Does Insurance Cover Addiction Treatment

Using Health Insurance To Pay For Drug And Alcohol Detox And Rehab

When it comes time to seek an alcohol or drug rehab program, paying for treatment may be the last thing on your mind. Yet treatment costs can mount and become overwhelming.

Fortunately, many health insurance plans now cover most or all of addiction treatment costs, so you and your loved ones can focus on what’s important: recovery.

Using your health insurance plan to pay for a drug and alcohol rehab or detox program can be an involved process. At Elevate Addiction Services, our treatment specialists can walk you through the process of verifying your benefits.

How Health Insurance Covers Drug Rehab Programs

When learning how health insurance covers drug and alcohol rehab programs, individuals need to know three main components:

  • whether prior authorization/precertification is needed for treatment
  • deductible amount for their plan
  • their copay responsibility

Figuring out these details can take as little as a few minutes when speaking to a treatment specialist or a provider representative, but can make the payment process easier overall.

Obtaining Prior Authorization For Addiction Treatment Coverage

Before entering a treatment, it may be necessary to obtain prior authorization (also called precertification).

Prior authorization meets two goals: it shows the individual has need for addiction treatment and helps ensure that treatment will be covered by the insurance policy.

To obtain prior authorization, your insurance provider may require you to see a primary care physician for a full clinical assessment, which determines your need for treatment.

Meeting Your Deductible

Most private insurance plans come with a deductible, or an amount an individual must pay toward his or her medical care before the insurance coverage kicks in.

High deductible amounts can make obtaining treatment coverage right away more difficult, so it’s important to figure out the details of your specific plan as soon as possible.

Figuring Out Your Copays

Perhaps one of the most important details of your insurance plan is your copay amount. This will become your financial responsibility toward the cost of addiction treatment.

List Of Addiction Treatment Services Generally Covered By Insurance

Which services are covered depend largely on an individual’s plan. For example, some plans cover only inpatient treatment, while others may require an individual to attend outpatient treatment before covering an inpatient program.

In general, most private insurance plans will cover the following addiction treatment services:

  • medical detoxification
  • inpatient rehab programs
  • outpatient rehab programs
  • medication-assisted treatment
  • Ongoing behavioral therapies

Which Types Of Addictions Are Covered By Insurance?

Most insurance providers cover treatment for all types of drug addiction, without exclusion. However, some plans will only cover certain types of treatment for specific drug addictions.

For example, alcohol use disorders and opioid use disorders cause withdrawal symptoms, which can be treated with medication. Most insurance providers will cover medication-assisted treatment only for drug addictions which lead to physical dependence.

However, if a person has a medical need for treatment for addiction to a substance, they are more likely to be eligible for treatment coverage.

The following are drug and substance addictions commonly covered by insurance:

  • alcohol
  • amphetamines
  • benzodiazepines
  • cocaine
  • crack cocaine
  • crystal meth
  • Ecstasy
  • heroin
  • methamphetamine
  • prescription drugs
  • opioids
  • stimulants

Types Of Insurance Plans

Private insurance plans can generally be grouped into three main types:

  • Private (PPO/HMO)
  • Public/state-funded (Medicaid/Medicare)
  • Group

Private Health Insurance Plans

Private insurance plans typically fall into three categories: PPO, HMO, and Point-of-Service:

  • PPO (Preferred Provider Organization) plans: these often require that an individual choose a rehab center from a list of preferred providers for treatment. The plan may also cover out-of-network care at a higher percent than HMO plans.
  • HMO (Health Maintenance Organization) plans: individuals with these plans choose treatment from a specified list of treatment providers. Out-of-network providers are not typically covered with HMO plans.
  • Point-of-services plans: Individuals with point-of-service may choose between HMO and PPO networks for each treatment service.

Public Health Insurance Plans

Public health insurance plans are those which are publicly funded, including Medicaid and Medicare plans.

Each of these plans have strict guidelines when it comes to covering addiction treatment. That is, only certain types of treatment are covered, individuals will often require prior authorization for treatment with these plans, and only certain rehab centers will accept Medicaid and Medicare.

Group Health Insurance Plans

Group health insurance plans are often private ones which are funded through a group or organization. These include employer plans and member association plans.

List Of Addiction Treatment Services Not Generally Covered By Insurance

Addiction treatment must be covered at the same rate at which other medical illnesses and injury are covered.

This means that any evidence-based therapies and treatment should be covered, so long as they fall into programs covered by your insurance plan, such as inpatient programs, outpatient programs, etc.

Some experiential therapies and alternative treatments may not yet be covered by insurance. However, insurance companies tend to pay a set amount for treatment even if services are included in the program which are not typically covered by insurance.

For example, if a person enters a rehab program which includes experiential therapy, and finds their insurance company is in-network with that facility, then the policy will likely cover a set amount toward treatment.

Rehab programs also bill a certain amount for treatment depending on the client need. This means the client will simply be responsible for the portion of treatment costs not covered by the insurance company, regardless of which services they seek.

List Of The Most Commonly Accepted Private Insurance Carriers

The majority of private insurance carriers now provide coverage for addiction treatment.

The following are the most commonly accepted private insurance plans for addiction treatment:

  • Aetna
  • Anthem BCBS
  • AmeriHealth
  • Anthem Blue Cross
  • APS Healthcare
  • Assurant
  • Beacon Healthcare
  • Blue Cross Blue Shield
  • Cigna
  • Core Source
  • Emblem Health
  • Empire Plan (UHC)
  • FEP BCBS
  • Golden Rule
  • Harvard Pilgrim
  • Magellan
  • MagnaCare
  • Medical Mutual
  • MHNet
  • Oxford
  • POMCO
  • SummaCare
  • Tufts Health Plan
  • UnitedHealthcare
  • United Medical Resources

Find Help Today Using Your Insurance Plan at Elevate

At Elevate Addiction Services, we are in-network with a handful of of insurance providers (with more each month) and can work with most private insurance plans even if they are out-of-network.

Since each plan is unique, the only way to determine eligibility is by calling one of our treatment specialists today at (831) 440-3568.

 


Sources:

Blue Cross Blue Shield  — What’s the difference between group and individual coverage

U.S. News — What To Know About Health Insurance for Addiction Issues