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Insurance Coverage Options for Drug Rehab in California

Article Contents

Article Contents

It is common for the price of addiction treatment to be a concern to those who need help. However, individuals with health insurance can significantly reduce and, in some cases, completely cover the cost of treatment. 

Although there are other ways to help cover the cost of drug and alcohol rehab, insurance is the most practical way to ensure that the cost of rehab isn’t the primary concern. Once financing is secured, individuals and their families can focus on what matters: finding a program to help them heal. 

What Kind of Addiction Treatment Is Covered by Insurance?

Depending on the specifics of the plan, people with insurance can apply their coverage to the following: 

  • inpatient care (from an approved facility) 
  • outpatient care (from an approved provider) 
  • detoxification (when deemed medically necessary)
  • follow-up counseling

What Mental Health Conditions Qualify for Insurance Coverage? 

People who struggle with substance abuse are more likely to have a mental health disorder such as major depressive disorder or generalized anxiety disorder. Insurance companies are required by the federal parity law to treat mental and behavioral health coverage equal to medical/surgical coverage. 

It is essential to check your plan’s details, as the parity law does not require insurance carriers to provide mental health coverage. Instead, the law requires that if they provide mental health coverage, it needs to be equal to medical coverage. 

For example, if a person’s insurance provides $40 to cover an appointment for a broken bone, they must also provide $40 for a counseling visit. 

The most reliable way to check your coverage is to look for the required one-page summary of mental and behavioral health coverage. 

General Insurance Coverage Options for Drug and Alcohol Rehab

Generally speaking, there are three insurance options that may help cover the cost of addiction treatment. These include: 

  • group insurance
  • public insurance
  • private insurance 

After the Affordable Care Act (AFC) was passed in 2010, health insurance was required to cover mental health and addiction services. 

Though coverage may differ, they should provide some financial assistance towards addiction treatment. 

Group Insurance 

Group insurance plans are typically provided to employees by their employer. Individuals with employer-sponsored coverage will likely have the option to elect any of the following:

  • their choice of health insurance plans 
  • pay some to all of their monthly premium
  • deduct their share of their premium from their paycheck each pay period

Depending on the employer, someones’ group plan may be partly or wholly covered. Addiction treatment coverage will vary from plan to plan but typically include some mental health coverage and essential health benefits. 

Group insurance benefits are also dependent on the size of the company. Companies with more than 50 full-time employees will cover the ten essential benefits, including addiction treatment. 

In comparison, companies with more than 50 full-time employees will have greater freedom to choose their coverage options. 

Public Insurance 

The U.S. government funds public insurance. The two main types of public insurance are Medicare and Medicaid. Medicare is a program designed for people 65 and older and individuals with disabilities. Medicaid is public health insurance for individuals and families with low-incomes or disabilities. 

Private Insurance

If someone cannot get coverage through their employer, they will still require coverage for themselves and their families. Often, this means they will purchase an individual health insurance plan. 

Although individual plans may not be as convenient as receiving group benefits through an employer, individuals will: 

  • purchase a plan that covers them and their family 
  • make all monthly premium payments
  • become more familiar with and manage all of their health coverage and benefits 

Individual plans can only be purchased during the open enrollment period. Individuals can only enroll during this time unless they qualify for special enrollment due to life-changing events. These events include: 

  • needing coverage for a new baby 
  • changing coverage because of a marriage or divorce 
  • job loss or loss of coverage from an employer 

After each event, individuals have up to 60 days to change their plan or enroll in a new one. 

Private insurance is perhaps the most flexible kind of coverage for people seeking addiction treatment. These insurance plans may cover more treatment options than others and have fewer limitations on where someone can enroll in treatment. 

Private insurance typically falls into one of the following categories:

PPO: Preferred Provider Organization

PPO or preferred provider organization insurance gives individuals a lot of flexibility. With this plan, you don’t need a primary care physician. Instead, you may go to any health care provider you want without the need for a referral. These plans operate inside and outside of your network. 

When you stay in-network with a PPO plan, you will typically have smaller copays and full coverage. If you choose to go outside your network, you will have higher out-of-pocket costs, and not all services will be covered. 

