If you or a loved one is struggling with a substance use disorder, rehab can be one of the best choices you can make. A rehabilitation clinic works to give you the tools to overcome addiction, to build new healthy behaviors, and to build a new life for yourself without drugs and alcohol. The thing is, for many of us, rehab is expensive. Luckily, you don’t have to pay for this medical treatment out of pocket. In fact, the Affordable Care Act, also known as Obamacare, mandates that insurance companies have to cover rehab. As a result, most insurance companies cover anywhere from 30-90% of total costs.
Of course, getting insurance to pay for rehab isn’t as simple as choosing a rehab center and going. Instead, you’ll have to figure out what your insurance provider covers, how much, and which specific clinics they reimburse. That’s much like choosing a new doctor, where not every doctor and hospital will be covered by your plan. However, the larger your plan, the more likely it is that most options are covered.
Contacting Your Insurance Provider
Your premium likely explains what it covers in the small print. Because most of us don’t keep those documents around, you’ll want to simply call your provider and ask questions. A lot of people are hesitant to do so because it means that your insurance provider might log that you have a problem, and they might raise your rates. However, that shouldn’t be an issue. You’ll get care at the same rate. Plus, insurance providers are well-aware that getting you treatment is long-term significantly cheaper than paying for the negative health consequences of substance abuse.
What Rehab Centers Do You Cover? Can I have a list? – Some insurance providers will cover a local selection of clinics. Others will cover a wider radius, sometimes with national coverage. Getting a list of options is always a good idea. If you have a specific rehab center in mind, ask about it. “Do you cover X Recovery Center”?
You’ll also want to look at items like:
- Can I attend a rehab center out of state?
- Are travel and living costs considered part of care?
Essentially, these questions will give you an idea of where you can go, if it has to be local, and what’s covered if you decide to attend rehab out of state.
Be Brave. Get Help.
What Types of Addiction Treatment Are Covered? – Insurance providers often try to work around federal mandates for affordable care by limiting what they cover. If this is the case, you’ll find that your insurance pays for far less of rehab than you’d like. For example, you want specific details on coverage and what percentage of coverage are offered for each of the following treatment options:
- Do you cover inpatient or outpatient care or both? What percentage of this care is covered?
- Do you cover residential stays? What percentage?
- Do you cover complimentary treatment? What percentage?
- Do you cover medically monitored detox? What percentage?
- Are treatments like Medication Assisted Treatment (MAT), Family therapy, and Therapy covered under your policy? What percentage is covered?
- Are sober home stays or sober living assistants covered under your policy?
This is important, because while some providers will cover residential treatment you might learn that they cover 90% of outpatient care and 80% of medically assisted detox but only 30% of residential care. Therefore, total coverage might be an important part of your decision-making process if you are concerned about total costs.
What Are Total Costs – While you’re on the phone, it’s important to ask about maximum payouts, your responsibilities, and other details. These questions should look like:
- How many days of treatment do you cover?
- How many days of treatment do you cover in a 1-year period?
- Do you cover aftercare or relapse treatment?
- Do you have a maximum payment for substance use disorder treatment?
- What is my copay?
- What is my deductible?
These questions allow you to decide if you have a safety net, if you can opt into aftercare, and what types of treatment are covered. For example, if your treatment provider only covers insurance for 28 days, a 90-day program might be out of your budget without finding financing or switching insurance providers.
Contacting Your Rehab Center
If you’ve already found a rehab center, they can verify with you whether they accept your insurance provider. Many clinics have a tool or a hotline you can call to check. This will involve having your insurance number at the ready when you call. Doing this kind of verification is also important, even if your chosen clinic is on your provider’s list. Why? It ensures that everything will go as smoothly as possible.
Additionally, while the rehab center can tell you if they accept your insurance policy, they can’t tell you how much your policy covers. You’ll always have to contact the premium provider for that.
What If I Don’t Have Insurance?
The Affordable Care Act mandates that insurance providers are required to accept patients with pre-existing conditions. This means that if you already have a substance use disorder and want to seek out treatment, you can simply apply for insurance. While it is important to disclose your substance use disorder and this will likely negatively impact your premiums, doing so is still more affordable than paying for rehab out of pocket.
At the same time, stopping to apply for an insurance premium can be disastrous if you’re relying on speed to get into care. People change their mind. Substance use disorders can be life threatening. And, if you’re waiting for more than a few weeks to get an insurance policy, things could happen. It’s important to try to set up moving into the rehab center as quickly as possible. In some cases, that may mean looking for funding or a grant for care. There are also multiple organizations that lend the cost of treatment.
Eventually, you can and should get insurance to cover rehab. Every policy is required by law to cover at least part of rehab. Getting them to do so is simply a matter of checking what they cover, choosing an organization they cover, and attending. Your insurance will do the rest. Of course, you’ll still have copays and deductibles. Few insurance policies cover the full extent of treatment. So, you’ll still owe your rehab center money. However, insurance can help significantly – even if your policy only covers the 30%.
Good luck with treatment.