How Can I Maximize My Insurance Coverage For Rehab?

Addiction treatment is vital for recovery, but the cost of substance abuse care often keeps people from receiving the treatment they need.

Fortunately, many health insurance plans cover addiction services.

You may maximize your coverage by understanding your plan, choosing specific treatments, and gaining prior authorization from your doctor.

Types Of Health Insurance That May Cover Drug Addiction Treatment

Many health insurance plans cover behavioral health treatment, including drug and alcohol addiction services. The amount of coverage varies by plan.

Commercial Health Insurance

Commercial (private) health insurance is often available through an employer, in which case the employer typically contributes to the insurance premium.

Government Health Insurance

Government health insurance includes Medicare, Medicaid, TRICARE military insurance, and other state and federally funded plans.

All insurance plans within the health insurance marketplace (the Affordable Care Act, or “Obamacare”) are required to provide equivalent coverage for physical and behavioral healthcare.

Getting Prior Authorization For Addiction Services

Some insurance programs only cover services that can be proven medically necessary. For many programs, this means prior authorization from a doctor.

If your plan requires prior authorization, you may ask your doctor to refer you to an addiction treatment program within your network.

Choosing Covered Addiction Services

Health insurance programs may cover an array of services for substance abuse treatment.

Some examples include:

• medical detoxification (detox)
• medication-assisted treatment (MAT)
• inpatient programs
• residential programs
• outpatient programs
• dual diagnosis treatment
• addiction therapy

Check your insurance plan to find out what types of services are covered.

For example, some programs only cover evidence-based treatments such as MAT, but not holistic treatments such as recreational therapy.

Others may cover outpatient services but may not cover the cost of room and board for inpatient care.

You may maximize your insurance coverage by only selecting treatment options that are covered by your plan.

How To Know What Your Insurance Covers

To choose addiction care options that your insurance provider covers, you’ll need to understand what those options are.

To do so, you can contact your provider, look up your deductible and copay, and look for rehabilitation centers that accept your plan.

Contact Your Insurance Provider

Your insurance provider likely has a website that you can use to see the specifics of your plan. Even so, it can be difficult to understand exactly what your plan offers.

If you need a more in-depth explanation, you can find your provider’s phone number on the website to talk to a representative.

The representative can answer questions about what services are covered, what percentage of care is covered, and whether a referral is required for treatment coverage.

Check Your Deductible And Copay

You may also avoid financial surprises by finding out what your deductible and copays are.

A copay is a fee that the patient pays for prescription medications, routine doctor visits, and specialist appointments.

A deductible is the amount of money that the patient must pay for medical care before the insurance company begins to cover further expenses.

For example, if your plan has a $700 deductible, and you pay $700 in eligible expenses before the year ends, your insurance plan will cover the remaining costs for the rest of the year.

Before choosing addiction treatment, take a look at your deductible and previous medical expenses. If you have already met your deductible, you will have fewer out-of-pocket treatment expenses.

Contact Rehabilitation Centers

Many addiction care centers list the insurance plans that they work with on their websites. As you look for substance abuse treatment, look for programs that accept your provider.

You may also call treatment centers to confirm that this information is up to date and ask if they still accept your health insurance.

Get Help For Addiction

Addiction is difficult for many reasons, and finding the right care can seem overwhelming. However, help is available, and you don’t have to search for treatment alone.

If you or a loved one are experiencing substance abuse, contact Addiction Resource to learn about treatment choices.

Written by the Addiction Resource Editorial Staff