Can my insurance pay for outpatient drug treatment?

Does My Insurance Cover Outpatient Drug Treatment?

Outpatient drug treatment is usually covered by insurance to some extent. Public plans, like Medicaid, as well as private and employer-based insurance providers like Blue Cross Blue Shield, Aetna and others will generally cover some part of the process, but there is not a one-size-fits-all answer to this question. If you or your loved one are looking for outpatient alcohol or drug addiction treatment, and you want to know if your insurance plan will cover your care, there are a few variables that you will need to check. Many of these questions can be answered by either your insurance company or the admissions staff of the treatment center that you or your loved one are considering.

Some of the factors that may determine whether your insurance covers outpatient treatment may include:

What Do You Mean by “Outpatient Treatment”?

Outpatient treatment simply means the dispensation of treatment services that don’t require an overnight or extended stay in a medical facility. Within this broad definition, however, is a vast group of therapies that may or may not be covered by your insurance provider. This can include anything from group therapy and counseling to medication-assisted treatment in an outpatient setting. Determining whether or not outpatient treatment is covered by insurance is often a matter of finding out if what types of therapies you’re exploring are covered, and doing some research regarding scope of coverage.

Some of the outpatient treatment therapies more readily covered by insurance include:

  • Cognitive Behavioral Therapy (DBT)
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Dialectical Behavioral Therapy (DBT)
  • Group Therapy
  • One-on-One Counseling
  • Transcranial Magnetic Stimulation (TMS)

Duration and extension of coverage will vary according to your specific health insurance policy. Different treatment providers will offer different tiers of coverage that will dictate your eligibility for total or partial treatment coverage.

Does Insurance Cover Medication-Assisted Treatment?

Medication-assisted treatment (MAT) is the use of select approved medications for the treatment of opioid use disorder. This therapy can be administered in both an inpatient and outpatient setting. It is offered in conjunction with counseling and behavioral therapy as a part of an approved opioid treatment plan (OTP).

Medicaid typically covers MAT for eligible patients, provided they are diagnosed and approved by their prescribing physician according to SAMHSA guidelines; however, different private insurers have different criteria for coverage. Medicaid is the primary means of insurance for approximately 40 percent of non-elderly adults that struggle with opioid use disorder. Currently, all state Medicaid programs cover some form of buprenorphine and extended-release naltrexone (Vivitrol®) for treatment of OUD.

How Much Does My Insurance Provider Cover?

The best way to fully determine the granular nature of your treatment coverage by your provider is by speaking with a representative directly or calling your prospective treatment center for a full insurance verification. Here is a brief synopsis of the coverage some larger insurance providers offer:

  • Substance Use Treatment through CignaCigna offers coverage for both outpatient and inpatient treatment through their employer-based health plans and follow-up with case management services if they’re applicable.
  • Substance Use Treatment through Aetna – Aetna offers a wide range of coverage options for substance use, including inpatient, outpatient, detox and more.
  • Substance Use Treatment through Humana – Humana provides a wide array of coverage options for substance use disorder through both their private/employer-based and Medicare programs.
  • Substance Use Coverage through Blue Cross Blue Shield – BCBS features many plans that offer some level of substance use disorder treatment coverage, based on tier of coverage and other variables. Plans include coverage for both inpatient and outpatient services.

It’s also important to realize that plans will vary according to members’ states of residence and the laws governing insurance and substance where they live.

Insurance Coverage for Outpatient Treatment at Recovery Unplugged

Recovery Unplugged works with most major insurance companies to make the treatment process more affordable and accessible to our clients. We are currently in-network with Cigna, Blue Cross Blue Shield of Texas, Aetna and several other insurance providers, and are ready to help you or your loved one get the care you need for substance use disorder. Don’t let money or cost get in the way of your recovery. Our representatives are standing by 24-7 to conduct a full insurance verification for or your loved one. Get help today.