Does health insurance cover addiction treatment?

Yes, many insurance plans now cover addiction treatment. Read on to find out more and to learn about options for gaps in coverage.

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Before you make the decision to undergo addiction treatment, it’s important to determine whether it’s covered under your current health insurance policy. If it’s not, you could end up with a large bill or even have your treatment cut short due to non-payment. You can learn more about your insurance coverage for addiction treatment by reading through your benefits guide or contacting your insurance company directly.

Insurance coverage for addiction treatment: What’s covered?

Your addiction treatment may or may not be covered by your insurance. Insurance coverage for addiction treatment usually depends on your insurance company as well as the type of treatment you decide on. Not all insurance companies cover addiction treatment, for instance. Those that do may not cover certain types of treatment.

Generally, traditional detox services are covered by health insurance; however, insurance companies will not usually cover rapid detox or ultra rapid detox, since these are still considered to be experimental treatments that aren’t medically necessary. Outpatient addiction treatment is typically covered by most health insurance plans, but not all insurance companies will cover inpatient treatment.

Does insurance cover addiction treatment?

Even if your insurance covers addiction treatment, there’s still a good chance that you’ll have some out-of-pocket costs. The majority of health insurance companies require policyholders to pay a small co-pay, or coinsurance, in order to receive addiction treatment. This may be a percentage of treatment costs or a fixed rate. Fixed co-pays can range from $10 to $150 per day of treatment.

If your insurance company denies your addiction treatment claim, there are a couple actions you can take. First, you can appeal this decision. In order to do this, you’ll need to investigate the appeals process and possibly gather evidence that addiction treatment is a medical necessity for you. You can then write an appeal letter or fill out an appeals form and send it to your insurance company along with any supporting documentation.

If your appeal is denied and your insurance company refuses to cover addiction treatment, you may qualify for reduced cost addiction treatment under sliding scale fees. Most addiction treatment facilities also offer financing options, in which you’ll make payments over time to cover the cost of addiction treatment.

Addiction treatment with no insurance

Even if you have no health insurance, addiction treatment is possible. There are a number of resources that you can use to help cover the costs of rehab.

1. Public government insurance covers the cost of addiction treatment with no insurance. This includes programs such as Medicare and Medicaid. Medicare is a government insurance program that covers taxpayers over the age of 65 and some younger individuals with disabilities. Medicaid is an assistance program that covers the medical bills of low-income individuals.

2. Likewise, the federal government sends money to state agencies every year to offset the cost of addiction treatment. This money, administered as a Block Grant by SAMHSA, goes to treatment centers directly. To learn where to go to access this low cost addiction treatment, call 1-800-662-HELP or visit the SAMHSA treatment locator website.

3. Sliding scale fees are also offered by many addiction treatment facilities. These are reduced fees primarily based on a person’s income. Other factors, such as the size of a person’s household and monthly expenses, may also be taken into consideration. If you don’t qualify for reduced cost addiction treatment, certain facilities may offer financing to help you pay for treatment.

4. Some non-profit groups also offer free or low-cost addiction treatment for those in need. One example is the Salvation Army, which offers free addiction treatment to anyone who needs it. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are free self-help recovery programs that anyone can use to overcome their alcohol or drug addictions.

Medical insurance for addiction treatment questions

Navigating the world of insurance can be frustrating, confusing, and time consuming. The good news is we’re here to help! If you have any questions about medical insurance for addiction treatment, feel free to leave them in the comments section below. We look forward to helping you make sense of every aspect of your addiction treatment.

Reference Sources: Wisconsin Department of Health Services: Benchmark Plan-Covered Services and Co-pays
Blue Cross and Blue Shield FEP
Health Insurance: What If Your Health Insurance Doesn’t Cover a Test or Procedure? What Can You Do?
ASPE: Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans
Treatment Solutions: Does Health Insurance Cover Drug Treatment or Rehab?
Legislative Analyst’s Office: Review of Health Coverage for Substance Abuse Treatment
SAMHSA: Acceptance of Private Health Insurance in Substance Abuse Treatment Facilities
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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