A: Yes, many insurance plans now cover addiction treatment.
However, sometimes your addiction treatment may not be covered by insurance. You can learn more about your insurance coverage for addiction treatment by reading through your benefits guide or contacting your insurance company directly. Your 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, and 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. More here:
Q: What if the insurance company denies your addiction claim?
A: There are a couple actions you can take.
At 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 offer financing options, in which you’ll make payments over time to cover the cost of addiction treatment.
Q: Does health insurance cover rehab?
A: Not always.
Yes, the costs alcohol abuse treatment can be offset by health insurance, but not always. However, more and more health insurance companies recognize that substance abuse is a mental health problem that needs treatment. Some insurance policies cover only specific treatments, such as psychotherapy, or will limit their reimbursements to certain amounts. Other insurance policies pay for medical detox or medications.
To find out if your health insurance company covers alcohol abuse treatment or rehab, read your policy’s benefits guide or contact the company directly. Most people’s health insurance policies will not cover all treatment or rehab expenses. Still, most health insurance policies require policyholders to pay for a portion of their own treatment, usually in the form of a co-pay or deductible. Co-pays are usually low set dollar amounts that you pay directly to doctors or treatment facilities, while your health insurance company pays the rest. Deductibles require you to pay for your healthcare costs up to a certain amount for the year, before your insurance company will begin coverage. Sometimes, you’ll still have some out-of-pocket costs. More here:
A: Yes, if you are eligible and treatment meets required criteria.
Medicare will usually pay for drug or alcohol detox, as long as the clinical treatment meets a few important criteria. There are a few stipulations you should be aware of when using Medicare to cover the cost of detox. For instance:
Medicare Part A will only cover inpatient services such as inpatient detox.
Separate detox clinics may also not be covered by Medicare.
Individuals on Medicare will usually need to undergo detox in an approved general or psychiatric hospital.
Q: How do you get Medicare coverage for drug or alcohol detox?
A: Usually, if the person is receiving Social Security benefits and is just before turning 65 years old – the enrollment is done by default.
If you don’t receive your Medicare cards by the time you turn 65 years old, you may need to enroll in Medicare during the proper enrollment period. You may also be eligible for Medicare if you’re receiving Social Security disability benefits as well. Individuals can enroll in Medicare a couple of different ways:
1. They can enroll online through the Social Security Administration website at SSA.gov.
2. They can visit their local Social Security office. Social Security professionals can also usually help Medicare recipients find facilities that accept Medicare coverage for drug or alcohol treatment.
3. The Substance Abuse and Mental Health Services Administration website also has a substance abuse treatment facility locator. This tool can be used to search for local facilities that offer detox services and accept Medicare.
More on MediCare benefits as related to treatment for substance abuse disorders here:
Q: How to pay for alcohol or drug addiction treatment without insurance?
A: There are a few different places you can turn to for financial help.
Drug or alcohol addiction treatment without insurance is costly. For example, outpatient addiction treatment averages about $135 per day. Inpatient and residential facilities average about $700+ per day, and the reason for this is that they to make up for the cost of housing and feeding several individuals each day. But if you have made a decision to enroll in inpatient drug or alcohol addiction treatment, there are a few different places you can turn to for financial help.
1. Savings accounts – If you’re the type of person to save up for a rainy day, it may be time to break into your stash. Depending on how much you have in savings, you may be able to pay for some or even all of your drug or alcohol addiction treatment without insurance.
2. Loans – Borrowing money to pay for drug or alcohol rehab is completely acceptable, provided that you pay it back. Your trusting friends or family members may be happy to help for you to get healthy, or can also get a loan from a financial institution. Borrowing money from retirement accounts and life insurance policies is also an option.
3. Financing addiction treatment facilities – Some drug or alcohol addiction treatment facilities allow their clients to finance some or all of their treatment through them. This means that you’ll be required to make manageable payments to the facility over a period of time to cover the cost of treatment.
4. Sliding scale fees – Many drug or alcohol addiction treatment facilities offer sliding scale fees to clients that are unable to pay for the entire cost of treatment out-of-pocket. These are reduced fees based on your ability to pay. Income is the most common factor used to determine your sliding scale fees. Other factors include household size and additional household income.
5. Government programs – Low-income households may also qualify for free medical care, including drug or alcohol treatment, through some government programs, particularly Medicaid. The eligibility requirements for this program vary by state and county, but income and expenses of your entire household are the most important factors.
6. Non-profit organizations – Community and national non-profit organizations sometimes offer payment assistance to individuals in need of drug or alcohol treatment without insurance. Some may even offer the actual treatment itself for free to anyone who needs it.
7. Choosing less expensive options – The cost of alcohol or drug addiction treatment will be determined by a couple important factors, including what type of treatment you choose. Selecting an outpatient addiction treatment center can significantly reduce your cost.