Does Insurance Cover Drug Rehab?
The disease concept linked with addiction is fairly new within our society. About 40 years ago, addiction was finally identified as a diagnosable and treatable mental illness by the U.S. medical communities. This allowed society as a whole to stop seeing someone’s urge to abuse substances as a failing in good judgment – but stigmas still cloud the public perspective of those requiring specialized substance abuse treatment to curb their addictive impulses.
Due to this progressive identification of alcohol and drug abuse, new health care laws have followed suit and begun deeming addiction treatment as an essential health care benefit that commercial health plans must cover.
This new perspective fostered by the insurance industry has resulted in the number of patients seeking help from addiction treatment centers to spike as the rolling healthcare reform measures have come into effect.
You can and should receive cost-effective and comprehensive addiction treatment if you are struggling with a substance use disorder. While plans will differ between carriers, educating yourself on the options and coverage provided by your insurance provider starts by researching your specific health plan.
Will Your Insurance Cover Rehab?
While your insurance company may not openly advertise their substance addiction coverage, as of now, 43 U.S. states require commercial group health insurers and rehab facilities to cover addiction treatment.
If you or a loved one has made the decision to pursue drug rehabilitation, it is imperative to know how your individual health insurance plan is worded and laid out in order to identify which treatment programs are covered.
You can start by looking at your health plan and parsing through the sections discussing substance abuse treatment and insurance coverage. The wording in your policy should define a full continuum of addiction care, which includes detoxification, intervention, inpatient treatment, outpatient programs, medication-assisted treatment, mental health treatment and intensive outpatient treatment.
Policies will also discuss family coverage and codependency treatment which can facilitate family members pursuing treatment options for loved ones who may be too overwhelmed in their addiction to properly pursue a treatment intervention.
Alternative Ways to Pay for Rehab
With the exception of Arizona, Georgia, Indiana, Iowa, Idaho, Oklahoma, and Wyoming, all states – as previously mentioned – currently require commercial group health insurers to cover addiction treatment services as they would any other prescribed medical treatment.
Legislation like the Mental Health Parity and Addiction Equality Act make it illegal for insurance companies to discriminate against patients because of their specific addiction, but it does not require all insurers to cover every available facility and therapy from a specific treatment provider.
If you are struggling to receive the necessary coverage from your insurance provider, or lacking in general coverage entirely, there are alternative options available.
Working with patient advocacy groups like the National Alliance for Model State Drug Laws or the Substance Abuse and Mental Health Services Administration can provide you with a wealth of knowledge in regard to available therapeutic resources and funding options for inpatient and outpatient services.
The fact of the matter is that consuming all of the applicable health insurance laws can be extremely overwhelming and leave you feeling lost and defeated. But how do you know if your insurance will cover rehab? One of the best ways to ease the burden of navigating insurance coverage is to contact the rehab center you want to attend directly.
Most addiction centers have dedicated admission experts ready and willing to help you uncover how to afford addiction rehab. This will allow you to spend more time and effort on what is most important: your journey to sustained recovery.
How to Get Your Insurance Plan 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, health 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, health insurance providers 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 the diagnosis and treatment of the condition and 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 cover substance abuse 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 medical 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 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 of how to get your insurance company to pay for drug rehab is critical to moving forward with making plans for obtaining treatment.
Holistic Addiction Treatment at Ranch Creek Recovery
Offering an alternative to the traditional twelve-step program, Ranch Creek Recovery offers a variety of all-encompassing, holistic in-patient treatment services. Your situation is unique; your treatment must be customized to fit your individual recovery needs.
Our admissions team is standing by and ready to help you uncover viable ways to pay for treatment.
You can quit your addiction. You can turn your life around. We’re here to help. Contact our admissions team today to learn more about accepted health insurance plans, finance options, and much more.
Do you already contend with an addiction because of your anxiety?
CALL NOW: (877) 293-8607
1. Psychology Today. Is Addiction Really a Disease? Accessed October 4, 2018. https://www.psychologytoday.com/us/blog/the-heart-addiction/201112/is-addiction-really-disease.
2. Partnership for Drug Free Kids. Number of People Seeking Addiction Treatment Could Double Under New Health Law. Accessed October 4, 2018. https://drugfree.org/learn/drug-and-alcohol-news/number-of-people-seeking-addiction-treatment-could-double-under-new-health-law/.
3. National Alliance for Model State Drug Laws. Continuum of Addiction Treatment. Accessed October 4, 2018. http://www.namsdl.org/continuum-of-addiction-treatment.cfm.
4. Substance Abuse and Mental Health Services Administration. Addressing the Opioid Crisis. Accessed October 4, 2018. https://www.samhsa.gov/.