Overdose deaths in Austin and surrounding areas have tripled over the last five years,1 and Travis County has the highest rate of fentanyl overdoses in the entire state of Texas.2 Austin ranks number five in the United States for the number of drinkers, leading to concerns about the rise in alcohol use disorders. These are concerning data points, but statistics only reveal so much. Substance abuse and addiction can leave lasting scars, emotional and physical, on those who struggle and their families.
At Harmony Haus, we applaud anyone who takes the first step toward recovery by accepting they have a problem, asking questions, and seeking support. Case management services for addiction constitute an important foundation of a successful recovery journey.
Does insurance cover case management?
Unfortunately, financial concerns are often a significant barrier to treatment. Many people ask who pays for case managers? How can regular people struggling to get by afford to receive the support and care they need?
Good news. Insurance, including Medicare and Medicaid, does cover case management.
Private insurance companies
In order to ensure that enrollees receive appropriate, cost-effective care, many private insurers will cover this service.
Medicare
Medicare Part B will cover case management services for people with two or more co-occurring conditions in order to ensure coordinated, quality addiction treatment.
Medicaid
A federal and state program, Medicaid supports people with low incomes. There are Medicaid programs under which people can receive coverage for case management.
In Texas, the law states that there must be parity between substance abuse treatment and any treatment for physical conditions.3 This includes:
- Coverage limits, both annual and lifetime
- Deductibles, copays, and out-of-pocket costs
- Limits on treatment frequency, such as number of visits or treatment duration
There is a robust system for appealing, for example, if your provider prescribes a higher level of care than you are approved for. The goal in Texas is to promote equity between mental and physical health care, including addiction treatment.
Coverage Type:
Private Insurance
Eligibility
Coverage Details
Cost to Patient
Enrollees with private health plans
Covers case management to ensure cost-effective, coordinated care
Varies (copays, deductibles, out-of-pocket max)
Madicare (Part B)
Eligibility
Coverage Details
Cost to Patient
People with two or more co-occurring conditions
Covers case management for addiction treatment coordination
May require copayments or deductibles
Madicaid
Eligibility
Coverage Details
Cost to Patient
Low-income individuals
Coverage available for case management services
Minimal to no cost, varies by state
Texas Insurance Law
Eligibility
Coverage Details
Cost to Patient
All insurers in Texas
Requires parity between mental health/substance abuse and physical health treatment
Limits on annual/lifetime coverage, copays, deductibles apply
Appeals Process
Eligibility
Coverage Details
Cost to Patient
All insured individuals
Allows patients to challenge insurance denials for needed addiction treatment
No direct cost, but time and effort required
Verification steps in Texas for insurance coverage of addiction case management
To qualify for case management coverage, you will need to:
- Gather the patient’s information, whether the patient is yourself or a family member, including name, birthdate, insurance numbers, etc.
- Establish pertinent details about the treatment being sought
- Contact the appropriate insurance provider, private, Medicare, or Medicaid
- Verify your coverage details with the insurance provider
- Ask if you need prior authorization
- Get the breakdown on the patient’s responsibilities such as copays, deductibles, and maximums for out-of-pocket costs
This can almost all be achieved over the phone with your insurance provider or online.
Coverage for case management reduces costs and increases access to needed care
What case management fees are is perhaps the wrong question. How can case management save lives and money at the same time might be more pertinent. Successful addiction rehabilitation benefits individuals and society as a whole.
The insurance programs above include coverage for case management because doing so enables people to get the help they need, thus reducing long-term medical costs. Most importantly, however, ensuring that people can recover from addiction safely and with positive long-term outcomes maximizes their ability to be productive, healthy members of society while minimizing their need for ever-increasing services, which is likely to happen if their health needs are not addressed.
Case management, by definition, streamlines care and creates efficient systems that benefit everyone. By identifying your needs, coordinating your addiction treatment and affiliated services, and monitoring your progress and well-being, successful recovery is possible.
Connect with case management services at Harmony Haus today
When you become a member at Harmony Haus, you will be secure in our sober living residences as you access treatment planning, social services support, legal aid services, and comprehensive case management. We can help guide you through costs and payment options, including your insurance coverage for certain services available at Harmony Haus.
Your lasting recovery is important to us. Submit our online contact form or call us at 877.349.1544 to get started on your best future.
Sources:
- The Texas Tribune. “Travis County Is Shifting Focus to Prevent Overdose Deaths as Fentanyl Ravages the Area.” Accessed March 26, 2025
- Axios Austin. “Travis County Has Highest Rate of Fentanyl Overdoses in Texas.” Accessed March 26, 2025
- Texas Department of Insurance. “Insurance Coverage and Parity for Mental Health and Substance Use Disorder Services.” Accessed March 26, 2025
