Insurance Coverage for Rehab

Substance use and alcohol use disorders can be considered a health risk, and as such, health insurance often covers it in some form. However, each provider has its own rules about what they are willing to cover and what they won’t. There are rehab solutions that cater to each provider, with a reduced cost to their clients. In some cases, individuals who want to get into rehab can work out a payment plan with the provider, depending on if they’re open to it.
Your personal health insurance may cover the cost of your rehab completely. The best approach for checking if insurance covers your stay at an inpatient or outpatient facility is to contact the facility first. Doing so will give you a detailed heads-up about whether your health insurance is likely to cover your stay. If there are any additional costs, the facility will work with you to sort out payment options if needed.

Does Health Insurance Cover Substance Abuse Treatment?

The most straightforward answer to this question is “yes.” However, the answer is usually never as simple as a single word. Health insurance will partner with several rehab facilities and accept their treatment covered under their plan. However, depending on the provider, there may be stipulations on the type of treatment available to a recovering person. For example, your health insurance coverage may only offer to cover an outpatient stay, but not an inpatient regime. Some facilities don’t even accept insurance coverage because it can be challenging to recoup the claims from the company. The company itself would have certain providers that it considers preferred or “in-network.” South Shores Recovery partners with several national insurance providers to offer our services, including:
  • Aetna
  • Cigna
  • Blue Cross Blue Shield
  • Humana
If you don’t see your insurance provider mentioned here, you can still contact us, and we’ll see what we can do to help you.
We accept most Major Insurance Providers.

What Types ofRehabs Does Insurance Cover?

Insurance will typically cover some part of the cost of substance use disorder treatment (drug or alcohol included). Your health insurance plan usually outlines what it covers and what it doesn’t. It will also let you know how much you’ll cover out of pocket. Insurance plans vary by contribution and deductible. Plans that have lower deductible rates tend to have higher out-of-pocket costs. Entering rehab usually happens at the spur of the moment, and calling your insurance can be a time-consuming process. With 24-hour facilities, you may not even have to consult your insurance company. Instead, you may be better off calling the rehab center directly or going into them.

Can I Go to Rehab Without Health Insurance?

It’s possible to go to rehab without health insurance, although the out-of-pocket cost could be expensive. Outpatient treatment plans tend to be the least expensive ones that rehab centers offer. If you don’t have health insurance, this might be the best option you have for getting treatment. Alternatively, there are also state-funded and free rehab centers that a person can go to without paying for anything. State insurance policies may also apply, depending on which location you belong to. The only way to know for sure is to search for these options online. If you would prefer going to a paid rehab center because of its reputation for success, you do have a few other options you can look at:
  • Loans or Payment Plans: As mentioned before, many of these rehab centers offer payment plans geared towards helping a person recover and paying for their treatment. After treatment, the person may be able to pay back their loan after resuming their everyday lives.
  • Scholarships: Several rehab centers offer grants or scholarships to those in need. The state government may also provide subsidies for individuals who need rehab but can’t afford the cost. A quick online search will determine whether you fall into a region that offers such amenities.
  • Family/Financial Support: Sometimes, a person may be able to ask their family to cover their stay at rehab. Depending on your family and if they’re willing to take a chance on your recovery, you may be able to pay for your healing stay with their help and support.

The ACA (Obamacare) Marketplace for Rehab

The Affordable Care Act (also known as Obamacare) came into being around March 2010. The law was designed to make health insurance more affordable for a broader range of people and expand the existing Medicaid plan. Thanks to ACA, the marketplace for health insurance was leveled, and many people who could never afford health insurance in the past were able to now. The ACA created stipulations about what insurance providers were allowed to and not allowed to do when filtering out potential insurance clients. It also outlined ten essential benefits that all health insurance providers needed to ensure to remain active. All health insurance providers must provide mental health coverage for their clients under this law. Rehab and substance abuse fall under this category. What mental health issues are covered by insurance? Thanks to the ACA, almost all of them.
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Can I Have Multiple Providers?

While most people only have one health insurance provider, others may have several. There’s nothing wrong with having multiple insurance providers. Together, they may be able to cover a more significant portion of the cost of treatment. When two or more providers combine like this, it’s called the “coordination of benefits.” Dual coverage happens in many situations, including:
  • You’re over the age of 65 and have coverage through Medicaid and your current or former employer
  • You’re under the age of 26, are stated as dependent on your married parents’ plans, and have your insurance coverage
  • You’re under 26, have divorced parents, and are stated as a dependent on each of them along with your own health insurance
  • You’re married, and both your own private plan and your spouse’s plan cover you
Usually, the coverage you get from one of the plans will be more relevant than the others. The most prevalent coverage (usually from your own insurance plan) is known as the Primary Provider. Other coverages that may apply to you are Secondary Providers. The Primary Provider usually covers costs first, up to the limit of their coverage. The secondary provider will then cover what’s left, meaning that you may not have to pay a cent. However, the more common situation is that you may need to cover some excess out-of-pocket charges on your own.

Common Types of Plans And Benefits

Health insurance providers usually provide three different types of plans. These are:
  • Health Maintenance Organization (HMO): HMOs allow their clients to choose their own medical provider within the network. Clients who choose this plan usually form a bond with their primary care physician, who knows their entire medical history. If a specialist is needed, the primary care physician must give a referral for the insurance to cover the visit. Typically, if a person doesn’t need a specialist, they will benefit the most from an HMO because of low or no deductibles and affordable premiums.
  • Preferred Provider Organization (PPO): PPOs offer a lot more flexibility, in that clients can choose their provider either in or out of the network. However, the catch is that you are likely to pay less if you stay in-network. The cost of premiums is generally higher than HMOs. One of the significant benefits of PPOs is the ability to visit a specialist out-of-network without a referral and still be covered by the plan.
  • Points of Sale (POS): POS plans are similar to HMO plans, but their details may vary from provider to provider. Consulting the provider will help to clear up questions about POS plans.
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Typical Costs of Addiction Treatment

Addiction treatment programs will vary in cost depending on the type of treatment and the level of wealth of the visitors. For example, luxury treatment centers that cater to celebrity rehabilitation may cost as much as $80,000 a month. Standard drug treatment facilities cost a fraction of that cost.
Most standard offerings cost anywhere between $25,000 and $35,000 a month. Inpatient care tends to cost more than outpatient care because the needs of the patients will differ from one to the other. Asking the right questions about the rehab center will usually help inform a decision. It’s far more cost-effective to pay for addiction treatment than it is to cover the costs of remaining addicted to a substance.
We accept most Major Insurance Providers.

Are My Medications Covered During Treatment?

While insurance companies are required to cover basic costs for addiction treatment, they may or may not cover the medication. Insurance companies usually have specific plan tiers, and at each level, the clients are covered for different things. Naturally, higher tiers pay more and have lower deductibles. However, at higher tiers, the insurance company covers the cost of medication. The insurance provider will likely require you to pay for your own medicines at lower levels as an out-of-pocket cost.

Insurance Aftercare Programs and Sober Living

After rehab, you’ll still need to attend group therapy for a bit or join a support group. Insurance providers may provide aftercare programs or contract a rehab center to do so on behalf of their clients. Sober living arrangements can help alleviate the pressures of falling back into drug and alcohol use, and our team always assists clients with aftercare planning that is aligned with their personal plan for recovery.
If you’re interested in getting your stay covered by your insurance provider, give South Shores Recovery a call today, and we’ll let you know the costs associated with treatment quickly and without obligation. Don’t hesitate to reach out: the best time to start your recovery is now.