Will My Insurance Cover Treatment at a Private Drug Rehab?

From one concern to the next. That\’s likely what you will encounter when you finally decide to do something about your substance addiction. First, you are concerned about your addiction and what it\’s doing to your life. When you finally reach out for help, your concerns will likely shift towards the addiction treatment process. If you are like many people, your first concern will be trying to figure out how to pay for treatment. Given your circumstances, it\’s a reasonable concern. If you don\’t have insurance, paying for rehab could be a real challenge. There\’s not many people dealing with an addiction who have a lot of extra money laying around to pay for anything, much less addiction treatment. Before we get into using insurance to pay for rehab, here\’s some treatment payment alternatives:

  • Pull money from savings or 401-K account
  • Take out personal loan on use credit cards
  • Inquire about rehab facility financing
  • Inquire about grants or scholarships from charitable organizations

Hopefully, you have insurance. The idea that you might need to drain your savings or increase your personal debt to get treatment isn\’t very appealing, though it could be absolutely necessary to save your life. If you have insurance, you have every reason to be relieved. You should have some substantial financial assistance sitting in the wings to help you pay for treatment. Let\’s discuss further.

Will Healthcare Insurance Cover the Cost of Private Treatment?

The answer to the titled question is yes, your healthcare insurance coverage should cover at least a large portion of your addiction treatment. That includes public and private care. That didn\’t used to be the case. Prior to 2009, most insurance companies treated addiction treatment like an elective procedure and would refuse coverage. That all change in 2009 when the Affordable Care Act (ACA) legislation was passed into law. Based on the ACA, insurance companies can no longer refuse coverage on preexisting conditions, something that would disqualify every addiction sufferer. Furthermore, the ACA dictates that healthcare insurance providers have to cover addiction treatment the same as they would treatment for any other medical condition. As for private care, the same rules apply. Remember, most reputable rehabs are private treatment centers. Just the same, insurance companies should not be able to discriminate against a type of hospital as long as the treatment centers bills for costs as directed by the ACA. We mention that because while the ACA dictates that insurance companies must cover certain addiction treatment costs, the law does not dictate to what extent coverage is to be provided. Since private rehabs tend to be a little more expensive, there could be dollar value limitations that would prevent full payment to a private rehab. As for what parts of treatment insurance carriers must cover, there is a dictate from the ACA. Let\’s look at this in more depth. Here\’s a list of what your insurance company must cover:

  • Medically-monitored detox
  • Prescribed Detox medications
  • Basic inpatient care
  • Outpatient care

Medically-Monitored Detox

Detox programs are a big part of the treatment process. The client needs time to go through withdraw prior to submitting to therapy. Insurance companies will generally cover 100% of detox program costs under the guise it sets the table for a successful treatment process and long-term recovery.

Prescribed Detox Medications

During the detox process, clients are exposed to some rather dangerous withdrawal symptoms. To prevent clients from suffering, the detox facility\’s medical staff will prescribe certain medications to help keep the client safe and comfortable. Insurance companies will generally pay for 100% of these costs.

Basic Inpatient Care

While insurance companies must cover inpatient care, there are two caveats. First, that only applies to standard treatment programs. Some insurance companies might not be willing to pay for holistic type programs. Second, the dollar value of coverage might be restricted by amount or time. The insurance company could cap the amount of payment and/or agree to only pay through 90 days of treatment.

Outpatient Care

Since outpatient care is significantly cheaper that residential care, insurance companies will usually offer to cover 100% of outpatient care. They do this in hopes the client will chose this option to avoid having to pay anything out of pocket. If you are ready to get help and have insurance, we can definitely help you with your addiction. We\’ll even go so far as to help you verify coverage prior to starting. Our interest is getting you into treatment and helping you. For more information, give us a call at 800-411-8019.

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