As with recovery from any chronic disease, relapse is sometimes part of addiction recovery.
A relapse can happen for a variety of reasons, including when a person doesn’t follow an aftercare plan upon completing a treatment program.
Relapses can be especially demoralizing when people are faced with the cost of a rehab program again. This brings up the question of how many times an insurance company will cover a rehab program.
Is There A Limit To The Number Of Times Insurance Will Cover Rehab?
Because of the Affordable Care Act (ACA), insurance companies are required to pay for addiction treatment and cannot treat substance abuse as a pre-existing condition.
This means that insurance companies cannot deny you coverage for addiction treatment. But they can write limits into your insurance policy that address recurring addiction treatment.
How Insurance Providers Set Treatment Limits
Insurance providers have different ways of setting limits regarding the number of times they will cover substance abuse treatment or whether they will cover recurring substance abuse treatment.
For example, one form of Medicare has a fee schedule for increasing patient responsibility for the length of treatment during a year, with a lifetime reserve of up to 60 days.
Other insurance plans may offer assistance with care management if you submit several claims for addiction treatment services in the course of a year.
If that is the case, these insurance companies may assign you a care manager, a person who tracks your treatment and helps you stay on course with your treatment plan after the rehab program is finished.
Why Relapse Prevention Matters
Relapse prevention is a serious matter both for insurance companies and for people in recovery from a substance use disorder (SUD). With some drugs, like alcohol or opioids, a relapse can be deadly.
If people with an SUD have achieved sobriety, their tolerance levels for substances will return to a more natural level.
With a relapse, a person may use a large amount of drugs that their body can no longer handle, and a fatal overdose could result.
How To Make Relapse Prevention Count
Due to the risks associated with a relapse, many addiction treatment centers offer robust aftercare options for clients once they complete a treatment program.
Aftercare services act as a safety net for you to use if you feel that you are in danger of relapsing.
Aftercare may include services such as outpatient therapy in an individual or group setting.
Regularly scheduled therapy sessions keep you in touch with your therapist and allow you to work through issues that may arise once you leave a treatment facility.
Sober Living Options
Sober living homes provide a structured, safe environment where drug or alcohol use is not tolerated.
A sober living environment is for people who are transitioning from immersive addiction treatment back to daily life but need an intermediary step, which has helped many people avoid a relapse.
12-Step Recovery Groups
The 12-step process is one that has helped many people find and maintain recovery.
While some treatment centers do not incorporate the 12 steps into their treatment approach, many recommend that you find a 12-step group or another peer support group after a rehab program is over.
Having a group of people who share a common goal and are facing similar challenges can be invaluable when it comes to avoiding a relapse.
Find Addiction Treatment
If you or a loved one are looking for addiction treatment, you can find it today. Call us to learn about your treatment options and how to access them.
Published on September 25, 2023
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- HealthCare.gov - Health benefits & coverage
- National Institute on Drug Abuse - Drugs, Brains, and Behavior: The Science of Addiction - Treatment and Recovery
- Medicare.gov - Inpatient rehabilitation care