Paying for Drug Rehab with Insurance: A Guide for Families

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Paying for drug rehab with your insurance can help make addiction care more affordable and accessible for your loved one. Over 19 million Americans currently struggle with some level of substance use disorder (SUD), only a fraction of whom can afford to pay for the cost of treatment out of pocket. Like other lifesaving medical interventions, treatment for substance use disorder requires the help of trained and experienced doctors, nurses and therapists to treat the totality of the condition, which means it can be a significant financial investment.

On the other hand, there comes a point in your loved one’s active substance use at which treatment becomes nothing short of a necessity. Maybe they’ve suffered a serious medical problem because of their alcohol or drug use; maybe they’re on the verge of losing their job because they can no longer keep it together; maybe they’ve become verbally or physically abusive and you don’t feel safe around them anymore; maybe they’ve come within an inch of fatality after overdose. Whatever the case may be, you shouldn’t have to weigh dollars and cents against the life and health someone you care about.

If you or a loved one is struggling with alcohol or drug abuse, you can use insurance to pay for drug rehab and alcohol treatment, but there are many different factors that can determine coverage eligibility. Here is some information that can help you as you start navigating the process. Remember that each person’s insurance situation is unique, and you will need to verify all coverage details with your insurance company and the facility at which you’re seeking your care.

What Types of Insurance Pay for Drug Rehab and Treatment?

Addiction is a chronic medical disease, which means that it is covered, to one degree or another, by every type of public and private health insurance. The Affordable Care Act has strengthened insurance coverage for rehab even more by making mental health and substance use services an Essential Health Benefit some of the factors that can determine the exact scope of eligibility include, but are not limited to:

  • Type of Insurance You Have (Public, Private, Etc.)
  • Type of Care You Need (Detox, Inpatient, Outpatient, Etc.)
  • Your State of Residence
  • Your Case History
  • Your Age and Medical History
  • Your Tier of Coverage within a Private Plan

The first step to learning how much of your treatment your insurance provider will pay for is to determine the exact nature of your plan. The most common types of insurances that pay for drug rehab include private insurances that are usually provided by your employer, or public insurances, like Medicare, Medicaid and other state-funded programs.

Paying for Rehab with Private Insurance

Recent changes to healthcare legislation have mandated that private, employer-based healthcare plans provide at least some level of coverage for substance use treatment. It’s also important to realize that The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurance providers offer the same level of coverage for mental health and substance use issues as they do for medical and surgical health issues. While coverage levels for each private individual insurance plan will vary, each plan will generally at least partially cover:

  • Detoxification and Withdrawal Management – Medical intervention for acute drug or alcohol withdrawal symptoms from doctors and nurses. These programs generally last anywhere from three to seven days.
  • Behavioral Rehab Services – Group therapy, individualized counseling and supplemental therapies to help you or your loved one address the root causes and sustaining factors associated with your substance use disorder.
  • Medication-Assisted Treatment – Use of FDA-approved medications, such as Suboxone® (buprenorphine and naloxone), Vivitrol® (monthly injectable naltrexone) and methadone to treat opioid use disorder symptoms.

Certain treatment plans will more readily cover outpatient treatment programs than inpatient and residential, due to the cost difference between the two. Coverage for different types of treatment therapies commonly used to treat substance use disorder, like cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), eye-movement desensitization and reprocessing (EMDR) and transcranial magnetic stimulation (TMS), will also vary.

How Can I Find Out What Type of Rehab My Insurance Will Pay For?

You have a documented legal right to a simple and concise explanation of your insurance benefits if you’re covered under the Affordable Care Act; however, individuals who are covered by their employer-based insurance or Medicare or Medicaid have the same reasonable expectation of transpareny and clarity. The first step is to contact a representative from your insurance company and find out what types of addiction treatment are covered.

Get an individual price breakdown of each service and the percentage of coverage offered under your plan. This will allow you to further narrow and refine your search. The best way to get the most accurate policy information is by talking directly to a representative from your insurance company.

When You’re Ready…

Contact the facilities you’re considering for a full insurance verification. An admissions representative should be able to tell you your exact scope of coverage. They will be able to tell you how much of your treatment will be covered by your insurance, how much you will have to pay out of pocket, and if there are any other means to cover the cost of care. The process of navigating insurance for rehab can be confusing and frustrating, especially when you’re trying to get your loved one the help they need immediately. It’s best to be proactive and go directly to the source to get the most accurate answers possible.

Using Insurance at Recovery Unplugged

Recovery Unplugged is in-network with most major insurance companies, including Blue Cross Blue Shield, Mines and Associates, Cigna, AmeriHealthAetna and many others. This means we probably have a contract with your health insurance plan to provide health care services to its plan members at a pre-negotiated rate to help you use your insurance to pay for drug rehab. Our admissions representatives are standing by to conduct a full insurance verification so you can help get your loved one into a treatment program. Contact us now to discuss your situation and how we can help your family member get the care they need. Recovery Unplugged offers detox and withdrawal management, comprehensive rehab and a full continuum of other treatment services through our multiple locations across the country.

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About The Author

The Senior Content Writer here at Recovery Unplugged, Dominic Nicosia oversees the maintenance of our online blog while also handling and overseeing all written communications within Marketing. He also writes articles, thought leadership pieces, and basically everything written regarding web content. Dominic has over seven years...
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