Does insurance cover drug overdose?

Getting prompt treatment for a drug overdose is important, and your health insurance will usually help cover this emergency cost. More on financing treatment for accidental drug overdose here.

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A drug overdose (OD) can cause a variety of health problems, ranging from vomiting to coma to death.  But is this a medical condition covered by insurance? We explore here and invite your questions about insurance coverage for OD at the end.

Insurance coverage for drug overdose

Many insurance companies do cover drug overdoses, but some may not. For example, some insurance companies may see drug overdoses as self-afflicted illnesses, which they will not cover. The type and amount of insurance coverage for drug overdose typically depends on the insurance company as well as the policy that you’re on.

But generally, health insurance companies consider drug overdoses to be accidental, regardless of whether you were using legal or illegal drugs. Drug overdoses also typically require emergency treatment. Therefore, if your insurance policy covers emergency or critical care services, you’ll most likely be covered for a drug overdose.

You can find out more about insurance coverage for drug overdose through your insurance company. Information about your coverage, out-of-pocket costs, and how to file a claim can usually be found in your policy’s benefits guide. If you need additional help, you can also contact your insurance company directly.

Does insurance cover drug overdose?

Typically, a drug overdose requires emergency medical care, meaning that you’ll need to be covered for emergency room visits. In 2012, the Kaiser Family Foundation and Health Research & Educational Trust found that the average emergency room co-pay was roughly $188. A hospital stay after being stabilized averaged $263.

Your out-of-pocket costs may not end there, however. Keep in mind that there is a possibility that your insurance company may raise your premiums slightly if they need to cover this type of treatment. Your claim for coverage may also be denied by some health insurance companies. In this case, you can file an appeal with the insurance company. If they deny your appeal, you can usually set up payment arrangements with the facility that treated you.

Drug overdose with no insurance

If you have no insurance, please don’t let that stop you from seeking treatment for a drug overdose! Seek emergency medical treatment as soon as possible. Drug overdoses can lead to severe medical complications and may even be fatal in some cases. Additionally, you still have a few options to help cover the costs of a drug overdose with no insurance.

1. Payment plans. Many hospitals and critical care centers are more than willing to work with patients who are unable to pay high medical bills. Any reputable medical facility will work with you to set up payment arrangements that allow you to pay back the bill a little at a time.

2. Charities. Charitable organizations in your region may also offer grants to low-income individuals to help pay for some or all of their medical expenses. Your hospital’s billing department will typically have more information regarding this and will also usually be able to tell you whether you meet the requirements for such programs.

3. Medicaid. Medicaid might also help you pay for drug overdose treatment with no insurance. This is a government funded program that pays for eligible participant’s medical needs. Eligibility varies from state to state, and is based on income, household size, and expenses. To find out if you’re eligible, contact your state or county assistance office or department of health.

Medical insurance for drug overdose questions

Always seek emergency medical attention for a drug overdose, whether you have health insurance or not. By law, you can’t be denied treatment. Your concerns and questions about medical insurance for drug overdose can be left in the comments section below. We’ll respond to you as soon as possible and look forward to helping you along this difficult journey.

Reference Sources: APIS: Health Care Services and Financing: Health Insurance: Losses Due to Intoxication (“UPPL”) Is your health plan at work any good?
Compdata Surveys: Medical Insurance Co-Pays in 2010
Health Insurance: What If Your Health Insurance Doesn’t Cover a Test or Procedure? What Can You Do?
Personal Health Insurance: Does Health Insurance Cover Drug Overdose?
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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