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One of the deterrents to people seeking addiction treatment involves the cost of services like detox and residential treatment. Many people assume they have to pay out-of-pocket expenses to cover the lengthy stays and professional therapy treatment needed to overcome their drug or alcohol addiction. They don’t ask the question, is addiction treatment covered by insurance? By researching and finding out payment options, many people would be surprised to hear how much insurance will pay for addiction treatment in an accredited addiction treatment facility.
Is Rehab Covered By Insurance?
Yes, drug and alcohol rehab treatment is covered by health insurance. Options for insurance coverage to cover the costs of rehab began expanding in 2014 when the Affordable Care Act (ACA) introduced a requirement that insurance plans offered in the individual and small group markets must include coverage for substance use and mental health services as part of the essential health benefits. Most private health insurance plans also cover substance use disorder treatment as an essential health benefit since the implementation of the Affordable Care Act. Many insurance plans are now required to provide some level of coverage for both inpatient and outpatient rehabilitation services, including detoxification, counseling, medication-assisted treatment, and mental health support related to addiction.
While rehab is covered by insurance, the extent of coverage can differ significantly between insurance providers. Some plans may cover only a portion of treatment costs, requiring patients to pay deductibles, copayments, or coinsurance. Coverage often depends on factors such as medical necessity, the specific treatment facility, the type of addiction, and whether the treatment is considered in-network or out-of-network.
How Long Does Insurance Pay for Inpatient Rehab?
Inpatient rehab generally lasts about 30 days, depending on the patient’s treatment needs, with insurance typically covering inpatient rehabilitation for 7 to 30 days. However, the exact coverage timeline is determined by the patient’s specific insurance plan, medical necessity, and the recommendation of healthcare professionals. Many insurance providers use a review process to determine the ongoing need for inpatient treatment. They will evaluate the patient’s condition to figure out if continued residential treatment is necessary. Some plans may cover extended stays up to 60 or 90 days in complex cases, while others might limit coverage to a shorter initial period.
How Many Times Will Insurance Pay for Rehab?
While there is no universal standard for the exact number of rehab treatments an insurance plan will cover, many providers will authorize multiple attempts at rehab. Some plans may limit coverage to two or three inpatient treatment stays within a specific timeframe, while others might provide more flexible coverage based on ongoing medical assessments.
When looking to verify insurance coverage for drug rehab, it’s important to determine specific types of coverage, like how many times it will pay for treatment. Insurance coverage for drug rehabilitation will vary from plan to plan, but most plans allow multiple treatment attempts, knowing a relapse can occur with addiction. In general, health insurance providers will cover multiple rehab stints, though each time another treatment enrollment is needed, it may require additional medical documentation to prove the patient’s medical needs. The number of covered rehab stays will often depend on the specific insurance plan, the type of substance use disorder, the patient’s treatment history, and the recommendation of treatment by healthcare professionals.
Does Insurance Pay for Outpatient Rehab?
Yes, outpatient rehab is covered by most plans. However, the outpatient rehab cost with insurance will vary just like it does for inpatient stays, depending on the plan’s policies. Most health insurance plans cover outpatient drug rehabilitation as an essential health benefit. The levels of treatment covered typically include individual counseling, group therapy, medication-assisted treatment, and intensive outpatient programs. The details of what will be covered involving outpatient rehab coverage will depend on the individual insurance plan, with copayments, deductibles, and the number of covered treatment sessions varying. Patients may need to use in-network providers, obtain pre-authorization from their insurance company, and provide medical documentation to show the need for addiction treatment.
Is Addiction Treatment Covered by Insurance? Contact Muse Treatment to Discover Coverage Options
Now that you know the answer to the question, is addiction treatment covered by insurance? It’s time to carefully review your insurance policy and verify the details of your substance abuse treatment coverage. As an accredited addiction treatment facility in Los Angeles, Muse Treatment accepts most insurance carriers to help cover the costs of treatment at our rehab center. We can help potential patients understand their financial responsibilities and potential out-of-pocket expenses before beginning treatment. Please call us at 800-426-1818 to learn more about covering the costs of addiction treatment through health insurance and how our services can be designed to help you achieve sobriety today.
External Source
- National Library of Medicine – Private health insurance coverage of drug use disorder treatment: 2005–2018
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