How Changes To Private Health Insurance Affect Drug & Alcohol Treatments

If you or someone you know is struggling with alcohol or drugs, it can be difficult to understand what sort of treatment options are available, let alone appreciate what they may cost.
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Drug and alcohol treatments have the power to change lives for the better, drastically improving the health of the person struggling with addiction. Recovery from addiction is a challenging journey but can result in drastic changes, including better relationships with family and friends, better health, better mental wellbeing, and improved employment prospects.

Knowing the importance of quality, affordable drug and alcohol addiction health services, the Australian Government last year announced wide-ranging changes to our health insurance system1. This includes reforms to the access of drug and alcohol services, as well as mental health treatments.

What are the changes to waiting periods for drug and alcohol treatment?

The Australian Government’s Department of Health has announced that it plans to make it easier for policyholders to access mental health services, and drug and alcohol treatment when they need it.

Typically, waiting periods of two months apply to patients needing in-hospital treatment for drug or alcohol addiction. This meant that people suffering problems with drug or alcohol were unable to access in-hospital treatments when they needed it most.

With the changes, patients will be able to access in-hospital psychiatric care, including alcohol and drug dependency treatment, without serving the two month waiting period. However, if you use this exemption, you’re only able to use it once in the lifetime of the policy.

What is the waiting period for drug and alcohol treatments?

A waiting period is a measure that protects health insurance customers, and providers, by making patients wait to become eligible for rebates on some treatments2.

Generally, waiting periods ensure that customers can’t make large claims shortly after joining a fund, and then cancel the membership directly afterwards2. Waiting periods for hospital treatments are legislated by the federal Government and are:

  • 12 months for pre-existing conditions
  • 12 months for obstetrics (pregnancy)
  • Two months for psychiatric care, rehabilitation or palliative care, even if it’s for a pre-existing condition
  • Two months in all other circumstances

Waiting periods begin when you take out a new policy or upgrade your existing policy.

What are the cover upgrade options for drug and alcohol treatments?

In addition to waiving the standard two month waiting period, the Government has allowed patients needing drug or alcohol treatments to upgrade their level of cover without serving waiting periods3.

This means that if you have a private health insurance policy that doesn’t cover drug and alcohol in-hospital treatment, you can upgrade your policy to access cover for the treatment without serving the two month waiting period.

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What are the removed limits on treatment?

An additional reform is the removal of limits on the number of mental health sessions or treatments a patient can access. Some health insurance policies placed limits on the number of services it would cover such as day programs, electroconvulsive therapy, and transcranial magnetic stimulation3.

These services may be helpful in the treatment of drug and alcohol problems, and now patients can continue to receive cover should they require multiple treatments.

When do the changes come into effect?

The changes have already been introduced and became law in April of 2018.

How does this help people suffering drug and alcohol addiction?

According to Australian Government Department of Health, many insurance policies provide limited cover for these important services, so if you need overnight or multi-day care in a private hospital for drug or alcohol treatment, you may face large out of pocket costs3.

By removing waiting periods, it’ll be easier for anyone needing mental health care to access it when they need it, without struggling with out-of-pocket costs. Additionally, fewer limits will make mental health care more accessible for those who need it3.

Do many people need drug and alcohol treatment in Australia?

According to the National Drug Strategy Household Survey 20164, the consumption of alcohol, tobacco and other drugs is a major cause of preventable disease and illness in Australia.

In addition, it states that pharmaceutical drugs is an increasing public health problem in Australia. Furthermore, users of illicit drugs are increasingly self-reporting psychological distress5.

Where to get help for drug and alcohol problems in Australia

Each state in Australia offers 24/7 alcohol and drug information services you can call for further assistance6:

  • Australian Capital Territory - (02) 6207 9977
  • New South Wales - 1800 422 599 (Regional and rural NSW Freecall), (02) 9361 8000 (Metropolitan)
  • Northern Territory - 1800 131 350
  • Queensland - 1800 177 833 (Freecall)
  • South Australia - 1300 13 1340
  • Tasmania - 1800 250 015 (Freecall)
  • Victoria 1800 888 236 - (DirectLine)
  • Western Australia - 1800 198 024 (Regional), (08) 9442 5000 (Metropolitan)

Want to learn more about drug & alcoholic treatments and private health insurance?

There are many factors to consider when finding the right health insurance for your needs. If you’d like to learn more about what policies may be right for you, feel free to call us on 13 19 20.



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