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Does My Insurance Cover Rehab?

Does My Insurance Cover Rehab?The status of addiction treatment coverage is an ongoing question. Constant legislative changes, changes to the industry itself, and different company policies and updates mean that there is no uniform answer to how or if health insurance coverage will cover the cost of treatment for addiction services. Even when an insurance policy does provide coverage for addiction treatment, which services are covered and in what amount will vary considerably as well.

Here is what you need to know to help you navigate the process of using insurance to help pay for the costs of treatment:

  • The Affordable Care Act currently lists substance abuse treatment as one of the 10 services that must be covered by all health insurance policies. The specifics will usually vary as to what services are covered, so make no assumptions.
  • Most health insurance providers have a short list of treatment services that are automatically approved up to a certain dollar amount with the referral of a doctor. These will vary but may include basic services, such as certain medications for thetreatment of withdrawal from certain drugs, outpatient therapies or programs, and others.
  • For the approval of coverage for services that are more in-depth, long-term, preventative, or expensive, the process may be more complex. Most health insurance providers will want proof that a requested addiction treatment service is “medically necessary.” For example, while most health insurance providers will cover some portion of the cost of outpatient treatment services for a finite period, they will require evidence that inpatient treatment and/or long-term care is necessary before they will provide coverage.
  • Drug rehab programs will have administrative personnel who regularly work with insurance companies regarding payment for treatment. It can be helpful to talk to them in advance and determine (1) if they accept your insurance, (2) what their experience is with your insurance company, (3) what you can do to make getting coverage easier, and (4) how to cover the amount of the bill not covered by health insurance.
  • Determining how much of the cost that your bill will be covered by health insurance should be addressed as early as possible. It is important to talk to your doctor, talk to your health insurance company, and work with your chosen drug rehab program to figure out how to expedite the process.
  • It is rare that a health insurance policy will cover the full cost of addiction treatment services, especially for a comprehensive drug treatment program. Most families will pull from different resources to cover the cost of treatment. While health insurance is the first stop, most will need to look to other options to pay the rest of the bill.

Other Payment Sources

In order to cover the remainder of the cost of treatment, many families look first at their own resources. For some, it is an option to liquidate resources: savings earmarked for another purpose may be tapped, an expensive car may be traded in for a less expensive model, or some shifts in budget can help to cover the cost of what remains after the health insurance company has covered what they will. For others, extended family may offer to help out with a loan or a gift of part of the cost. Many will take advantage of financing offers that allow them to pay back a small loan over time as it suits their budget. Almost all will utilize a combination of these options in order to come up with a financial plan that works best for their families.

How Will You and Your Family Cover the Cost of Treatment?

Does My Insurance Cover Rehab?When you begin the process of seeking out a drug addiction treatment program, your primary focus should be on which services will best support your loved one in transitioning from active addiction to recovery safely and effectively. Though finances are important, it is important to choose a drug rehab program based on its ability to provide your loved one with treatment services that will be genuinely helpful, otherwise, no matter how inexpensive the bill, it could add up to a wasted investment.

Once you have identified the best program for your loved one, begin to address the issue of finances with your family and with the program you have chosen. Take the time to map out all your options and start putting rough numbers on the page to visualize what you have and what you need to turn your loved one’s treatment goals into a reality.

Families are encouraged to:

  • Call the insurance company to get an idea of what to expect in terms of what they will pay for and what will be left over for you and your family to cover out of pocket. Do not forget to include copays for therapy visits and medications, if necessary.
  • Hold a family meeting and discuss the need for treatment openly and honestly, addressing the rough numbers provided by the health insurance company and the drug rehab program you have chosen.
  • Determine what family resources are immediately accessible and what can be realistically liquidated in a short period of time.
  • Discuss options for covering the rest of the cost. Start by creating a budget of all monthly household expenses and income, then looking at what can be cut for the next six months to a year to help get back on solid financial ground. Consider taking on overtime hours, a part-time job, or otherwise engaging in employment that will help to pay off any debt incurred for treatment more quickly.
  • Avoid postponing treatment due to cost. Working toward recovery takes time, and every day spent in addiction is a day that the individual is at risk for overdose, accident under the influence, and other medical emergencies.
  • Ask for help. If you are unsure how best to cover the cost of treatment, talk to the administration personnel at the drug rehab program or work with a financial advisor to determine the best path forward.

No matter how you ultimately cover the bill for addiction treatment, drug rehab is well worth the cost when it provides comprehensive and individualized care for your loved one.

About The Contributor
Editorial Staff
Editorial Staff, American Addiction Centers
The editorial staff of River Oaks Treatment is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed... Read More