One of the biggest questions we often hear is whether you can use insurance for rehab to treat substance use disorders and co-occurring behavioral health conditions. The answer is yes, but it can be more complicated than that as you’re looking for a treatment option or comparing treatment facilities.
Going to rehab for drug or alcohol addiction can be expensive. The worries about how much it will cost are a major deterrent and barrier to receiving drug and alcohol abuse treatment, according to groups like the Mental Health Services Administration and the National Institute on Drug Abuse.
We want to point out that payment options are still available even if your health insurer won’t cover all of your addiction treatment services or you don’t have insurance. We’re happy to speak with you and work to find a solution that will allow you or your loved one to get life-saving treatment for an addiction to drugs or alcohol.
Paying for Rehab with Insurance
As of the passing of the Affordable Care Act, marketplace insurance plans are required to cover alcohol and drug addiction treatment. Parity laws also mean coverage for mental health disorders and substance abuse has to be equal to what’s offered for other medical conditions related to physical health.
The benefits, however, can vary depending on your insurance provider, state, and the rehab facility you’re considering attending. The benefits can also change from year to year.
The services and rehab costs that are very often covered by health insurance policies include:
- Intervention and screenings
- Medically-managed care
- Inpatient care and residential treatment
- Medical detox services
- Outpatient care and services
- Behavioral health care, such as counseling
- Treatment for co-occurring disorders like depression or anxiety
Depending on the plan and company, a range of other services may also be available with your health insurance coverage, including:
- Inpatient hospitalization
- Intensive outpatient services
- Partial hospitalization programs
- Medication-assisted treatment
- Preventative counseling
- Follow-up counseling
So, what’s unlikely to be covered by health insurance companies related to substance abuse issues?
- High-end amenities not related to your medical and mental care
- Holistic care
- Food delivery
- Alternative therapies and similar additional services
- Some types of private treatment services
People have two main types of health plans in the U.S.—public and private.
Public health insurance plans are from the government for low-income individuals and families. These plans are more affordable but may not cover a rehab program as extensively as a private insurance policy.
You get private insurance through your employer or a private insurance company. The coverage and payment plans, as well as out-of-pocket costs, can vary significantly.
This health coverage is more expensive than public government insurance, but they’re also more likely to cover a large portion of addiction treatment.
How to Find Out If Your Insurance Will Cover Rehab
If you’re asking whether health insurance pays for rehab, you should go directly to your company.
While they are required to cover some types of substance abuse treatment, since there are so many variations between companies, states, and plans, the only way you’ll know what your coverage is will be to talk to the company.
You can call your health care provider directly, and along with asking about general coverage, you can ask some other specific questions. For example, you might ask:
- Do I have to go to an in-network treatment provider? If so, what programs are available in-network?
- What will the co-pay and deductible be for rehab?
- How many days of treatment are covered by my plan?
- Will my insurance cover prescription medications?
- Are the costs of a medical detox covered?
- What types of treatment programs do I have coverage for?
Insurance Companies and Rehab Coverage
Below is an overview of some of the largest health insurance providers in the country, that are also in-network with Covenant Hills Treatment, and what they might provide regarding addiction treatment coverage.
Remember, even if you use the same company, your plan may offer more or less coverage than what’s detailed below.
The only way to get a confirmation on coverage is by talking to the company or having a treatment center contact your insurance provider. We would also like to note that our treatment center is in-network with each of the companies below.
- Aetna: This company will often cover rehab, and many centers across the country take this insurance including our facility. Aetna may also cover individual therapy, such as cognitive-behavioral therapy for people with substance abuse disorders.
- Anthem Blue Cross: Anthem is one of the biggest health benefits companies in the country, and they provide a broad set of health services. They typically cover at least some of the costs of detox for drugs and alcohol and rehab. Anthem Blue Cross and Blue Shield have specific behavioral health programs, including substance abuse treatment and mental health care. The programs do have to be appropriately credentialed and often in network.
- Beacon: This insurance company came about in 2014 after a merger between Beacon Health Strategies and ValueOptions. Beacon has around 50 million customers, and the company specializes in substance abuse disorder management and behavioral health, making it a standout among insurance providers. Other insurance providers work with Beacon to provide their customers with substance abuse treatment and behavioral health care.
- Kaiser Permanente: Your drug or alcohol addiction treatment may be fully or partially covered by Kaiser Permanente. Depending on your plan and coverage for health care services, you may need a primary care physician to authorize you for further treatment following an assessment.
- MHN: This stands for Managed Health Network, and benefits may include inpatient and outpatient treatment, intensive outpatient programs, partial hospitalization, and individual and group therapy. Some plans may also cover long-term residential rehab.
- Optum: Coverage is available in 15 states, and your coverage depends a lot on where you live, your specific plan, and whether it’s an HMO or PPO. Generally, an Optum plan may cover inpatient treatment and detox.
Paying for Rehab Without Insurance
If you don’t have insurance or won’t cover some or all of your addiction treatment, options are still available.
Many treatment centers have sliding scale payment plans, financial assistance, and private financing options.
There are also state and local government programs. This might mean that you go to a state-run treatment program that’s federally funded. Sometimes, the programs are a separate agency; in other cases, they’re included as part of a larger behavioral health department. Government-run programs usually include inpatient, outpatient, and aftercare support programs.
There are SAMHSA grants available to get drug and alcohol treatment if you’re part of certain groups, such as pregnant women.
If you’re worried about the cost of treatment, it’s critical to realize the costs of not getting help tend to be much higher. There are costs relating to the health care problems you’ll experience with untreated addiction, lost jobs, legal problems, and potentially the loss of your life.
Covered Addiction Treatment in Orange County, CA
We know navigating insurance can get tricky and complex, and often frustrating. The Covenant Hills Treatment team can help verify your coverage and help you learn more about available essential health benefits; simply call 844-268-8412.