Asana Recovery

How to Get Insurance to Pay for Drug Rehab

female client during insurance verificationIf you or a loved one is struggling with drug or alcohol abuse, you’re far from alone. Substance use disorders are one of the most common health problems in the United States. In fact, the 2020 National Survey on Drug Use and Mental Health shows that some 40.3 million Americans qualify as having a substance use disorder.

For that reason, insurance companies are required by law to treat substance use disorders as a temporary disability. This means that you are legally entitled to healthcare and mental healthcare for drug addiction problems. However, the amount and type of coverage offered from provider to provider can vary quite a bit.

Call Your Insurance Provider

The first step to getting your insurance provider to pay for drug rehab is to figure out what they actually cover. For example, while your insurance provider is legally required to cover drug addiction treatment the amount and the specifications can vary quite a bit from provider to provider.

Therefore, the best way to get answers is to call your provider. Here, you should have a specific list of questions on hand. You may be able to answer many of them by checking your provider’s website to see what they offer. In addition, you might feel ashamed to ask about addiction coverage. Don’t. It’s a normal medical problem and your insurance provider is used to it.

Here, you can ask specific questions like:

  • What do you cover?
  • What percentage of coverage do you offer for residential treatment? What about outpatient treatment? What about for detox?
  • Do you have a preferred provider or a provider network? Do you offer coverage outside of that network?
  • Do you have a list of rehab centers you cover in the area?
  • How many days of treatment does my plan cover?
  • Do you have specific policies for specific rehab clinics or doctors?
  • Do you need your primary physician to refer people to treatment? E.g., if you have a Health Maintenance Organization (HMO) policy.
  • Is screening part of coverage?
  • Is ongoing therapy or maintenance part of coverage?
  • What are Copays and Deductibles per treatment type? Do you have an information sheet you can send?
  • Does coverage include medication-assisted treatment?
  • Is family therapy or childcare included in coverage?

Here, many insurance policies include specific coverage and percentages per provider based on type of care and whether they are or are not in the preferred network. This means that you may have to shop around to find a rehab clinic your insurance provider will optimally cover.

Get Your Questions Answered

Understand Your Options

addiction rehab female staff discussing insurance options with a female clientIn most cases, you can expect to get 20-90% coverage for your drug rehab care. If you choose an outpatient program, you’ll likely get maximum coverage from your provider. On the other hand, if you choose an inpatient program, especially a luxury one, you’ll likely see percentage of coverage drop or cap at a specific amount.

  • Detox – Detox is normally covered to the maximum amount allowed for by your insurance policy. This is often medically necessary and may be conducted in a medical facility or at a hospital. In most cases, you can expect 50-90% coverage.
  • Outpatient – Outpatient treatment involves staying in your own home and seeking out treatment with daily or multi-weekly sessions with a counselor or psychologist. Outpatient care is effective, affordable, and a suitable alternative for inpatient care for light-to-moderate addiction. You can normally expect 50-90% coverage on outpatient drug treatment.
  • Residential care – Residential treatment normally includes a 30-90 day stay in a treatment facility, with housing, food, and even pet and childcare provided by the facility. This can make treatment accessible to individuals who are homeless, can offer extra support and care for people with long-term or heavy addictions, and can improve outcomes for those exposed to stress and triggers in their home environment. However, because treatment includes paying for living situations, it’s often not given the same amount of coverage as other treatment options. Here, you may get as little as 30% coverage – but up to 90%.

The more “premium” your insurance policy, the more likely it is that it will cover inpatient programs. However, every insurance provider has its own policies, provider networks, and standards. You’ll have to talk to your provider to get that information.

What to Do If Coverage Isn’t Enough?

In most cases, your insurance provider will be happy to cover at least some part of any rehab center you choose. In other cases, that won’t be true. However, if you’re attending a 90-day medical program, costs can be quite high. If your insurance provider isn’t covering enough of it, you may have to resort to funding your treatment in other ways. If your insurance provider refuses to offer coverage at all, they are breaking the law.

  • Your Employer – The Mental Health Parity and Addiction Equity Act of 2008 requires that companies with 50+ employees cover substance use disorders as part of treatment. If you can’t afford care on your own, your boss may have to help you. However, you will have to go to a company-approved program.
  • Financing – Most rehab centers offer extensive financing programs to help you shoulder the cost of going to rehab. If you need financing, talk to the consultant when you call the rehab center, they will be happy to tell you about options, rates, and interest.
  • Medicaid – If you’re under 19, over 65, or below the poverty line, you can attend a Medicaid sponsored rehab program. This will be a state program, normally outpatient, and not anything you choose. However, it does mean that you can attend rehab for free.

If none of those options work, many local governments and cities offer grants and financial assistance to help people attend rehab. These may be granted on a first-come first-serve basis, may be restricted to certain types of rehab, or may be based on “merit”. However, most states have at least a few of them, meaning you can ask for assistance, even at your local city hall.

Over 40 million Americans have a substance use disorder. If you or a loved one is looking for help, it is there. And, your insurance is legally required to cover at least part of that care. If you still need help after, looking into employer-sponsored or state-sponsored programs can be another option – however, most of us prefer to choose the program we go to. Good luck getting treatment.

Asana Recovery offers detoxresidential, and outpatient addiction treatment services at our center located in Orange County, California. Please contact us today to speak with one of our experienced addiction treatment team if you have any questions about our programs.