If you need help for a drug or alcohol problem, one of the first questions you’re likely to consider is, “are drug rehab costs covered by insurance?”
It’s an important one, certainly, because drug and alcohol treatment isn’t cheap. Like every other protracted medical procedure, a 30-day residential inpatient stay that provides room, board, meals, therapy, medical and psychiatric care, counseling and so much more costs money. Fortunately, a facility like Cornerstone of Recovery provides those services at affordable rates comparable, if not in many cases cheaper, than many high-end treatment facilities around the country.
But it isn’t free. Fortunately, if you have a private or commercial health insurance plan, you’re most likely eligible for coverage in the event you or a loved one on your insurance plan needs drug and alcohol treatment.
So are drug rehab costs covered by insurance? Absolutely … but there’s more to it than just answering “yes.”
Are Drug Rehab Costs Covered By Insurance: How Does It Work?
Few things are more stressful than trying to get the help you need, for yourself or a loved one, with a problem as urgent and critical as addiction or alcoholism, and having to navigate financial hurdles in order to do so. Fortunately, as the National Institute on Alcohol Abuse and Alcoholism (NIAAA) points out, “Treatment providers should be able to help you understand:
- Costs for a typical course of treatment — and how long it might last.
- Accepted health insurance plans.
- Services usually covered by insurance versus those billed separately.
- Other ways to pay (cash or credit cards).
- Payment plans, if available.”
In addition, the NIAAA continues, “Most health insurance covers some alcohol or drug treatment. Insurers may call this ‘behavioral health’ coverage. You can contact the insurance company (call the number on the insurance card) or review the schedule of benefits to learn what is covered.”
So how does that work? According to 2015 article in the peer-reviewed health care journal Health Affairs, “The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which went into effect in 2010, requires private health insurance plans that offer coverage for mental health or substance use disorder services to cover those services on a par with medical or surgical services (the act is often referred to as “federal parity”). The act applies to employer-sponsored health insurance plans, Medicare Advantage coverage offered through a group health plan, Medicaid managed care, the Children’s Health Insurance Program, and state and local government plans.”
In addition, the Affordable Care Act — colloquially known as “Obamacare” — “are now required to offer mental health and substance use disorder benefits in compliance with the requirements of the federal parity law.”
What does that mean, exactly? If you have health insurance, your provider is required by law to consider drug addiction and alcoholism the same as any other medical problem, as far as access to treatment goes. In addition to federal law, all but a small handful of states currently require commercial group health insurers to cover addiction treatment as they would any other medical treatment.
Insurance is often a benefit that most people don’t think about until they actually need it. The vast majority of people may not even stop to consider, when enrolling in a health insurance plan at the end of every year, exactly what benefits are covered. That’s understandable, because few people, if any, go into a new year expecting to need treatment for a drug or alcohol problem. However, if those problems develop, asking, “are drug rehab costs covered by insurance?” is the last thing you want to be dealing with in the middle of a personal or family crisis.
So know this: If you have insurance, your coverage will, in the vast majority of cases, extend to drug and alcohol treatment. However, taking advantage of those benefits can sometimes be stressful in and of itself.
Are Drug Rehab Costs Covered By Insurance?
As the NIAAA points out, reaching out to your provider should answer the questions you have of what is and is not covered by your particular insurance plan. Some particular topics to inquire about:
- Number of inpatient days and outpatient sessions.
- Which medications, if any.
- Any additional services.
- What the copayments (if any) will be.
- Whether the treatment options are limited to in-network providers, and who they are.
Fortunately, a quality drug and alcohol treatment center with a trained staff in its Admissions Department can help you navigate those questions, and in many cases, find out the answers to them on your behalf. How does that work? The same as it does for any other medical entity with which you do business: You give them your necessary insurance information. As part of the pre-admissions process at a drug and alcohol treatment center, an admissions counselor will need to certify your coverage and eligibility, which helps determine what sort of coverage for which you’re eligible.
You can always find out that information yourself, of course, should you choose to do so, by consulting your Summary of Benefits and Coverage (SBC), something every insurance provider is required to give you as part of the Affordable Care Act in 2010. In its SBC, each insurance company details what is and is not covered, the deductibles you’ll need to meet and more.
It’s important to note that just because you have coverage doesn’t mean that addiction treatment is automatically paid for. Like any other medical service, you’ll need to meet your deductible before insurance will begin to pick up the tab, and that can be expensive: According to eHealthInsurance.com, in 2020, “the average annual deductible for single, individual coverage is $4,364 and $8,439 for family coverage.” Even after your deductible is met, insurance will only pay for part of your services — anywhere from 80 percent down to 50 percent, depending on your plan.
In addition, drug and alcohol treatment often requires what’s known as prior authorization — meaning your insurance company has to evaluate your need for treatment, the benefits you have and whether the facility you want to get treatment from is in network.
Needless to say, trying to determine the answer to that question — are drug rehab costs covered by insurance — may be a “yes,” on the surface, but it’s also followed by a “but …”
Deep breaths. You don’t have to figure it out on your own!
If you’ve made it this far, you may be breathing into a paper bag, so stressful is the process of just getting some help for a serious problem like addiction or alcoholism.
Stop. Take some deep breaths. And make sure the facility from which you’re seeking help is doing everything it can to make the process easier.
A reputable drug and alcohol treatment center doesn’t put the onus on you to answer all of these questions. In fact, trained Admissions staff members have years of experience doing exactly that, and they can talk you through these various fine points of getting the help you need, if not do it all for you. Because a quality drug and alcohol rehab is in network with most major private and commercial insurance plans, Admissions staff can:
- Obtain prior authorization for you;
- Explain in detail the amount you’ll be required to pay up front;
- Help you understand the process insurance companies use to determine coverage eligibility;
- Give you a rough idea of what your total out-of-pocket expenses will be; and
- Help you maximize your savings by involving accounting personnel who can help you.
For example, did you realize that there is sometimes a savings involved when you bundle certain services together — for example, residential inpatient treatment and intensive outpatient treatment? Or that you can often set up a payment plan so that the financial hit isn’t so burdensome? Or that there may be alternative avenues of paying for treatment you haven’t thought of?
Are drug rehab costs covered by insurance? Yes, but … don’t let the “but” paralyze you. You (or a loved one) need help. Let the facility that can provide it assist you in figuring out the specifics of what isn’t covered, and how you can pay for a future that’s unencumbered by addiction.