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6 Questions to Ask About Addiction Treatment and Insurance Coverage

a doctor writes on a clipboard while a person asks about addiction treatment and insurance coverage

Do you know how addiction treatment and insurance coverage overlap with your provider? One of the most challenging parts of selecting a rehab center to attend is figuring out how to pay for it. Exploring your options is important and keeping in touch with your insurance provider during the process is an absolute necessity. Treatment can be expensive, so it helps to know the options available when understanding insurance coverage and the cost of drug rehab.

Know What Type of Insurance You Have

Maintaining consistent contact with your provider will help you check your insurance benefits against the treatment centers you’re considering. There are many types of health insurance, each covering a different amount for addiction recovery treatment. Some health insurance options include:

  • Private insurance
  • Medicare
  • Medicaid
  • Military insurance
  • State-financed insurance

In many cases, the treatment centers you consider are willing to handle the process of determining whether your insurance benefits cover a portion of their fees. While it is convenient for the facility to handle the communication with your insurance provider, it’s always better to find out for yourself. Most insurance companies will help you locate a facility covered by your insurance benefits. The first step is to call your insurance company and ask them this list of questions.

1. How Much Will Rehab Cost?

The high cost of some addiction rehab treatment centers may make it seem like every rehab charges an impossibly large amount, but this is not the case. There are plenty of affordable rehabs available that should be within the coverage of your insurance. The cost of rehab also depends on the type of treatment program you select. There are four main types of rehab, each with varying price points:

  • Detox starts at around $1,000 and up per day.
  • Inpatient rehab costs anywhere from $6,000 to $30,000 for a 30-day stay.
  • Outpatient rehab is generally around the $5,000 mark for three months of treatment, depending on the program’s intensity.
  • Drug and alcohol counseling widely depends upon the counselor or therapist you see, but it costs around $100 for an hour-long session.

By contacting your provider to find out more about your insurance coverage, you will get a better estimate of the actual cost of treatment. Though the numbers may seem intimidating, insurance will usually cover at least some of the price. When it comes down to it, your sobriety is priceless, and paying for rehab could be considered a down payment on a healthier, happier life.

Some low- or no-cost options for addiction rehab treatment are also provided by nonprofits or are state-funded. These facilities are available to those with few options to pay for treatment. Other facilities offer a sliding-scale payment model and will help find a way for you to attend treatment, whatever your budget may be.

2. What Are My Insurance Benefits for Addiction Rehab?

If you don’t want to call your insurance company immediately, you could read through the outline of your benefits package and look for the information that addresses the connection between addiction treatment and insurance coverage. Sometimes this may be difficult to locate or understand on your own, so getting in touch with a representative from your insurance company can be quicker and more helpful. Call your provider at the number on your insurance card or their website to connect with an agent who will assist you regarding further details about your insurance coverage.

Depending on your insurance plan, you may not have a deductible that must be met before they begin paying for your treatment. Other companies will cover a portion and leave you to cover the rest. Some are lucky enough to have incredible insurance packages covering their entire stay. Give yourself a chance at recovery and explore your options; do not quit before you even begin.

3. Does My Insurance Coverage Require that I Go to a Specific Rehab Facility?

Some insurance benefits will require you to attend treatment-specific facilities within their network. For example, HMO plans, in particular, have a list of locations they cover; anything not on that list is your responsibility. On the other hand, PPO plans often allow you to go to any facility you would like, and they will still cover a portion of the total cost. Still, you must call your insurance provider to find out more about your insurance coverage and know for certain.

Some plans are different even though they exist under the same umbrella, and you need to find out whether or not your plan covers any facility or if you need to go to a specific set of facilities. This is particularly true for state-sponsored insurance, in which only some locations are covered.

4. Do My Insurance Benefits Include Out-of-State Rehabs?

Some people prefer to attend rehab far away from where they currently live. This minimizes the chances that they will run into someone they know or previously used with, which can cause a conflict of interest or trigger feelings that will encourage the desire to use. Other times it is helpful to simply get out of your regular environment and start your recovery in a new location.

However, if you’re seeking insurance coverage for your stay in an addiction rehab facility, this is only an option for some people. Certain insurance plans will allow you to attend any rehab facility you wish or will cover treatment centers that aren’t in your state of residence. The only way you will receive an accurate answer to this question is to call your insurance provider and ask about your insurance coverage.

5. Am I Limited in the Type of Drug Treatment My Insurance Coverage Will Provide?

There are a few different types of addiction rehab treatment options:

  • Detox – The first step in addiction rehab treatment as many times people will experience withdrawal symptoms when suddenly separated from substances they’ve used for an extended period.
  • Inpatient rehabilitation – An inpatient center is where someone can spend their first few weeks of sobriety in a supervised environment. Inpatient rehab provides intensive addiction treatment through individual and group therapy sessions that teach about substance dependence and how to overcome it and remain sober.
  • Partial hospitalization program (PHP) – PHPs utilize the intensive methods used in an inpatient program while letting participants go home or to a residential facility at the end of the day.
  • Intensive outpatient program (IOP) – An IOP maintains similar flexibility to a PHP, but with even less structure. People in an IOP will spend less time but still receive constant support as they continue recovery.
  • Outpatient program – Outpatient programs are less intensive than IOP and usually take place in individual therapy sessions scheduled on request.

Every insurance provider differs on which levels of care their plans cover. Some can cover every step of the way for addiction treatment, while others cover only certain parts of the process. It is helpful to find out what your insurance coverage includes before researching facilities so that you only select a facility within your network or benefits.

6. Will Treatment Be Covered by My Insurance Benefits if I Have to Go Multiple Times?

Some insurances will cover multiple stays in addiction rehab treatment, while others will provide only one. Another way to phrase this question would be, “How many days am I covered for?” Your insurance provider may view your trips to rehab in terms of the number of days attended instead of the number of stays.

Verify Your Insurance at Northpoint Recovery

After you speak to your insurance representative, you can verify that your addiction treatment and insurance coverage work in harmony. Our admissions counselors at Northpoint Recovery are happy to help you understand your insurance policy and what it covers.

Verify your insurance now or call 888.296.8976 for more help getting on the road to recovery.