Does Health Insurance Pay for Rehab?

Written by Chloe Nicosia

If you are wondering, does health insurance pay for rehab, we have the answers you need

Figuring out how to pay for rehab can be one of the biggest challenges to getting the treatment you need for recovery. If you or someone you know is trying to enter treatment for drug addiction, one of the first questions you need answered, is “Does health insurance pay for rehab?” Questions about addiction treatment insurance coverage are particularly relevant right now, when the nation is considering rolling back certain standards of insurance coverage, including the one that states that substance abuse treatment is one of the fundamental services that every plan should cover. As of right now, with the 2014 Affordable Care Act (also known as Obamacare) in effect, the answer is yes, most health insurance does pay for rehab. The next step is figuring how much your health insurance will pay for rehab, and what expenses you will need to cover.

Is payment for rehab guaranteed?

As of right now, 43 states have laws that require commercial health insurance plans to pay for  substance abuse treatment. No one is really sure what is going to happen with regards to rehab coverage from insurance plans obtained through the Affordable Care Act in the future.  There is a possibility that even if you have coverage now, rehab may not be covered in the future. Make sure you verify coverage with your specific health insurance provide before entering rehab.

What factors can affect whether my insurance pays for rehab?

Several factors will determine the amount of addiction treatment insurance coverage  your plan will provide. These include:

  • Prior treatment – You cannot be denied coverage for substance abuse because you received treatment for it in the past, because pre-existing conditions are now covered under insurance. However, insurance plans have strict guidelines on how many days of treatment are covered. If you have already received the maximum number of mental health or substance abuse treatments your plan covers this year, another stint in rehab may not be covered.
  • Pre-approval – Many insurance plans require patients to go through a pre-approval process before entering rehab or undergoing other expensive treatment. Staff at the treatment center will have experience navigating the paperwork needed to get payment for your rehab approved.
  • Deductible and co-pay – If you have not met your yearly out of pocket deductible, you may need to pay a large portion of the cost of rehab up front. You may also be responsible for a co-pay equal to a percentage of the cost of treatments.

 What do I do if my health insurance will not pay for treatment?

Now that you’ve asked, does health insurance pay for rehab, we can go on about what to do if it does not. First, find out what the laws in your state say about substance abuse treatment. The National Alliance for Model State Drug Laws is a good place to start. If you are denied coverage, you can file an appeal with your provider asking them to reconsider their decision, or you can ask your local legislator to intercede. If your insurance simply does not cover the rehab center you want to attend, talk to the financial department at the rehab center. Some rehab centers charge on a sliding scale that base your costs on your income and ability to pay. Most substance abuse treatment centers have financing programs available so you can still get the treatment you need for recovery.

 

Sources:

https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

http://www.hbo.com/addiction/treatment/362_not_covered_by_insurance.html

If you would like assistance finding an addiction treatment center that works with your insurance and offers the treatments that offer your best chance at recovery, BetterAddictionCare can help. Call 1-8888-4482-1364 today to speak to one of our compassionate specialists. We will assess your needs and find the addiction rehab program that provides the best chance for long-term recovery.