Does Insurance Cover Drug Rehab?

Written by Chloe Nicosia

Does Insurance Cover Drug Rehab? Discover How Your Health Insurance Plan Can Help with Rehab

An estimated $740 billion is spent annually to cover the cost that addiction has on health care, lost productivity at work, and the cost that addiction has through crime. Of course, the government has many public service initiates to reduce the levels of substance abuse across the country in order to lower the cost that current substance abuse has in the long term. In the same way, health insurance cover for substance use disorder aims to get help for an individual before even greater costs are accrued due to the devastating effect that the disease has. In this article, we will answer the question “does insurance cover drug rehab?” to help you understand what your treatment options and costs will be.

Call us today at 1-800-429-7690 to find a rehab that takes your insurance. 

Barriers to Treatment

Before we answer the question “does insurance cover drug rehab?” an important fact to note is that only roughly 10 percent of people with substance use disorder actually get help for their clinical addiction. Since most health insurance plans will have provisions for addiction treatment, it can be strange to think that so many avoid treatment. In fact, active avoidance of treatment is one of the common symptoms of addiction and many people struggle with the disease for far longer than they have to because of it.

Stigma surrounding addiction and treatment still remain to this day. This is another reason as to why some people avoid treatment even if they have insurance coverage for drug rehab. However, everyone deserves to have access to treatment, regardless of the barriers to treatment that individuals have or communities impose.

If these barriers can be overcome, then the next step is to understand your options and coverage when it comes to addiction treatment and your health insurance plan.

Does Insurance Cover Drug Rehab?

To better understand of your limitations when it comes to your coverage for rehab, we will explore the many facets that have an impact on your coverage. Insurance plans must provide at least one page that breaks down benefits of therapies and the cost involved, under the Affordable Care Act.  Find this information in your plan before continuing.

Ascertaining Your Level of Cover

Does insurance cover drug rehab? The short answer is yes; however, each person may have different levels of cover that they need to consider before choosing a rehab. Insurance coverage for drug rehab is often included as a provision. However, just because you have provisions for rehab, it doesn’t mean that it automatically includes full coverage.

Before choosing a drug and alcohol rehab, take a closer look at your health care plan to discover just what you have covered. It’s common for there to be various stipulations in your health insurance plan such as:

  • Coverage does not include a medical detoxification.
  • Some health insurance plans only cover treatment at rehabs and physicians that are a part of their “network”.
  • The extent of your coverage may change based on treatment length, the type of substance that was abused, and the type of treatment that is required.
  • Some people may even be denied coverage if they have relapsed after receiving covered treatment.

Reading the fine print in your insurance plan is crucial to finding out “does insurance cover addiction treatment?” and in order to avoid surprises in your bill.

Relapse and Coverage

Upon reading your health insurance plan to determine “does insurance cover addiction treatment?” you may notice the term “pre-existing condition”. In this case, it refers to a person having used a rehab in the past and then relapsed, labeling the condition as “pre-existing” according to the insurance policy.

Repeat treatment attempts, or going back to rehab after relapsing, can be considered by some health insurance policies as grounds for denial of coverage. This stipulation can mean that paying for drug rehab with insurance is out of the question.

Inpatient, Outpatient and Partial Hospitalization

Upon further reading, you may discover that you are covered in part or in full for one of the treatment options: inpatient, outpatient and partial hospitalization programs among others.

Inpatient rehab is a type of treatment that places the addict in the care of the rehab for the length of the treatment program. This around-the-clock care that is provided has many benefits, including being able to put all of your focus on recovery with no distractions and no chance of a relapse since no drugs or alcohol are available. However, this type of treatment program tends to be more costly and may only be covered to an extent.

Outpatient care provides much of the same treatment programs but without the residential benefits. It does however give the addict a chance to carry on with their responsibilities with next to no disruption to their day-to-day. Of course, it tends to more affordable and therefore it can be covered to a greater extent by most health insurance plans.

Partial hospitalization can be seen as a mix of the two programs. A patient will generally receive their medical detox while staying at the facility, but then continue with outpatient care once they are ready for treatment as the symptoms of withdrawal become manageable or dissipate.

Making the Decision

Of course, addiction is a serious mental disorder that can ruin lives. Regardless of the level of care that your plan has, it is important to always defer to the healthcare professional. If you have had an assessment by a physician or addiction specialist and they have recommended that you seek intensive inpatient care, then it advised that you take the steps to bring it about, where possible.

One of the most dangerous times for an overdose is during a relapse; due to a lowered tolerance, the dosage strength can come as a surprise resulting in an overdose. It is therefore important that you seek the best care possible to minimize relapse risk.

Still Unsure Whether or Not Paying for Drug Rehab with Insurance is Possible?

It can be difficult to discern what exactly you’re covered for even after reading through your plan. If after you have examined your insurance policy and you’re still unsure of does insurance cover drug rehab, then feel free to get in touch with Better Addiction Care at 1-800-429-7690. Representatives will be more than happy to help you discover your level of treatment coverage and which of their many listed-rehabs would accept your particular health insurance plan.