How Can I Verify If My Insurance Plan Covers Rehab?

Because of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), health insurance companies are required to cover mental health and substance abuse treatment.

These two acts were passed into law in 2008 and 2010 respectively and, among other things, categorize mental health and substance use disorders as health conditions that require insurance coverage.

How Can I Verify If My Insurance Plan Covers Rehab?

Your health insurance plan covers some form of addiction treatment. But that doesn’t mean that it covers all aspects of treatment offered by every rehab program.

It also doesn’t mean that you won’t be left owing money. Your out-of-pocket expenses could still be considerable depending on several factors.

Factors that could affect your out-of-pocket expenses include:

• uncovered treatments
• whether the rehab center you’re considering is an in-network provider
• your deductible and copays

If you can verify these ahead of time, you will have a much clearer idea of what to expect from insurance coverage.

Verify Treatment Services Covered

Before you start a treatment program, find out from your insurance provider if there are any treatments that need prior authorization in order for them to be covered by your insurance plan.

The rehab center can probably help you determine this. You don’t want to be in the middle of treatment and find out that your insurance company doesn’t cover a portion of it.

Insurance companies typically cover:

• inpatient treatment
• medical detox
• outpatient treatment
• intensive outpatient programs (IOP)
• medication-assisted treatment (MAT)
• substance abuse counseling
• psychotherapy
• group therapy
• family therapy
• cognitive behavioral therapy (CBT)
• dialectical behavior therapy (DBT)

Insurance companies may not cover holistic care like yoga classes, faith-based services, or high-end amenities at luxury rehab centers.

Verify An In-Network Provider

Verify that the treatment center you’re interested in is in-network with your insurance company.

In-network providers have formal, contractual relationships with insurance companies, allowing the two parties to verify coverage and benefits quickly.

Whether or not the treatment center is an in-network provider may affect your costs considerably. For example, insurance companies often provide a higher deductible if you use an out-of-network provider.

Most addiction treatment centers display on their websites which insurance companies they work with. Some even offer online insurance verification tools that help you figure this out quickly.

Verify Your Deductible And Copays

If you are in the beginning stages of looking for addiction treatment, take a moment to call your insurance company and review your deductibles and copays.

A deductible is a set amount of money that you pay for medical services before your insurance coverage begins.

Once the deductible is met, your treatment services will be covered, usually with your insurance company paying a higher percentage of costs than you will, or even covering all treatment costs.

Deductibles and coverage can get complicated. Be sure to ask if you have one deductible for inpatient care and another for outpatient care.

You may also have copays that you’ll want to verify. Copays are a fixed amount that you pay for a service like a doctor’s visit or a session with a therapist.

Find Addiction Treatment Today

If you or a loved one is looking for addiction treatment, you can find it today. Call us to learn about treatment options, the recovery process, and how to get started.

Written by the Addiction Resource Editorial Staff