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Can I Get Coverage for Process Addictions?

Can I Get Coverage for Process Addictions?

Process addictions (PAs) are also known as behavioral addictions. A 2013 article in the journal The Professional Counselor defines them as “compulsive-like behavior that interferes with normal living and which causes significant negative consequences in  [people’s] family, work and social life.“ Common PAs include gambling, sex, exercise, eating and internet addiction.

Process addictions have been studied less extensively than substance addictions, but as research accumulates, so too does the understanding that PAs are disorders that share characteristics and some brain chemistry with addictions to drugs and alcohol. A 2010 article in The American Journal of Drug and Alcohol Abuse notes that process and substance addictions are similar in areas including neurobiology, tolerance, genetic contribution, natural history, comorbidity and response to treatment. A 2009 article in the Journal of Addictions and Offender Counseling reports that process addictions may also produce withdrawal symptoms, including sleep disturbances, anxiety, depression, irritability and changes in appetite.

Insurance Coverage for Mental Health Disorders

Health insurance that includes coverage for mental health treatment often covers process addictions. Fortunately coverage for mental health disorders is increasing. This is due, in part, to the implementation of the Affordable Care Act (ACA). All individual and small group policies sold on the health insurance marketplaces established under the ACA must cover ten essential benefits. The Healthcare.gov website lists the benefits, which includes services for mental health and substance use disorders.

Although process addictions are frequently covered by insurance, they may be covered under other names. This is due to the fact that insurance companies sometimes base coverage decisions on whether a disorder is listed in either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Disease (ICD). The most recent edition of the DSM has a new category for behavioral addictions, but currently gambling is the only PA listed in the category. Internet and sex addiction are listed in the DSM’s appendix in an effort to spur further research. Often PAs are covered under the categories of obsessive-compulsive or impulse control disorders.

Whether a process addiction is covered by insurance may depend on whether an individual’s condition meets diagnostic criteria. The DSM criteria for gambling disorder, for example, includes the experiencing of at least four symptoms within a 12-month period. These include the need to gamble with increasing amounts of money, feelings of restless and irritability when attempting to cut down or stop, unsuccessful attempts to control the behavior, preoccupation, engaging in the behavior when feeling distressed, chasing losses, lying to conceal the behavior, jeopardizing relationships, jobs or opportunities and relying on others to cover financial hardship caused by gambling activity.

The Co-existence of Process and Substance Addictions

Process addictions often co-exist with substance addictions. A 2005 article in the Journal of Addictions and Offender Counseling reports on a number of studies showing the correlations. These include the following:

  • Connections have been demonstrated between excessive eating, drinking and gambling.
  • The co-occurrence of chemical dependency, gambling, compulsive eating and compulsive shopping has been observed.
  • Gambling and alcoholism often co-exist.
  • A study of chemically dependent adolescents found 87% reported relationship dependency, 74% reported compulsive sexual behaviors and eating disorders were reported by 61% of respondents.
  • A study of sexually addicted individuals found 42% to be chemically dependent, 38% to have an eating disorder, 28% to work compulsively and 26% to be compulsive spenders.

Although the amount and type of coverage varies, it is becoming rare for insurance policies to fail to cover substance addiction at all. It is sometimes possible, then, for people who suffer from both substance and process addictions to receive at least partial coverage for treatment received through a program that addresses co-occurring disorders. Unaddressed mental health conditions such as anxiety, depression or PTSD may underlie and contribute to a wide variety of addictions, and addressing them may be a significant part of recovery.

When shopping for an insurance policy that covers mental health disorders including process addictions, it is wise to consider many variables. These include whether or not treatment must be received from a network provider, whether there is a cap on the number of covered treatments and whether a referral from a primary care physician is necessary. Insurance policies also vary greatly in such factors as co-pays and deductibles. Some policies put an annual or lifetime limit on the amount they will cover, the out-of-pocket costs of policyholders, or both.

Help is Available

If you suffer from both substance addiction and a co-existing mental health condition, we can help you find integrated treatment that addresses your needs in a coordinated way. Our toll-free helpline is available 24 hours a day, so there is never a wrong time to call. We can answer your questions about treatment and can check your insurance coverage if you wish, at no cost or obligation. Help is available. Why not call now?