The average cost of drug rehab is $13,475. But don’t get sticker shock. Your insurance provider can help you cover the cost of treatment.
The exact amount your insurer will chip in depends on various factors. They include whether the rehab facility is in-network, the plan you are enrolled in, and the type of treatment program you need.
This guide explains how to get insurance to pay for drug rehab. We will also discuss the services that may be covered, so keep reading to learn more.
Does Medicare/Medicaid Pay for Rehab?
Yes, Medicare and Medicaid plans do pay for rehab. Mental health and substance use disorder treatments fall under one of the 10 categories of essential health benefits all insurance plans must offer.
The types of services Affordable Care Act (ACA) plans cover include but are not limited to:
- Evaluations
- Interventions
- Medication
- Psychotherapy
- Group therapy
Low-income individuals and families are eligible for Medicaid. Meanwhile, Medicare is available for older adults (age 65+) and some non-seniors with disabilities or certain health conditions.
Does Private Insurance Pay for Rehab?
Yes, private insurance pays for rehab services. The ACA requires all valid health insurance plans, including private ones, to offer the ten essential health benefits, which include rehab services.
However, not all insurance providers offer the same benefits for rehab. You may be required to go to certain treatment centers, pay a portion of the cost out of pocket, or only receive coverage for certain benefits.
Importantly, insurance companies can’t reject your application for coverage just because you have an addiction. Under the ACA, substance use disorders are no longer considered pre-existing conditions.
How to Get Insurance to Pay for Drug Rehab
Once you find the right rehab facility, you don’t have to worry about getting your insurance provider to pay up. That is the job of the rehab center’s administrative staff.
The only aspect you are responsible for is figuring out what treatments and services are covered and where. Some individuals must also receive prior authorization before treatment, though not all plans require it.
Learn more about the steps to take if you want your insurance provider to pay for drug rehab.
Verify Your Rehab Insurance Benefits
The best way to verify your rehab insurance benefits is to call your insurance company directly. You will speak to your plan administrator, who can give you details about the providers and levels of care covered.
A second option is to verify your benefits with a rehab that accepts your insurance. Most rehabs list the insurers they are in-network with on their websites. A quick Google search can turn up rehabs accepting your insurance.
When verifying your insurance this way, don’t just verify that the rehab is in-network and that your treatments are covered. You should also ask about copays, deductibles, how much of your treatment is covered, medical necessity criteria, and pre-authorization requirements (more on this in a moment).
Meet the Criteria for Medically Necessity
Mental health and substance use disorders are like physical illnesses in that treatment must be medically necessary for an insurer to cover them. But what does medical necessity mean regarding addiction?
Medical necessity differs for inpatient and outpatient treatment. Inpatient rehab is more expensive than an outpatient program. As such, insurers have higher standards for medical necessity, including:
- Needing around-the-clock access to a medical professional
- Requiring intensive therapy, defined as three hours of therapy per day
- Having a doctor’s opinion that inpatient rehab will improve your SUD
The above standards are set by the ACA. That means private insurers may have stricter standards for medical necessity. Ask your benefits manager about the criteria for medical necessity when verifying your insurance.
Find a Rehab That Accepts Your Insurance
If you haven’t already, find a rehab near you that accepts your insurance. Most insurance plans provide cost advantages for patients who see in-network providers.
Your benefits administrator may be helpful in this department. They can help you find out which treatment centers in your area are in-network, how long you can receive coverage, and which services you can get benefits for.
Again, you can also verify that a treatment center accepts your insurance through the rehab directly. For example, you can verify your insurance with Altitude Recovery Community for free on our website.
Get Prior Authorization Before Treatment
Some insurers require prior authorization for covered services and treatments. However, this is not always a requirement, so check with your insurance provider for more information.
