Getting treatment for addiction can be very costly, especially if you need medication-assisted treatment, inpatient care, or ongoing medication management. Many people worry about getting help because of these costs. But does insurance cover drug rehab?
Does Insurance Cover Drug Rehab?
Yes, all insurance providers are required by federal law to cover the cost of mental health services, including addiction treatment.
No matter the provider, this applies so you can use your benefits to cover basic drug rehab costs.
Note: Almost all insurance providers require that you get an official diagnosis from your primary care physician before you can apply your benefits to addiction treatment or co-occurring mental health and substance abuse disorders.
What is Included in Insurance-Covered Drug Rehab?
That said, there are certain caveats or limitations. Insurance coverage does not just apply to a blanket bill. This means you can’t simply go to rehab, get a bill for $5,000, and have your insurance company cover it.
In most cases, each insurance provider is different in terms of what they provide coverage for and for how long. For example:
Inpatient/Outpatient
All insurance will cover the cost of outpatient drug rehab and many will cover the cost of hospitalizations for things like detox. However, not all providers offer coverage for inpatient treatment; this is something you will have to review with your policy.
Therapy
Many insurance providers will cover the cost of therapy, but some have specific rules about which type of therapy and for how long. The most basic coverage applies to 12 weeks of therapy, but again this is based on your policy and the plan you have.
Medication
In almost all cases, medications are covered by insurance policies, although you might have to pay a percentage of each medication cost. This means if you are given over-the-counter or prescription medication during detox or for the remainder of your treatment, and your policy requires that you pay 10%, that’s all you would have to pay out of pocket for medication.
By comparison, if your policy doesn’t require that you pay anything for prescription medications, that part of your drug rehab might be covered entirely by your insurance provider.
Note: The medication prescribed during drug rehab can be for your addiction or for a co-occurring mental health disorder.
Deductibles
All insurance plans will have a deductible, the amount of money that you have to pay for all of your health care services in a given year before your policy steps in to cover the rest.
This deductible applies to all services, not just drug rehab so if you have already paid for certain services, treatments, or medications, those might apply to the total amount you have to pay out of pocket at the start of your coverage.
Copays
There might be copays especially for an outpatient program, an amount of money that you have to pay each time you go to an appointment.
In-network/Out-of-network
Almost all insurance providers will require that you work with what is called an in-network facility, a facility with whom they already have a price agreement. In rare cases if you have very extensive coverage it might apply to an out of network treatment center but there could be limitations there.
What is Excluded in Insurance-Covered Drug Rehab?
There are some situations where certain types of drug rehab facilities or services may not be covered by your individual insurance provider.
Luxury Stays
In many cases, staying at a luxury facility for an inpatient treatment program may not be covered by your insurance provider particularly if it is an out of network facility.
Holistic Care
Certain holistic programs may not qualify for coverage especially if they are not therapeutic programs but are instead things like yoga, meditation, or adventure therapy.
How to Apply Your Benefits to Drug Rehab
It is always recommended that you review your policy so that you know which benefits you can apply and have a better understanding of what your expected out-of-pocket costs will be, if any.
When you reach out to a treatment center like American Detox, you can get help in this otherwise complicated review process. Insurance specialists who have experience reviewing policies and understanding insurance benefits will talk to your insurance provider, look at your plan, and break down what you can expect in terms of out-of-pocket expenses versus expenses paid for by your insurance provider.
Don’t let finances stop you from getting the help you need. Call American Detox today to review your insurance benefits.
