We get a lot of questions about using insurance to pay for treatment. Let’s face it: Treatment can be expensive, and insurance is just downright confusing. But that’s why we’ve put together this guide. Here’s what you need to know about insurance, as well as what to ask when talking to your insurance provider.
Because every plan is different, the best way to learn about your coverage is to speak directly with your insurance company. If your insurance is provided by your workplace, you also have the option of speaking to your human resources representative.
Here’s what to ask them as you prepare for substance abuse treatment:
1. “Will my insurance pay for detox, rehab, and aftercare?”
Usually, assessment and preventative care are fully covered by your insurance provider. Detox and outpatient programs also tend to be mostly covered. However, inpatient (residential) programs may only have partial coverage. You’ll want to explore your treatment options and talk to your doctor about what he or she recommends, then talk with the insurance representative to find out exactly how much you’ll need to cover out of pocket.
2. “Will insurance will pay for any prescription medications?”
Detox and treatment sometimes require the use of prescription drugs to ease withdrawal symptoms and discourage relapse. While this is explicitly stated for some insurance plans, such as Medicare (it’s covered under Part D), for others it can be a little hazy. Asking this outright will clear up any confusion.
3. “What will my copay be?”
The copayment is the out of pocket charge your insurance company will require you to pay for a service. For example, an office visit might have a $20 copay.
4. “What will the deductible be?”
Your deductible is the amount that you pay on your own before insurance coverage kicks in. It varies depending on your plan. For example, you may have an inexpensive insurance plan, but need to pay $4,000 on your own before the plan begins offering coverage. Conversely, you could have an expensive plan and only pay a few hundred out of pocket.
5. “How long of a treatment program will my insurance plan cover?”
Treatment programs can vary in length, from roughly 28 days to 120 or more. Your insurance may only cover a portion of this time. For example, Medicare will cover essentially unlimited general hospital care (with appropriate deductibles), but only 190 days as an inpatient at a psychiatric hospital.
6. “Do you use provider networks?”
Normally, your doctor must give a referral to a mental health specialist in order for your plan to cover the mental health visit. But with a provider network, you can see any specialist from a given list without a referral.
Of course, you can still visit a specialist outside of the list (called “out-of-network providers”), but you’ll typically need to pay more. Some insurance companies cover out-of-network providers through reimbursement. If you want to work with a mental health provider who does not accept your insurance, you may be able to complete a claim form from your insurance company and submit it with the mental health provider’s invoice to get reimbursed for your payment.
What if Your Insurance Doesn’t Cover Rehab?
Some insurance plans don’t offer mental health coverage. In this situation, you have a few options:
- Talk to your employer. They may offer coverage even if they’re not required to by law. Even if they don’t, your employer may be willing to help you pay for treatment, especially if you’re in a specialized position. Many employers will also grant extended leave so you can have a job to return to after treatment.
- Ask the treatment center about payment plans. Many rehab centers will offer payment plans so you can get better now and pay for it once you’re doing better and able to have a steady income.
- Ask about scholarship programs. Some treatment centers may offer financial assistance through scholarship programs, where patients can receive help from generous donors.
At The Recovery Village, we offer a full spectrum of care so you can work with the same doctors throughout your treatment and keep the paperwork all in one place. Learn about our treatment programs, and feel free to reach out to our compassionate representatives with any questions.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.