HMO: Health Maintenance Organization  

HMO or health maintenance organization insurance requires individuals to pick a primary care physician. As a result, all health care services must go through that doctor. Because of this, individuals will need a referral to see any other health care professionals, except in the case of an emergency. 

With HMO plans, any visits outside of your network will most likely not be covered. HMO insurance’s benefit is that coordinating all health care through physicians means less paperwork and lower health costs for everyone. 

Point-of-service Plans (POS)

Point-of-service plans operate on a set network, typically tied to a geographic area. POS plans allow people to pay less for using doctors, hospitals, and other health care providers that belong to the plan’s network. 

POS plans do require individuals to get a referral from your primary care provider to see a specialist.

Exclusive Provider Organization (EPO)

Exclusive provider organization insurance is a managed care plan where health care services are only covered if individuals use doctors, specialists, or hospitals in the plan’s network, except for emergencies. 

How to Determine Your Insurance Coverage for Drug and Alcohol Rehab

The best way to determine how your insurance is applied to addiction treatment is to call your provider and request this information. You can also contact our admissions team to verify your coverage. An admissions advisor can provide you with a cost estimate for treatment, obligation-free. 

Some things to be sure to ask about include: 

  • copayment amount 
  • deductibles
  • out-of-pocket maximums 

Factors That Can Influence Insurance Coverage 

The cost covered by an insurance plan will vary per the insurance carrier, the plan, and the rehab facility. In general, most private insurance plans will cover 40 to 80 percent of all addiction treatment costs. 

It is crucial to keep in mind that other factors may affect the amount a plan will pay out for treatment, including: 

  • In-network vs. out-of-network: As noted above, depending on the type of insurance you are carrying, if the treatment center is out of your network, your plan may cover less or none of the cost of treatment. 
  • Length of treatment: In some cases, insurance plans will only cover short-term treatment options like 28 or 30-day programs. In contrast, other plans may cover longer-term treatment, as long as it is deemed medically necessary. 
  • Approval first: Some insurance plans will need the individual to register their treatment with the insurance company before entering treatment. If they fail to do this prior approval, they will be 100 percent fiscally responsible for their treatment costs. 
  • Medical necessity: It is common for insurance companies to require addiction treatment to be deemed medically necessary by a health care professional before they will cover the cost of treatment. Either your primary care physician or an addiction treatment provider will examine you for signs of drug abuse, addiction, or dependence. 
  • Detox requirements: If it has been deemed medically necessary for someone to receive addiction treatment, they will likely need to go through a detoxification. This is especially true for people who struggle with addiction to substances that produce severe withdrawal symptoms like alcohol and opioids. 

It is vital to confirm your coverage before you start treatment to ensure peace of mind and allow you to focus on your recovery. 

How to Find a Rehab Facility that Accepts My Insurance Plan 

Every rehab center has a list of insurances that they accept. It is also common for treatment facilities to provide payment plan options to individuals to help them with any remaining balances, such as copays. 

A typical rule of thumb is if a rehab center accepts public insurance; the treatment options they offer will typically be more restrictive. This is because much of their facility will be held to federal guidelines, which can be influenced by state and local laws. 

Insurances Accepted at Elevate Addiction Services 

For individuals looking to attend treatment at Elevate Addiction Services, we accept the following insurance carriers: 

In-Network Options: 

  • BlueCross BlueShield
  • Health Net

Out of Network Options: 

  • Aetna 
  • Cigna
  • UMR
  • Humana
  • ValueOptions
  • Presbyterian

If your insurance carrier is not listed, please contact our admissions team or verify your insurance securely on our website. 

What Substance Abuse is Costing You: Is Treatment Worth the Price?

Attending a reputable rehab center can be more costly than state-funded treatment centers. However, as with much in life, you get what you pay for. Treatment centers such as Elevate Addiction Services provide a quality of care that will help you address your drug abuse at its core, not just its symptoms. 

The actual cost of someones’ addiction depends on the substances of abuse and their geographical location. But in many cases, it costs them more to stay addicted than it does to attend treatment. 

Drug and alcohol addiction treatment will also range in price depending on: 

  • services offered 
  • amenities offered
  • location 

To learn more about insurance coverage for addiction treatment, reach out to an addiction specialist today. 

See Information on Individual Insurance Policies:

Sources: 

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