Using Insurance Benefits to Cover Inpatient Rehab Programs
It is a widely known fact that residential programs for addiction are not inexpensive, and that getting your insurance to cover the costs can be complex and often confusing.
We understand, that getting insurance to pay for residential treatment is not always an easy task. Sometimes, it can be so challenging that people consider delaying or even putting these treatments on hold.
But that is not something you should do if you want to recover quickly and effectively from alcohol or drug abuse. Thankfully, there are many insurance plans out there that offer coverage for inpatient rehab program treatments.
Does Insurance Cover Residential Treatment Program?
So, will my insurance cover a residential treatment center for drug rehab? Well, the insurance coverage for inpatient rehab programs will depend on your insurance plan – and provider.
Generally, most insurance companies offer coverage for residential treatment programs. But, the specifics of the insurance coverage can vary – again, depending on the provider and health plan itself.
That is one of the reasons why you should look into the specifics of your insurance plan to find out if it offers coverage for such treatment programs. For instance, health insurance plans might cover a part of the cost of the treatment. However, the coverage to cover treatment might be available only if the treatment appears “medically necessary”.
While some cover inpatient treatment (i..e, staying at a specialized treatment facility or rehab center), others also cover residential mental health treatment. So, start reviewing your policy’s details to get a better understanding. Or better yet, call your insurance provider to get accurate information and details.
What Types of Insurance Plans Are There for Inpatient Rehab
You may already know, there are different types of insurance plans in the United States. For instance, you can go for private insurance or a federal government-approved grant. Then, there are also state-specific grants and insurance plans, like the California Drug Medi-Cal (DMC).
Medicare
If you have the Medicare health insurance plan, you can get coverage for different types of residential treatments. This works especially if the individual has a qualifying disability or is above 65. However, Medicare offers limited and short-term coverage for inpatient rehab treatments.
For instance, it offers coverage for inpatient rehabilitation facilities (IRFs). But that too comes with certain criteria for eligibility. Similarly, Medicare also offers limited coverage for mental health services if the care is from a hospital that is part of the Medicare program.
For more information, you can check the official website of The Medicare Payment Advisory Commission (MedPAC) for more information on the plan’s coverage.
Please be aware that while Medicare offers valuable coverage options in many instances, South Shores Detox & Recovery is unable to accept Medicare insurance at this time.
Medicaid
On the other hand, Medicaid offers more extensive coverage compared to Medicare. Most of the coverage is for low-income individuals and families. What’s more important is that it also includes residential treatment for substance use disorders and mental health issues.
However, the coverage for such treatments (like inpatient rehab facilities) could vary depending on the state. For example, outpatient and inpatient treatments for SUDs are within the coverage of Medicaid.
Furthermore, Medicaid might also cover behavioral and mental health parity services if your state laws allow it. For more information, you can review the detailed report from the Medicaid and CHIP Payment and Access Commission (MACPAC).
We want to inform you that South Shores Detox & Recovery currently does not accept Medicaid insurance. However, we encourage you to explore other resources that may assist with your needs and can offer other options if you reach out for support.
Private Insurance Plans
These plans come from independent providers. Most are often through employers and offer more customizable coverage compared to the government-funded insurance that covers Medicaid or Medicare. But there are limitations and exclusions as well – that vary from provider to provider.
So, to make sure you can get started with the right treatment plan, review the specifics of your private insurance plan. Some examples include:
- Aetna (South Shores is an In-Network provider)
- Cigna
- Blue Cross Blue Shield (BCBS)
- TRICARE (South Shores is an In-Network provider)
- Health Net
- Anthem
- Humana
State Programs
Then, there are state programs that cover residential treatments or part of the total cost. It is also important to know that the coverage for these grants and plans varies significantly on two factors – (i) your location, (ii) your eligibility. For instance, in California, there’s Medi-Cal and the California Mental Health Services Authority (CMHSA). There’s more:
- California Department of Health Care Services (DHCS)
- Los Angeles County Department of Mental Health
- San Francisco Department of Public Health
Most of the plans like these offer coverage for residential treatment services like:
- Mental health services
- Inpatient rehabilitation
- Outpatient rehabilitation
- Detoxification services
- Counseling
- Crisis intervention services
What Should Residential Treatment Offer?
