Addiction and drug abuse are one of the number one causes of hospitalization, injury, and death in the United States. Today, an estimated 18.5 million individuals have a substance use disorder, requiring drug rehab or alcohol treatment. Yet, statistically, only 11% of us ever get that help. Most of us cite the high costs of medical care over 30-90-day hospitalized stays and ongoing care. Yet, with most insurance programs offering significant assistance for rehab, that excuse is less valid than you might think.
Today, western medicine is rapidly recognizing addiction for what it is, a mental behavioral disorder compounded with chemical dependence. This scientific view allows us to separate addiction from the long-held belief that substance abuse is a personal failing, shameful, or something to hide. It means that if you struggle with a substance, you can walk into a treatment center and get help just like you would for anxiety, depression, or any other mental health problem. Part of that shift is the fact that your treatment will be covered, at least in part, by your insurance provider, just like with any other medical treatment. This is required, by law, for as long as the Affordable Care Act (Obamacare) remains in place. The following information will help you figure out how to get your insurance to pay for drug rehab.
What Parts of Drug Rehab Do Insurance Companies Cover?
There are many different types of drug rehab, ranging from very basic bare-bones outpatient treatment centers to high-end, luxury, celebrity retreats. Most of us want something in between, able to offer distance from the stress and responsibility of daily life so we can focus on recovery, but at an affordable rate. Most insurance will help you there. If you’re going for basic rehab, you can expect your insurance to cover 30-90% of costs. You should expect that your insurance will use copays and deductibles and plan for this when calculating total costs of rehab.
Detox – Detox, or medically assisted withdrawal, is a period of controlled withdrawal with medical monitoring and sometimes medication. This ensures that you move through the most physically dangerous aspect of drug addiction recovery as safely as possible. In many cases, detox is medically necessary and prevents further complications and more incurred costs, so your insurance provider will cover at least part of it.
Outpatient Care – Outpatient drug treatment is a relatively light drug treatment program where you visit a therapist, attend classes, and see counselors in the morning or night, but otherwise stay at home. This type of program allows you to go to work, take care of responsibilities, and mostly continue your daily life. Most insurance providers cover this type of treatment.
Inpatient Care – Not all insurance providers will cover inpatient care, however, many do. Inpatient or residential care includes hospitalization for a period of 28-90+ days, where you are able to receive intensive care. This can improve outcomes, especially for heavily addicted persons, but isn’t necessary to provide good outcomes for anyone with a good family support network, housing, and the ability to manage stress at work and at home. This means some insurance companies will see it as a luxury service while others see it as necessary for specific cases.
Many insurance companies maintain individual policies for:
- Specific rehab clinics – Some only cover specific clinics or specific doctors. If you have a Health Maintenance Organization (HMO) provider rather than a Preferred Provider Organization (PPO), you’ll also have to make sure you can get your primary physician to refer you to the treatment center before your insurance will cover it.
- Screening – Some insurance providers see screening as part of care, others expect you to do this with your primary care provider.
- Residential Stays – Your provider may cover outpatient stays with a clinic but not inpatient or residential stays. Check individual policies per clinic to be sure.
- Maintenance/Ongoing Therapy – Not all providers cover ongoing or maintenance therapy. This is important because aftercare is normally an essential part of long-term recovery.
Not every insurance company will cover every type of rehab. Some only cover outpatient programs. Individuals with high premiums might find their insurance covers a fair amount of luxury as well. Eventually, it’s important to check your provider’s policies, call them, or review their website for more information. They are, however, required by law to cover at least part of the treatment.
Get Your Questions Answered Now.
What to Ask Your Insurance Provider
The best way to find out what your insurance provider covers is to simply ask them. Most of us will be at least a little ashamed to ask about drug addiction treatment, even if asking for a friend or family member. That’s okay. Your provider is accustomed to dealing with medical requests like this one on a daily basis.
Call your insurance provider and be specific with questions. Be to the point and ask about specific circumstances rather than broad questions that “might” answer your question. Many insurance providers use very specific policy regarding individual treatments and treatment centers.
You should ask:
- For a list of all covered rehab centers in your area
- How many days of treatment are covered under your plan?
- Ask about Copays, Deductibles, and what percentage of treatment is covered
- About whether inpatient care is covered
- About which types of treatment are covered (e.g., therapy, family therapy, etc.)
- If MAT (medication assisted treatment) programs are covered
- If detox is included in coverage
In most cases, these questions should give you a very good idea of what you can expect, which rehab centers you can choose from, and how much you can expect to pay. You may want to request a written letter from your doctor, having them recommend a rehab facility to you and listing reasons you should go to that specific treatment center.
So long as your insurance provider covers the rehab center you’ve chosen, that’s all you have to do to get your insurance provider to pay for drug rehab. As stated, most providers will vary in coverage, so it is important to ask for specific details.
What to Do If You Don’t Have Insurance?
If you don’t have insurance, it’s important to apply for and get insurance before going to rehab. The Affordable Care Act mandates that providers must accept you, even with a pre-existing condition like drug addiction. Applying for coverage before seeking out therapy could significantly reduce the cost of attending rehab.
You can also seek out other options including:
Government Grants – There are numerous government and local grants offering financial assistance with substance abuse treatment. The Substance Abuse Prevention and Treatment Block Grant offered by SAMHSA is one of the best-known. Check your area or ask for assistance with your local city hall for more information.
Mental Health Parity and Addiction Equity Act of 2008 – This Act requires that companies with 50+ employees cover substance use disorders as part of insurance. Your employer may be required to cover treatment for you.
Financing – Many organizations specifically finance drug treatment recovery. It is critical to look into these programs as some may offer very high interest, which you are not likely in a position to take on.
Medicare/Medicaid – Medicare and Medicaid cover treatment for individuals under 19 or over 65 and those with an income below the poverty line. You will have to attend a state-based program, typically offered on an outpatient basis.
Millions of American struggle with drug addiction and abuse. There’s no shame in admitting you have a problem and getting help. In fact, some insurance programs will even cover a part of an intervention, simply because it costs them less to get patients into treatment sooner. Your insurance provider is legally required to cover at least part of your drug rehab. All you have to do is make the call and get started. Good luck with your recovery journey.