Navigating Insurance Coverage for the Sinclair Method

So, you’ve decided you’re ready to overcome alcohol addiction. Perhaps you’ve also decided that the Sinclair Method (TSM)—or another form of medication-assisted treatment—is the best choice for you. But now you may have another big question on your mind: How do I pay for it?

While there are some free resources online for the Sinclair Method, research suggests that following a program which pairs some type of psychosocial support system with medication will get you the best results. But with so many options available, and so much variation in which programs are covered by different insurance providers, choosing the right treatment plan can become confusing.

To add to the complication, there’s been a long-standing bias in favor of 12 step programs amongst many insurance providers. This can make things extra tricky if you’re looking for evidence-based, medication-assisted treatment that isn’t 12 step-based.

Fortunately, this is starting to shift. More providers are now offering coverage for medication-assisted treatment, including the Sinclair Method. There are also newer, more affordable options for accessing medication-based alcohol rehab. Below, we’ll offer some good rules of thumb for navigating insurance coverage for the Sinclair Method, and controlling the cost of effective alcohol addiction treatment.

Will My Insurance Cover TSM?

person on phone, insurance coverage for the sinclair method
Photo by Priscilla Du Preez on Unsplash

Increasingly, the answer is yes. But it’s complicated.

For a long time, the majority of insurance plans directed people toward 12 step programs, or other abstinence-based solutions for alcohol use disorder. This limited treatment options for much of the population, and contributed to keeping the Sinclair Method and other medication-based treatments off of many people’s radars.

Now, things are beginning to change. Medication-assisted treatment has been getting strong results in clinical studies for some time—especially when coupled with some type of medical or psychological support. As a result, some health insurance plans are beginning to recognize this as an option, and include it in their coverage plans.

But this shift is still very much in progress, and the rollout has been uneven. Depending on your specific plan, you may still not be covered, or may only be covered for very specific programs or services.

The best way to find out if your plan supports the Sinclair Method, or other forms of medication-assisted treatment, is by going directly to the source: Contact your insurance company or review the schedule of benefits. You can also contact individual treatment providers to ask if their program is covered by your insurance.

Curious if you’re covered for Ria’s online program? Schedule a no-obligation call with a member of our team today.

How Much Does Insurance Cover?

The next question, if you have coverage for TSM or any type of medication-assisted treatment, is how much your insurance plan covers, and exactly what. This is especially important if you’re comparing several different treatment options. The details of your coverage will often affect which program is the most affordable.

One thing to check is whether there are any caps on how many doctor’s visits you can make for alcohol treatment, or how many days you can attend a program before beginning to pay out-of-pocket. You may also have a higher deductible for certain services, or need to pay for some aspects of treatment yourself. Finally, your insurance plan may cover certain treatment providers and not others.

Check with your insurance plan about:

  • Deductibles – This is the amount you must pay out-of-pocket before insurance kicks in to help with the cost.
  • Copayments – The flat-rate amount you’ll contribute individually for each visit or treatment session.
  • Coinsurance – Similarly to co-payments, some people will need to pay a percentage of the cost of treatment each time.

As you do your research, you should also ask which providers are in-network for your insurance plan, and which are not. In some cases, out-of-network providers will not be covered. In others, you may still have coverage, but the rules may be different. It can all seem complicated at first. But the better you understand the details of your coverage, the better prepared you’ll be to choose the best program for your needs.

When You Aren’t Covered

In some cases, your insurance plan may not cover medication-assisted treatment for alcohol addiction. You may also not have insurance coverage, or find you have only partial coverage for the program that works best for you. In these cases, you may have to shoulder some of the cost of treatment yourself.

Fortunately, there are a number of solutions to this that may work for you.

For starters, there are now more affordable options for treating alcohol dependency—including telemedicine. Telemedicine programs reduce the cost of treatment, and make it more flexible, by putting the whole process on your smartphone. You can skype with doctors and coaches, and get prescription medications without ever visiting an office or disrupting your schedule.

Telemedicine programs are often available at a flat monthly rate, which is generally much cheaper than the cost of a traditional treatment program. Additionally, many insurance plans will cover them. Ria Health is one such telemedicine provider that is covered by many major insurance plans, including Anthem/Blue Cross Blue Shield and United Healthcare/Optum.

If you have no insurance, another option is to pay out-of-pocket to see a physician once. Design a plan of action with that physician, and execute it on your own. This can work for some people, especially since there are some free online resources for those following the Sinclair Method.

Overall, however, research shows that people with access to some psychosocial support, such as therapy or coaching, generally have a higher success rate. Many general practitioner doctors also remain reluctant to prescribe naltrexone or other medications for alcohol use disorder. If you can access a program, therefore, it will often be the best long-term investment.

Additional Tips for Managing Out-Of-Pocket Costs

man holding compass, insurance coverage for the sinclair method
Photo by Anastasia Petrova on Unsplash

If it turns out you don’t have full insurance coverage for your program of choice, there are still some things you can do to manage the cost:

  • If you have some assistance from insurance, consider beginning treatment before your deductible resets at the start of the year.
  • For those with a health savings account, or flexible spending account, try to time your payments to maximize your benefits.
  • Some treatment programs may offer payment plans, so that you don’t have to cover the whole cost at once.

Overall, even if the research is time consuming, there may be a workable solution that lets you get the support you need without breaking the bank. Taking the time to find the right solution may feel like a hassle at times. But in the long run, it’s worth it.

Check Your Coverage for Online Treatment

One of the easiest ways to find affordable medication-assisted treatment, such as the Sinclair Method, is through telemedicine. Ria Health’s program is one option that is covered by many plans, including United Healthcare/Optum and Anthem/Blue Cross Blue Shield.

Our team can help you determine whether or not you’re covered, and for how much. Schedule a call today to learn more. We keep all information confidential, and there is no obligation to join.

We encourage you in your search for an affordable, evidence-based support system that meets your own unique needs. And whichever path you choose, we wish you the best of luck!

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