6 Questions to Ask About Addiction Treatment and Insurance Coverage

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6 Questions to Ask About Addiction Treatment and Insurance Coverage

Do you know how to find out information regarding your insurance coverage for addiction rehab treatment? One of the most difficult 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 an expensive process so it helps to know the options available to you when you’re trying to decide. 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 and each determines the portion of cost they will cover 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 are looking at are willing to handle the process of finding out whether your insurance benefits cover a portion of their center’s fees. This is a great option as the dealings are out of your hands, but it is highly suggested that you also contact them yourself. While it is convenient for the facility to handle the communication with your insurance provider, it’s always better to find out for yourself.

Do not feel as though you will never have the opportunity to get sober by attending a treatment center. Finding an addiction treatment center does not have to be an impossible process. Most insurance companies are willing to help you locate a facility covered by your insurance benefits. The first step in the process 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 around $1,000 and up per day
  • Inpatient rehab costs anywhere from $6,000 to $30,000 for a 30-day stay, or more if you select a 60- or 90-day program
  • Outpatient rehab is generally around the $5,000 mark for 3 months of treatment, varying depending on whether you attend an Intensive Outpatient Program or a less intensive outpatient program.
  • Drug and alcohol counseling widely depends upon the counselor or therapist you see, but costs around $100 for an hour long session

These are the prices you’ll generally be looking at before insurance is applied. By contacting your provider to find out more about your insurance coverage you will be able to get a better estimate on the actual cost of treatment. Though the numbers may seem intimidating, insurance will usually cover at least some portion of the price. When it comes down to it, your sobriety is a priceless thing and could be considered putting a down payment on a healthier, happier life.

Depending on the company you work for, some employers cover an employee’s addiction rehab treatment stay. This is courtesy of their insurance benefits as opposed to your own and can be an incredible benefit available to some people. Some companies will pay the entirety of the cost while others will front the bill for your stay in treatment and then deduct a portion of your paycheck once you return to work. This is usually only available for those in higher-up positions at extremely profitable corporate companies, though.

There are also some low- or no-cost options for addiction rehab treatment provided by nonprofits or that are state-funded. These facilities are available to those who have few options to pay for treatment. Though they are in the minority, it would still be beneficial for you to do some research and locate these locations. Other facilities offer a sliding-scale payment model and will help find a way for you to attend treatment whatever your budget may be.

  1. What are my insurance benefits for addiction rehab?

This information is likely available in the coverage packet you received when you signed up for your insurance benefits. If you don’t want to call your insurance company right away, you could read through the outline of your benefits package and look for the information that addresses addiction treatment. Sometimes this may be difficult to locate or understand on your own, though, so getting in touch with a representative from your insurance company will be quicker and more helpful.

Call your provider at the number located either on the back of your insurance card or on their website to be connected with an agent who will assist you regarding further details about your insurance coverage. They have the knowledge to find out more about your individual plan and what benefits you can receive. Depending on your insurance plan, you may or may not have a deductible that must be met before they will 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 that will cover their entire stay.

Do not be intimidated by the possibility of what you may hear as you truly will not know their answer until you ask. As the adage says, “You’ll never know until you ask.” Give yourself a chance at recovery and explore your options; do not quit before you even begin.

  1. Does my insurance coverage require that I go to a specific rehab facility?

Some insurance benefits will require you to attend treatment specific facilities that are within their network. For example, HMO plans in particular have a list of locations that they cover and 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 or the full amount of the cost.

Still, it is absolutely necessary that you call your insurance provider to find out more about your insurance coverage and know for certain. Although there are general rules of thumb, they do not apply for everyone. Not every plan is the same 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 certain set of facilities.

This is particularly true for state-sponsored insurance. Not every location is covered. Many of the luxury rehabs will be outside of your scope of possibility, but this does not mean you cannot get sober. Luxury rehab is not necessary to get clean; you can get clean at any type of rehab facility.

  1. Do my insurance benefits include out of state rehabs?

Some addicts and alcoholics 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. Similar to the question above, whether or not out of state rehab will be covered depends upon your insurance benefits. 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. This isn’t always the case, though. The only way you will receive an answer to this question is to call your insurance provider and inquire about your insurance coverage.

