Addiction Treatment Insurance Coverage: FAQs

Written by Chloe Nicosia

Looking for health insurance that covers substance abuse? Learn how to get the help you need.

If drug or alcohol addiction has taken over your life or the life of someone you love, you may be considering entering into an addiction treatment program. While there are numerous questions one should ask in order to find the right rehab program, one of the most common is, “Does insurance cover rehab?” This is a crucial question to ask before enrolling in a program. Having health insurance that covers substance abuse can lower a portion of the total rehabilitation costs, and could save you the stress of not being able to complete a program because of price or nonpayment.

When researching addiction treatment insurance coverage, you will find that in many cases, yes, the program is typically covered in some amount by insurance. But you will need to dig deeper to determine what amount it will cover and if it will even cover the treatment course that would work best for your addiction needs. Back in 2014, “Obamacare,” also known as the Affordable Care Act, added substance abuse and mental health treatment into its essential health benefits list. And while care for these issues is now considered “fundamental” it doesn’t necessarily mean you will receive coverage for the program that may be best tailored to the addiction you are battling. In the case of addiction and insurance coverage, let’s take a closer look at other commonly asked questions:

 

  1. Do all insurances cover addiction treatment? While most addiction treatment services are covered, there are some cases where a health insurance company may not cover treatment. In addition, the type of treatment matters when it comes to coverage. For instance, while traditional detox or addiction programs might be covered, a rapid detox or ultra rapid detox will typically not be, as these are not considered medically necessary. You would likely be required to enroll in a traditional program first.
  2. Is both inpatient and outpatient treatment covered by insurance? In many cases, outpatient will be a covered service of most health insurance companies. Inpatient treatment coverage will depend on your health insurance provider.
  3. Are there any out of pocket costs if insurance covers treatment? The reality is, even if your health insurance provider does cover treatment costs, it may not cover all of the cost. This means you could be required to pay a co-pay or fixed percentage of total costs. Health insurance that covers substance abuse might expect a payment from the patient in an amount anywhere from $10 to over $150 per day. This percentage or copay would depend on the type of treatment you are receiving, the individual facility costs, etc.
  4. What if my insurance carrier denies addiction treatment insurance coverage? In this case, you could file an appeal against their decision. You would have to research the appeals process for your particular insurance provider, and present them evidence of why this treatment is medically necessary. Remember, the more supportive documentation you have, the better.
  5. What if my appeal is denied? When this occurs, you can speak to your chosen addiction rehab facility about potentially qualifying for a sliding scale fee. In addition, be sure to ask if the addiction treatment center offers any financing options. With financing, you will be required to make payments over a specific period of time to cover your treatment costs.

 

If you are in a situation where you have no addiction treatment insurance coverage and need to enroll in a detox/rehab facility, you do have some options. Government assistance programs such as Medicare and Medicaid may help cover some costs. In addition, you may want to research SAMHSA treatment locations online. These centers are typically given grants directly from the government to help offset some treatment costs for individuals. Last, reach out to nonprofits or 12-step program such as Alcoholics Anonymous and the Salvation Army that offer free recovery/self-help programs and meetings for anyone struggling with addiction.