The world of health insurance coverage is complicated and difficult to maneuver. Unfortunately, this complexity can stop people from getting the care they need.

People often cite expense as one of the top reasons they avoid drug and alcohol treatment. With copays, premiums, and deductibles, even people with health insurance may hesitate to seek rehab services because of the cost.

People interested in rehabilitation services for their substance use disorder should consider asking their insurance provider questions for clarification.

What Does My Insurance Plan Cover?

Health insurance is intended to help people treat their conditions and improve their wellness. Due to changes in health insurance laws and regulations, insurance providers now have to handle mental health issues as they would physical health issues, meaning that substance use disorders are covered just like a broken bone would be.

Because of this change, private health insurance can pay for rehab. Most people can expect full or partial coverage from their health insurance, but plans vary, so people need to ask questions and find out about:

  • Coverage for Detox

    The detoxification process is crucial to overall treatment as it allows the person time for the substance(s) to leave their bodies. The safest way to detox is with professional supervision at a medical detox facility. Insurance coverage may vary based on each facility.

  • Inpatient and Outpatient Rehab Coverage

    Some plans may restrict certain forms of treatment or treatment duration. Check to see if the available health insurance plan allows for inpatient or outpatient treatment, or allows for both. Inquire about yearly and lifetime limits to health insurance outpatient and inpatient coverage.

  • Prescription Medications

    Health insurance’s prescription drug coverage adds another layer of confusion to the rehab process. Ask the insurance company if they have restrictions against any medications or the providers who prescribe them.

  • Coverage for Aftercare Programs

    The best substance use treatment programs offer long treatment programs and offer referrals to aftercare programs to maintain sobriety. Ask if the insurance company pays for aftercare and if there any limitations.

Does My Plan Cover the Duration Of Treatment?

Rehab ranges in length depending on the program and the needs of the individual. In general, the duration of treatment is anywhere from 28 to 90 days, although some residential programs can last for a year.

When checking with the insurance company, ask about the length of time covered. If the program recommends a 90-day course of treatment, but the insurance will only pay for 60 days, adjustments may be needed.

Insurance companies may use limits as a way to keep costs down, but these restrictions can end up creating serious barriers for someone hoping to achieve sobriety and lasting recovery. Since longer periods of treatment are linked to longer periods of recovery, people will want to utilize all the services their insurance affords.

It will be vital for a person to ask about potential caps to coverage as well. Caps are lifetime limits some insurance companies may put on policies. Perhaps a plan allows for 100 total days of rehab, but 90 days were used previously, which only leaves ten days for the next stay.

Someone needing treatment should investigate any and all the ways their insurance can hinder treatment options to avoid any surprise costs.

What are My Expected Out-Of-Pocket Expenses?

Even with insurance plans, the costs of rehab can be expensive. Before anyone goes to rehab, they should have a conversation with their insurance company to estimate their expected, out-of-pocket expenses.

Unfortunately, in many situations, the insurance company will be unable to provide an exact amount that the person will pay for the treatment because there are too many factors to consider. The company should be able to offer an educated guess based on the facility and the services provided.

Understanding terms, like copay and deductible, can help people understand what they may have to pay out-of-pocket.

  • What’s My Copay?

    A copay is a dollar amount the insurance company instructs the facility to collect from the individual. Depending on how the treatment is billed, a single copay could cover the entire course of treatment, or there could be multiple copays during the stay. The average rehab copay generally ranges from $10 to $40, but if copays are collected throughout treatment, the total could quickly rise.

  • What’s My Deductible?

    Deductibles are a predetermined amount of money one must spend out of pocket on their medical needs before the insurance kicks in. Often, once the person meets their deductible, they have only copays to pay out-of-pocket. Some plans have zero deductible while others could charge thousands of dollars. Calling the insurance company to learn about the drug rehab deductible medical expense can help inform the treatment choice.

What are the Differences Between In-Network vs. Out-Of-Network Coverage?

When planning addiction rehab learning to navigate the differences between in-network coverage and out-of-network coverage charges is essential. The insurance company may have one set of rules that apply to in-network providers and another set for out-of-network providers.

Insurance companies build agreements with certain facilities with regard to payment fees and rates of services. Facilities with established agreements are referred to as in-network while treatment centers without an established relationship are usually considered out-of-network.

In some cases, insurance policies will pay a smaller percentage of out-of-network treatment. In other cases, they will refuse to cover any services at all, so be sure to call the insurance company before treatment begins to obtain a complete list of in-network providers.

Are There Other Payment Options?

Luckily, there are numerous rehab payment options for people who need treatment.

People use creative methods to pay for their addiction treatment. Some may use crowdfunding websites, bank loans or borrow money from trusting, supportive family members. Other people explore rehab payment options like:

  • Employer Programs

    Some places of employment may have arrangements with local substance abuse treatment centers to provide free services to their employees. These programs have benefits and drawbacks. The low cost is a bonus, but the idea of being limited to one center may seem like a negative.

  • Treatment Center-Specific Payment Plans

    Rather than using insurance, some treatment centers offer to pay the initial treatment costs and set up rehab payment plans with the client when services conclude. These options are great for people without coverage or high deductibles.

  • Financial Assistance Programs

    The best way to pay for rehab could be with a financial assistance program, essentially a drug rehab scholarship program. Offered directly through the rehab facility or a community group, the program could pay for the person’s entire course of rehab. The availability of such programs is limited, so anyone interested should pursue all options to qualify.

If you or a loved one are considering professional addiction treatment but are unsure how insurance costs could impact the quality of treatment, call The Recovery Village Palm Beach at Baptist Health to speak with a representative who can help determine the level of coverage. Don’t let insurance worries hold you back from a healthier future, call today.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.