Does insurance cover substance abuse treatment?

The 2014 TEDS Report states that in 2011, only 10.5 percent of the adults over the age of 25 who were admitted for substance abuse treatment had health insurance. Out of those who were insured, only a certain percentage had coverage for the services they needed. But in recent years, federal legislation has expanded the rehab services that insurance policies must pay for. The Mental Health Parity and Addiction Equity Act of 2008 requires group plans covering more than 50 employees to provide mental health coverage — including coverage for substance abuse treatment — that equals the coverage provided for medical conditions.

While the act benefits employees who work for larger companies, it does not apply to small group plans covering 50 or fewer employees. It also does not apply to individual insurance plans. However, some individual and small group policies do extend coverage for substance abuse treatment.

Signed in 2010, the Affordable Care Act (ACA) made substance abuse treatment one of the essential health care benefits available to Americans. As of 2014, policies sold on Health Insurance Exchanges must provide coverage for drug or alcohol rehab. The ACA is expected to make substance abuse treatment part of primary care, focusing on prevention as well as recovery. It will also cover treatment at all stages, from early substance abuse to full-blown addiction. However, the services that must be covered are still being determined, and the regulation applies to adults who are newly eligible for coverage. If you have an existing policy, it may or may not cover the type of care you’re seeking.

In addition to federal regulations, state laws can affect insurance coverage for addiction treatment. Because each state can establish its own guidelines, it’s important to check with your insurance company about the specifics of your plan or policy.

What will insurance pay for?

Today many individual and group insurance policies do cover substance abuse treatment, usually as part of their mental or behavioral health services. However, there are certain limitations that may apply:

  • The policy may only cover certain levels of care (for example, detox and outpatient services may be covered, but not inpatient treatment).
  • The policy may cover only certain types of facilities, such as dedicated detox centers, hospitals, or outpatient clinics.
  • The policy may only cover services for a certain period of time (a policy may be limited to 30, 60, 90, or 120 days of treatment).
  • The policy may limit treatment to a certain number of days per year or per lifetime.
  • The policy may cover only rehab facilities in its authorized provider network (if you go to an out-of-network provider, you may be charged a higher copayment, or the services may not be covered at all).

The extent of your coverage will depend not just on your insurance company, but on your policy itself. The most accurate way to determine exactly what your insurance will cover is to review your policy manual or to call the provider directly.

To find out if you, or a loved one, are covered under an insurance policy, call the company’s toll-free number. Many companies have separate numbers for behavioral and mental health services, which can be found on your insurance card. A representative should be able to provide information such as:

  • Your coverage status
  • The dates that your coverage is valid
  • The services that your policy covers
  • The amount of your deductible or copayment (the portion of the costs that you are responsible for)

An insurance company representative may not be able to verify coverage for a specific service or treatment provider over the phone. Some plans require that a request for authorization be submitted before payment can be approved.

It’s not always easy to understand the legal language of insurance contracts, or to make sense of the rules and restrictions of a policy. As part of the admission process to a rehab center, you should have the guidance of an intake counselor or insurance verification specialist who can help you figure out your financial responsibilities. Most treatment centers that accept insurance have staff members who will help you request authorization for care from your provider.

Many people hesitate to seek substance abuse treatment because they’re afraid of repercussions from their employer. They may be concerned that they will be demoted or fired if their employer finds out that they have a substance abuse problem. They may also worry that their insurance carrier will drop them from the plan or restrict future coverage.

The law protects the privacy of individuals seeking drug or alcohol treatment through the provisions of 42 Code of Federal Regulations (CFR). To ensure that people who need rehab will not be discouraged by the stigma associated with addiction, 42 CFR imposes limits on the information that can be released by treatment centers that receive funding from the federal government. The law states that any records that identify the patient as a substance abuser or as a participant in a rehab program may not be disclosed to any entity — even for the purpose of payment or medical treatment — without written consent from the patient.

Because many treatment facilities receive some form of financial support from the government, 42 CFR applies to a wide range of rehab programs across the country. Facilities that do not receive federal assistance may still be subject to state privacy regulations. Programs that do not comply with these privacy regulations face criminal penalties, including fines of up to $5,000 for each offense.

As you compare the services and costs of various rehab programs, you’ll notice that facilities differ in the types of payment they accept. While some programs accept insurance, others accept only cash payment. The first step in your search is to verify whether the facility accepts insurance; the second step is to find out whether services are covered under your plan. An intake specialist will take your insurance information and help you determine whether your insurer will cover care at that facility.

Depending on the type of plan you have, you may be asked to pay a deductible or a copayment for your treatment. You may also be asked to pay an additional amount for specific services, like prescription medications or consultations with specialists.

Insurance Options

The Recovery Village will work with most insurance providers with the exception of Medical Assistance and Medicare. We accept insurance for health care coverage from Aetna, UBH, United Healthcare, Cigna, GHI, Beacon Health Options (Formerly known as Value Options), BCBS, Individual Insurance plans, Humana, etc., with the approval from your provider.

We accept most major health plans to help you pay for your drug rehabilitation treatment. Please call for verification of benefits coverage or check with your health insurance carrier for final determination regarding specific covered services. All products, logos, and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement.

If you do not have an insurance provider there are financing options available.

Top insurance companies with drug rehab coverage

Learn about insurance options

Please contact our intake coordinators and they will assist you in gaining all of the information about how to utilize your insurance coverage

In the event that your provider does not approve coverage for The Recovery Village, we are standing by to assist with information for private pay options and when possible cash pay scholarships at reduced rates. It is our goal to assist you as much as we possibly can to obtain quality care and treatment options. We will do our best to make treatment available and help you find the treatment you need.

When it comes to getting help for addiction to popular drugs such as alcohol, heroin, meth, and oxycodone, paying for treatment shouldn’t be your first concern. But the reality is that drug treatment requires an investment of money as well as an expenditure of time and energy. Fortunately, many of the leading rehab centers accept health insurance. In order to have your costs reimbursed, however, you must verify that your insurer will pay for substance abuse treatment. You must also find out which recovery services your insurance company will authorize, and whether the program you choose will be covered. For example, some plans and providers cover drugs used in treatment such as methadone and suboxone. Make sure to check with your specific provider for details or give us a call. We are happy to check on your behalf to help make the process as easy as possible.

Where can I find affordable drug treatment?

At The Recovery Village, we believe that confidential addiction treatment should be accessible to everyone who needs it. We provide top-level recovery services and luxury accommodations at reasonable rates, so that you and your loved ones can have access to progressive care at prices you can afford. To make payment easier, we accept most types of insurance plans. Call our intake counselors today to find out how we can help you take the first step toward healing through our advanced drug rehab programs. We’re here for you. 352.771.2700

Insurance was last modified: June 25th, 2017 by The Recovery Village