Before we discuss whether your insurance coverage for rehab will pay for residential treatment, let’s understand what inpatient rehab treatment (i.e., residential treatment) includes.
These inpatient rehab programs can include a range of treatments, starting from behavioral therapies all the way to medication treatments and detoxification. Here’s a quick look:
- Personalized care
- Behavioral therapy
- Counseling
- Clinical services
- Medical services
- Family therapy
- Therapeutic boarding schools
- mental illness treatment
- Detoxification
- Medication plans
- Partial hospitalization programs
Residential treatment, or inpatient rehab, refers to a comprehensive care and support system. This residential program is where you or your loved one will get medication treatment and therapies to overcome your mental health challenges and substance abuse disorders.
Think of it this way: you’re in a caring, specialized facility where you have one or more professionals dedicated to helping you. They are there around the clock to make sure your needs are met.
These compassionate professionals in an inpatient rehab program environment are there to offer their support and expert services when you face discomfort or challenges during your recovery from SUDs.
When is Inpatient Rehab a Right Choice for You?
It becomes the best option when you or your loved one needs extra support that intensive outpatient programs (or IOP) might not offer. In fact, if you think that you or someone that you know might find it difficult to navigate an outpatient rehab program environment, an inpatient program is the right choice.
The National Institute of Mental Health indicates that substance use disorders often lead to mental health disorders. In fact, research suggests that people with substance use disorders are at a higher risk of developing mental health issues. The co-occurring mental health challenges can make it even harder to stay on track.
However, an inpatient rehab program gives you a safe and structured environment to cope with mental health challenges while recovering from drug use disorders. It gives you access to 24/7 care care and is especially helpful in preventing relapses.
These residential treatment plans provide a higher level of supervision for struggling patients and give them a chance to focus on their recovery with professional guidance at every step.
How Can You File a Claim for Residential Treatment
The process of filing a claim to pay for your residential treatment is really straightforward. It follows a few simple steps where you have to get the pre-authorization and verify benefits too. Here’s what it looks like:
Getting the Pre-Authorization
Many insurance plans will require a pre-authorize from you to cover residential treatment. This means that you should contact South Shores Detox right away to learn whether the facility accepts your current insurance plan and its coverage.
Verifying the Benefits With the Insurance Company
During this step, you will have the chance to find out whether the insurance provider covers specific services (like a residential treatment facility/inpatient rehab). And if so, to what extent? This will help you determine the out-of-pocket costs, if any.
Note, that this is an important step because it helps you avoid unexpected costs mid-treatment.
Submitting Your Claims
After verifying benefits confidentially, you will be able to begin treatment. And then after the treatment, you simply have to submit the claim to your own insurance company directly (or state insurance provider). You will share the treatment records and detailed invoices along with any other necessary documentation.
Use Your Coverage to Begin on a Proven Path to Recovery
So, there are different types of insurance plans, with each offering a varying level of coverage when it comes to inpatient rehab and residential programs. Even though it can be a bit challenging to manage the high costs of a residential treatment program at first, using the right insurance plan can make it more manageable.
If you’re signed up with a state-offered insurance plan like Medi-Cal in California or California Drug Medi-Cal, check your eligibility for inpatient rehab. In the same way, if you have private insurance providers like Aetna, Cigna, or Blue Cross, learning about their coverage in detail will help.
Reach Out to South Shores and Get Inpatient Rehab Covered Today
At South Shores Detox, we help struggling individuals get on the path to recovery and stay on track with personalized, and more importantly, compassionate care. By accepting many different insurance plans, we extend a warm and comforting hand to those who need rehab treatment.
Don’t hesitate to schedule a confidential consultation to discuss your needs and get answers to all your questions. Step toward a healthier, brighter future today!