David Rofofsky | October 21, 2024

Does Health Insurance Cover Drug Rehab?

It can feel daunting attempting to navigate the complexities of health insurance, especially when it comes to finding treatment for substance addiction. According to the National Center for Drug Abuse Statistics, 13.5% of Americans 12 and up have used drugs in the last month — a 3.8% year-over-year increase. With substance use on the rise, it is crucial to educate society on the dangers of drugs, as well as the treatment and financial resources available to manage addiction. Does health insurance cover drug rehab? Let’s explore some of the different providers and the various aspects of their coverage. Here at Muse Treatment, we aim to treat as many people as possible by making checking your insurance coverage against our programs easy. By shedding light on the available coverage, we aim to prove treatment is possible regardless of your financial background. 

 

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Does Anthem BCBS Insurance Cover Drug Rehab?

Blue Cross Blue Shield’s Anthem is one of the country’s largest insurance providers, serving 14 states and about 40 million people. Anthem is available through employers and privately, offering plans for dental, vision, prescription drugs, and more. Meanwhile, Anthem makes things easy by being accepted by 90% of doctors and hospitals that take Blue Cross Blue Shield. 

Anthem will cover drug addiction treatment, as most major insurance providers do. However, the amount of coverage will depend on the patient’s insurance plan and the specific rehab. Muse Treatment is an accredited rehab center, meaning we qualify for many in and out-of-network plans. The insurance specialists at Muse can work with you to determine how much coverage your plan allows. 

So, if you have an Anthem plan and are wondering if your policy does or doesn’t cover drug rehab, we are here and happy to help. 

Does Aetna Health Insurance Cover Drug Rehab?

Next, let’s explore Aetna Insurance coverage for addiction treatment. Aetna is another provider that generally covers drug rehab. The U.S.-based company is one of the more common employer-provided insurers, covering medical services to more than 46 million people nationwide. Aetna insurance works by having its members pay all medical care costs up to a deductible. Once a policyholder reaches their deductible, Aetna will cover the rest. There is also an annual out-of-pocket limit that includes all copays, coinsurance, and deductible payments. Once that limit is hit, Aetna will pay for all other costs. 

Whether or not Aetna will cover drug rehab depends on your exact plan and the treatment facility. Muse Treatment prides itself on its customizable programs that allow us to meet many insurance policy requirements. Our programs include medical detox, medication-assisted treatment (MAT), inpatient rehab, partial hospitalization, outpatient programs, and aftercare. Substance abuse doesn’t always look the same, and neither does its treatment.  

The Affordable Care Act passed in 2010 decreed mental illness and drug addiction health disorders, making it necessary for insurers to provide coverage. Consequently, Aetna will likely cover at least a portion of drug rehab. The amount will depend on your plan, the state of residence, and whether the treatment center is in or out-of-network. 

 

Does Health Insurance Cover Drug Rehab

 

Does Value Options Insurance Cover Drug Rehab?

According to the Association of American Medical Colleges, just 11% of people suffering from a substance abuse disorder seek treatment. That figure is largely because of the high costs associated with rehabs and therapies. Value Options Insurance aims to curb that perception by expanding its reach and offering policy plans that are either partially or fully funded by the government. 

Like most insurance providers, whether Value Options will cover drug rehab is more complex than a simple yes or no. A claim could be approved or denied based on whether or not the treatment meets the medical necessity criteria. For instance, people must first attempt treatment at an outpatient facility before requesting coverage for rehab. 

If Value Options deems rehab necessary, the provider will cover different parts of your treatment. This could include the following: 

  • The Initial Assessment: This will include the evaluation cost that gives a diagnosis and decides the type of treatment you require. However, experiment clinical trials will likely be excluded from coverage.
  • Detox Treatment: Rehabs will generally provide a medically supervised period for the individual to manage their withdrawal symptoms and refrain from triggers. 
  • Emergency Services: Withdrawing from drugs or alcohol can take a toll on the body and may require emergency interference. 
  • Required Therapy: Treatment for psychological disorders is essential in rehab and the patient’s ability to achieve lifelong sobriety. 
  • Aftercare: Treatment can be a lifelong process, requiring regular maintenance therapy to prevent a relapse. 

It can feel overwhelming researching whether your health insurance does or doesn’t cover drug rehab. That’s why Muse Treatment will work closely with your insurer, including Value Options, to ensure you pay as little out-of-pocket as possible. 

Why Do Insurance Companies Deny Rehab?

The American insurance market is vast, comprising 5,978 unique providers as of 2021. With so many different types of plans and coverage, there are several reasons an insurance company might deny a rehab request despite addiction’s status under the Affordable Care Act.

  1. Rehab Is Deemed Not Medically Necessary: Most insurance providers will require a document showing a person’s history of addiction. Some companies will even require the individual to try other treatments before seeking rehab. Otherwise, they may not deem it a medical necessity. 
  2. Policy Exclusions: Many insurance plans limit the type of services covered. It is crucial to research exactly what addiction-related treatments your policy will insure.  
  3. Out-of-Network: An insurance company will sometimes partially cover an out-of-network facility. However, they may deny it entirely, so it is helpful to request a list of their in-network rehab centers. 
  4. Incomplete Documentation: The claim may be denied if the individual does not submit sufficient or appropriate documentation to support the need for rehab. As a result, it can be beneficial to be organized and collect as much evidence from medical professionals and even family testimonies as possible.
  5. Duration of Treatment: Some insurance companies limit coverage based on the expected duration of treatment. If they determine that the recommended length of rehab is excessive, they might deny coverage for the additional time.

If a denial occurs, you can sometimes appeal your insurance company’s decision by providing additional information. However, Muse Treatment can help avoid the hassle by working with your provider to understand your policy before it reaches that point. 

Does Health Insurance Cover Drug Rehab at Muse Treatment?

Paying for rehab in Los Angeles, where Muse Treatment is located, can be costly. That’s why we aim to work closely with insurance companies and tailor our treatment to your exact needs. In addition to drug addiction, we treat alcohol dependency and a range of mental health disorders. Our levels of care include medical detox, inpatient and outpatient addiction treatment, aftercare services, and sober living. So, let us help answer the question, “Does health insurance cover drug rehab?” and get you the affordable treatment you deserve. Call us at 800-426-1818 today. 

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David Rofofsky
David Rofofsky
After growing up in New York, David chose to get help with substance abuse in California because of the state's reputation for top-tier treatment. There, he found the treatment he needed to achieve more than nine years of recovery. He's been in the drug and alcohol addiction rehab industry for eight years and now serves as the Director of Admissions for Resurgence Behavioral Health. David remains passionate about the field because he understands how hard it is to pick up the phone and ask for help. However, once the call is made, someone's life can be saved.


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