Insurance companies that do require prior authorization want to ensure all treatments and services are medically necessary and that you have picked the most affordable option. Obtaining prior authorization is a three-step process:
- Ask your healthcare provider about what’s needed for prior authorization
- Fill out any forms your provider needs to authorize your treatment
- Hold onto the paperwork just in case your prior authorization gets denied
If your insurance company requires it, you may also need prior authorization for medications. In that case, your provider will use electronic prior authorization (EPA) technology.
Go Through the Admissions Process
The final step is to complete the admissions process at your chosen rehab. Only when you customize your treatment plan and finalize admission will you know exactly how much you might pay out of pocket.
The steps of the admissions process differ depending on the treatment center. At Altitude, our admissions process begins with an initial inquiry. You will schedule an assessment wherein our experts will evaluate your unique needs.
With our addiction experts’ help, you will customize a treatment plan that is right for your unique health needs. We can also discuss financial options with you to help you cover the full cost of treatment.
What Rehab Services Do Insurers Cover?
The rehab services insurers cover depend on the provider and the plan but often include detox, inpatient and outpatient treatment, medication, and aftercare services.
Learn more about the types of services and treatments to expect during rehab next.
Detoxification
Detoxification, or just detox, is the first step of treatment for moderate to severe addictions. It involves tapering off a substance to remove all traces from the body. Withdrawal symptoms typically emerge during this time.
Some people with mild addictions may not need to detox. These individuals may also benefit better from a less intensive form of treatment. Individuals at risk for severe withdrawal symptoms should consider supervised detox.
Additionally, drug detox can be done in an outpatient setting. Also known as ambulatory detox, this service is best for people with mild to moderate addictions and withdrawal symptoms.
Inpatient Treatment
Inpatient treatment takes place at a residential facility. Patients live at the rehab center and receive 24/7 medical and therapeutic support. This greatly reduces the risk of relapse and complications during recovery.
These programs require patients to reside at the facility for at least 30 days. Longer programs are also available, though individuals should verify that their insurance benefits cover them.
Treatment may include counseling, group therapy, and medication management. Alternative therapies are also available, such as art therapy, yoga, meditation, and equine-assisted therapy.
Outpatient Treatment
An outpatient program does not require patients to live at the treatment center. Instead, they live at home and commute to therapy sessions. There are varying levels of intensity for outpatient treatment, including:
- Traditional outpatient programs
- Intensive outpatient programs (IOPs)
- Partial hospitalization programs (PHPs)
Depending on the type of program, patients attend one to 40 hours of therapy per week. Because they will live at home, individuals should ensure they have strong support systems at home to reduce the risk of relapse.
Medication
Medication is available for withdrawal management. They are available for opioid use disorders, alcoholism, and other types of substance use disorders. These drugs can help people detox safely and more comfortably.
Some patients may also require medication after withdrawals. For example, people with alcohol use disorders may benefit from anti-craving medications like naltrexone, acamprosate, and disulfiram.
Other patients may require ongoing medication management for co-occurring mental health disorders. These medications are available in residential programs as well as outpatient and ambulatory settings.
Aftercare
Recovering from a substance use disorder is a lifelong journey. That’s why aftercare services are crucial. Aftercare involves all the treatments and services available after someone is discharged from inpatient rehab.
Aftercare includes 12-step programs and outpatient programs. 12-step programs allow fellow addicts to support, advise, and encourage each other. As mentioned, outpatient programs offer the same treatments as inpatient rehab but in a non-residential setting.
The available aftercare resources will depend on the facility. This may include career support, legal advice, case management, mentoring programs, academic support, and much more.
Verify Your Insurance With Altitude Recovery Community
This is how to get insurance to pay for drug rehab. You must find an addiction treatment facility that is in-network with your insurer. Then, you should verify what levels of care are covered and how much you can expect to pay out of pocket.
Are you searching for a rehab center accepting your insurance? Altitude Recovery Community offers comprehensive substance use disorder treatments in Ventura County, CA. Verify your insurance for free to get started.