  1. 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: Drug and alcohol detox is a 1 to 10 day stay in a facility that most often uses medication-based treatment to separate an individual from drugs and alcohol and clear the toxins from their system. Detox is often considered the first step in addiction rehab treatment as many times addicts and alcoholics will experience withdrawal symptoms when suddenly separated from substances they’ve used for an extended period of time.
  • Inpatient rehabilitation: Inpatient rehabilitation takes place in either a 30-, 60-, or 90-day stay where an addict or alcoholic is able to spend their first few weeks of sobriety in a supervised environment. Inpatient rehab provides intensive addiction treatment through both individual and group therapy sessions that teach about substance dependence and how to overcome it and remain sober. These sessions teach about trigger management and coping skills necessary for recovery. Oftentimes 12-step programs are incorporated into inpatient rehab.
  • Partial Hospitalization Program (PHP): Partial Hospitalization Programs 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. PHP provides 4.5 to 5 hours of treatment per day, 5 days a week.
  • Intensive Outpatient Program (IOP): Intensive Outpatient Programs are often confused with Partial Hospitalization Programs but there is a distinct difference in the amount of services provided. IOP consists of 2.5 to 3 hours of therapy per day, 3 to 5 days a week, for 9 hours total per week. IOP educates individuals on the nature of substance abuse and dependence by combining individual and group therapy sessions. Addicts and alcoholics learn the coping skills and trigger management necessary for recovery.
  • Outpatient Program: Outpatient programs are less intensive than IOP and usually take place in individual therapy sessions scheduled on the addict or alcoholic’s request. Some outpatient programs offer group therapy in addition to individual therapy for those who benefit from the socialization provided in group sessions. Like IOP, coping skills and trigger management are taught but on a more individualized basis, pertaining specifically to the individual’s life.

Every insurance provider differs on which levels of care their plans cover. Some are able to cover every step of the way for addiction treatment while other cover only certain parts of the process. It is helpful to find out what your insurance coverage includes before researching facilities so that you do not select a facility outside of your network or benefits.

Though it can be helpful to some to go through every part of the addiction treatment process, it is not a requirement to get sober. You can still find recovery by going only to detox or inpatient rehab or an intensive outpatient program. Treatment is not the only way to achieve sobriety but can be a beneficial tool that helps catapult you into the next phase of your life. Having comprehensive insurance benefits will assist you in attending treatment.

Do not assume what your provider will cover, find out for yourself! Though this may seem like it’s been repeated a few times, it is the most important thing for you to take away. You must find out for yourself what your insurance offers in terms of addiction recovery treatment before you begin searching for a facility. You do not want to find what seems like the perfect facility and then find out that your insurance will not help you go there! Make sure to prepare yourself.

  1. Will treatment be covered by my insurance benefits if I have to go multiple times?

It is difficult to provide a solid answer for this question in this guide as this is entirely dependent upon the insurance company, your insurance coverage, and their policies. For those who relapse after a period of sobriety and need to attend rehab again, this is a scary question. 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 amount of days attended as opposed to the amount of stays.

You may have some other questions regarding insurance coverage and addiction that aren’t necessarily addressed to your insurance provider but would be beneficial to cover.

How do I go to rehab if I don’t have insurance?

Do not give up hope that you will get sober if you don’t have insurance coverage. You don’t necessarily have to have insurance to go to addiction rehab. Your options are admittedly more limited than for those who have insurance benefits, but there are facilities who provide treatment to low income individuals.

Low- or no-cost addiction treatment centers funded by nonprofits or the state are available to those who are eligible. However, there are likely many people who are also trying to get into these facilities. Your best option would be to contact the facility or center directly to find out more about their process of admittance as well as the waitlist for their program.

Does President Trump’s stance on the Affordable Care Act affect my ability to attend rehab?

Addiction treatment is listed as one of the “ten essential health benefits” covered by the Affordable Care Act, also known as Obamacare. This enabled thousands of people in need of addiction rehab to attend facilities that helped them on their path to recovery. However, with President Trump’s insistence on repealing Obamacare, this coverage will likely be affected.

There is still not enough information about how President Trump plans to replace or substitute for the Affordable Care Act, resulting in much questioning about how addiction treatment will be handled for those with government insurance. As more is revealed regarding how exactly the President will approach repealing the Affordable Care Act, there will be a greater understanding of how it will affect your ability to afford and attend addiction treatment.

What to do now

Hopefully you were able to gain a better understanding of how to approach the conversation of insurance coverage with your provider. Be sure to make the call prepared with this list of questions, as well as any others you might have. If you look for treatment centers before contacting your insurance and they offer to do it for you, remain involved in the process and ask questions of the facility.

If you’re still worried about the price of treatment, consider how much your addiction cost you to maintain and how much you were willing to spend. When you think about it, attending treatment is a small price to pay compared to continuing to pay for drugs and alcohol for the next 20 to 50 years.

Look up the number of your insurance provider and make the call right now. The longer you wait to find out about treatment, the more likely you are to talk yourself out of it. If you are struggling, you deserve to give yourself a chance to get sober and leave addiction behind. You don’t have to do it alone; your insurance company, the treatment center you select, and your loved ones are all behind you.

Make the call. Today.

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By |2017-03-23T17:00:57+00:00February 26th, 2017|

About the Author:

Northpoint Recovery
Northpoint Recovery is the premier drug and alcohol rehab, detox, and treatment facility in the Northwestern United States.

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