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Does Health Insurance Pay for Rehab?


Well, kind of, mostly!

So, there’s not a cut and dry, yes or no, answer to this but the great news is that it’s much more yes than no.

Things changed in a big way with the passage of the Affordable Care Act passed a number of years ago. According to the Department of Health and Human Services, “the law requires that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services. Also required are rehabilitative and habilitative services that can help support people with behavioral health challenges”.

That’s the upshot, you’re mainly covered for the traditional treatments involved in rehabs like detox, inpatient & outpatient care, counseling and medication. However, procedures and therapies that aren’t deemed medically necessary may not be covered. That includes many holistic and otherwise alternative therapies that while extremely useful, lack enough proper empirical evidence in the eyes of the insurer.

You’re mostly in good shape though.

Who Needs Rehab?

Kicking a substance use disorder is no easy task. It’s hard work and rehab is among the best ways to get to the clean side of addiction.

Someone suffering from addiction, even a mild case, by definition is having difficulty with a substance. While the severity of the addiction is indeed important in considering your rehab options, the nature of chemical dependency means professional help should never be off the table.

Unfortunately, with substance use disorders, things often get worse before they get better. A minor dependency can spiral into something more all-consuming quickly. If drugs or alcohol are taking a big toll on your health, are increasingly becoming your main focus or you’re taking larger and larger doses to catch a high or buzz, you’ll want to seriously consider rehab.

Does Insurance Cover Drug Treatment?

As previously mentioned, the ACA really represented a sea change with respect to insurance coverage. Gone are the days of not only struggling to get sober but having the added weight of figuring out how to pay for a pricey stay at a drug treatment center. 

Crucially, a good outcome in rehab is predicated on devoting adequate time to a program. The National Institute of Drug Abuse points out that, “generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes”.

With more time comes increased costs, so having the vast majority of plans cover, at least in part, treatment is major.

Different Ways to Pay for Rehab

While insurance these days will cover rehab, there will still be costs that you’ll incur. You’ll need to cover the costs of things like premiums, deductibles and copays along the way.

There are some plans which will cover treatment 100% after you’ve met the deductible, which can potentially be a sizable amount depending on your plan, while others will still expect you to pay a portion of coinsurance even after meeting your deductible.

And there are other variables at play that can affect your out of pocket expenses as well, like if the rehab is in or out of your network.

It’s all a little complicated and convoluted, but don’t despair! Payment for services like these is complex and unfortunately not necessarily straightforward. Because of that, it’s without a doubt necessary to get in touch with your insurance provider and learn the details of what your plan covers and who is in your network. That part is straightforward. More importantly though, know that you have a partner in Addiction Treatment Solutions, give us a call and we give you comprehensive guidance and support in working through and simplifying the quagmire of payments. One less headache to worry about.

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