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Does Insurance Cover Rehab?

Does Insurance Cover Rehab?

If you have employer-based or any other type of health insurance and are suffering from substance use disorder (SUD), there’s a chance that all or part of your treatment may be covered by your provider.

There’s no question that addiction treatment is expensive. One of the cruel ironies of this disease is that it robs victims of their ability to hold down a job, consumes their savings and wreaks economic havoc so that, by the time it’s time for them to look for treatment, they find themselves priced out of the process. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that only 10 percent of the nearly 20 million Americans that need addiction treatment actually receive it; one of the primary drivers of this disparity is the inability of many SUD sufferers to pay for treatment.

As unthinkable as it may seem, lack of money has often led to unnecessary overdose fatality.

Although deaths from drug overdose continue to escalate, reaching over 70,000 in 2017, according to data from the Centers for Disease Control and Prevention (CDC), a variety of factors, including lack of funding, inadequate resources and stigma are preventing Americans from getting the treatment they need.

Recent changes to healthcare legislation such as the Patient Protection and Affordable Care Act (colloquially referred to as Obamacare) have directed insurance providers to cover certain substance use disorder services as they would other types of medical conditions like diabetes, heart disease, asthma and other serious medical conditions.

Some of the major insurance companies that cover rehab include:

How Much Does Alcohol and Drug Rehab Cost?

Generally speaking, insurance companies more readily cover outpatient services over residential because of the relative cost differential. The average out-of-pocket cost for inpatient rehab runs around $500-$700 per day for a month. Lower-end facilities can run $2,000 to $3,000 for a 28-day program, mid-level facilities can run around $15,000 to $30,000 and higher-end programs cost around $60,000. Exact cost of inpatient will vary based upon amenities, location, program resources, quality of staff and more.

Outpatient and intensive outpatient programs (IOPs) are comparatively more affordable and are the most common type of addiction treatment paradigm. These programs can be ideal for SUD sufferers who need quality care but can’t afford the cost or time associated with getting help from an inpatient program. The cost for one day of IOP treatment often ranges from $250 to $350 per day. These programs offer multiple weekly treatment sessions over the course of a four to six-week period. (IOP programs are generally six to eight weeks in duration.) These programs include group therapy, individualized counseling and supplemental therapy techniques to offer patients a well-rounded recovery. Medication-assisted treatment, including the use of opioid maintenance drugs like Suboxone® (buprenorphine and naloxone) and Vivitrol® (monthly injectable naltrexone).

What Does Insurance Cover in Rehab?

The exact scope of addiction rehab services covered by insurance will vary according to each patient’s individual plan and tier of coverage. It’s important to realize that private insurance will likely provide a greater scope of coverage than the public option. The Affordable Care Act has required that doctor’s offices must charge an equal amount per visit for mental health issues as they do for other medical issues that are considered more immediate (cough, flu, sore throat, chronic pain, etc.). Insurance companies that wish to participate in the ACA marketplace must provide basic behavioral healthcare services, but there are limitations to this coverage.

Public insurance to which patients are not required to contribute is often largely subsidized by Medicaid and other state-funded initiatives. Generally speaking, public insurance providers will cover some measure of rehab, the scope of which will depend upon resources and patients’ immediate healthcare needs. Private insurance plans are apt to cover higher-tier treatment services like luxury inpatient rehab programs or different kinds of supplemental therapies if they are deemed medically necessary.

Therapy is generally covered by most insurance providers, so long as it is a model of treatment approved by the American Psychological Association. Some cover all detox and treatment expenses after deductibles are met. Other plans require copayments to be paid by clients. Out-of-network treatment facilities usually cost the most, as they often have to pay a percentage of all treatment costs, even after their annual deductibles are met.

Insurance and Medication-assisted Treatment

Very often, patients suffering from severe opioid use disorder (OUD) may find themselves in need of and eligible for maintenance drugs that can curtail cravings and withdrawal symptoms. Medication-assisted treatment (MAT) is commonly covered under private insurance plans; however, public plans that are funded by ACA can make it a bit more difficult to pay for these drugs. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that Medicare and Medicaid plans will only cover these medications if their use is deemed vital for the ongoing health of the person in recovery. If the person is deemed somehow capable of healing without the medications, coverage wouldn’t be provided under these plans. Maintenance drugs should be administered along with behavioral counseling and medically supervised detox.

Insurance Coverage for Drug and Alcohol Detox

Generally speaking, public and private insurance plans will cover all or a portion of drug or alcohol detox because it is a life-saving service tied to the immediate medical health of the patient. Like other treatment services, however, the amount of coverage is contingent upon the type of insurance and patients’ individual resources.

Inpatient detox programs typically last three to seven days and offer the benefit of experienced and qualified medical personnel who can provide expert relief for withdrawal symptoms and intervene in the event of a medical emergency. This is a critical part of the treatment process and is necessary to help patients achieve medical stabilization. Your insurance company may ask you to choose from a pre-selected set of detox providers with whom they have current business arrangements.

Finding a Rehab Facility That Accepts My Insurance

Part of the admissions process for any treatment facility is conducting a thorough and comprehensive insurance verification to find out what your plan covers and what portion of the treatment process for which you’ll be responsible.

It’s important to remember that, while treatment can admittedly be expensive even with help from your insurance company, the cost of doing nothing can be far greater.

If you or someone you care about needs help for drug addiction, start browsing our database of treatment centers to find the best option.



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