, you can make more informed choices about providers.

Depending on your plan, in-network providers may be a more reasonable price, because they’re required to use the pre-determined rate approved by your insurance provider. Some insurance plans cover out-of-network providers. If yours doesn’t, and you're going to receive out-of-network care, ask your insurance provider about filing an appeal to have this service covered.

Your healthcare provider (HCP) may be able to recommend a treatment facility for you, but it’s important to research treatment facilities in your area and be ready to discuss options when you meet with your HCP.

No insurance doesn’t mean no treatment

Even if you have no insurance, you can still get help. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes a variety of ways you may be able to work with providers to receive treatment. These include:

  • Sliding-fee scale pricing, where your payment depends on your income, is often offered by HCPs
  • Grants, “charity care” programs, and scholarships are sometimes offered by hospitals or large treatment centers
  • Payment plans, offered by many hospitals and HCPs
  • Free or low-fee services are sometimes offered at health centers

Support groups are usually free to join. In addition to meeting people with similar experiences, your group may provide useful advice and tools for navigating the healthcare system.

Regional resources

Use these tools to search for facilities and other resources in your region:

SAMHSA’s National Helpline is a 24-hour free and confidential treatment referral routing service for individuals with mental and/or substance use disorders. Access it by dialing 1-800-662-4357.

If you or someone you love is in crisis, call 911, head to the nearest emergency room, or contact the 988 Suicide & Crisis Lifeline by calling, texting, or chatting the number 988.

Getting help for substance use disorder may not be an easy task, but it can start with just a phone call or text message. And the sooner you reach out, the faster you or your loved one can begin to feel better.

Article sources open article sources

Centers for Medicare & Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). Accessed on July 27, 2023. 
Substance Abuse and Mental Health Services Administration. Find Free or Low-Cost Treatment or Support for Mental Health, Drugs, or Alcohol. Page last updated April 24, 2023. 

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