How to Get Insurance to Pay for Drug Rehab

How to Get Insurance to Pay for Drug Rehab

Reduce Overall Pocket Expenses When Utilizing Health Insurance for Rehab

If you have been holding off on getting treatment for a substance use disorder because of perceived high costs, wait no longer.  While addiction treatment can be indeed a pricey investment in your future, knowing how to get insurance to pay for drug rehab will empower you to take control of your life while reducing overall costs.

Too many people in need of life-saving drug or alcohol addiction treatment assume that receiving it is outside their ability to pay.  This hesitance to get help can literally become life threatening, as unchecked addiction will always proceed to the end stages of the disease.  Understanding how to get insurance to pay for drug rehab will offer new hope to those who assumed they had none.

How to Get Insurance to Pay for Drug Rehab

While the types of insurance plans are numerous, most do offer some level of coverage for addiction treatment.  Since the passage of the mental health Parity Act of 2008 and the subsequent passage of the Affordable Care Act in 2010, insurance companies now offer benefits toward detox, treatment, medications, and aftercare for drug and alcohol dependency and any co-occurring mental health disorders.  Because of the variety of plans out there, it is important to research your specific insurance plan’s benefits for addiction treatment as coverage varies based on the state you live in.

When reading through the details of your healthcare policy, note the principle of “medical necessity.”  This term is important when understanding how insurance companies decide what treatments they will cover.  In most cases, if you can prove you have a legitimate need for rehab, the insurance provider should approve your claim.

The American Society for Addiction Medicine (ASAM) lists the core components that determine medical necessity.  The ASAM Criteria is used to guide medical necessity decisions for the various levels of care in addiction treatment, such as residential, outpatient, intensive outpatient, and detox.  The insurance providers review the three core components for medical necessity before authorizing treatment.  These ASAM components are:

  • Services requested are needed to identify or treat an illness that has been diagnosed or suspected
  • Treatment services are consistent with a) the diagnosis and treatment of the condition and b) the standards of good medical practice
  • Treatment services required are for reasons other than convenience

Which Preconditions Will Likely Result in Authorized Treatment by Insurer?

Substance use disorders include a wide range of severity, from recreational abuse of a drug or alcohol to chemical dependency.  Certain criteria will help determine whether an insurer will authorize treatment, including:

  • Cognitively able to participate in a treatment program, with no other medical conditions that preclude the ability to participate
  • Withdrawal symptoms can be managed at the requested level of care
  • Demonstrate a desire and motivation to work toward recovery

In addition to the above basic criteria, a potential patient must meet at least one of the following criteria:

  • Severity of the self-harm or risk taking behaviors present a threat to the individual or others and cannot be managed outside of a 24 hour care facility
  • Substance abuse is causing severe problems in at least two life domains, such as school or work, social relationships, family, or physical health
  • Acute medical problems make it difficult or impossible to remain abstinent outside of a residential treatment environment
  • Dysfunctional living environment that endangers the recovery process
  • Condition will continue to worsen if not in residential care, which could lead to hospitalization
  • Attempts at outpatient care have failed to achieve sustained sobriety, indicating residential treatment

Having a clear understanding about how to get insurance to pay for drug rehab is critical to moving forward with making plans for obtaining treatment.

Ranch Creek Recovery Offers Inpatient and Outpatient Addiction Treatment

Ranch Creek Recovery offers both outpatient and inpatient care and is located in Temecula and Murrieta, near Los Angeles, San Diego, and Riverside in California.  RCR offers a holistic non 12-step drug and alcohol treatment program that specializes in individualized care and experiential therapies.  For more information about our programs, please contact us today at (877) 997-8931.

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