Taking that first step toward drug or alcohol addiction treatment can be very difficult but necessary for a better life. The decisions can be overwhelming, so don’t let health insurance worries add to any confusion for you or your loved one. Start the journey with the information you need and use this guide to be sure all of your important questions are answered before rehab begins.
Does Health Insurance Cover Drug or Alcohol Rehab?
You may be wondering if insurance covers treatment at all. The short answer is yes. Most companies today cover addiction and behavioral care because of the Mental Health Parity and Addiction Equity Act and also due to the Affordable Care Act. While addiction was previously not covered by health insurance, these two laws have required most companies to add it to their benefits just as they would any other medical condition.
Many companies cover assessment and preventative care, and even detox. Outpatient and inpatient care coverage varies greatly but many providers offer at least partial benefits.
Remember not every plan is created equal and each has differences in their coverage. Plus there are some that do not cover it at all. It is best to talk to your health insurance company directly. But you might be confused on exactly what you should ask them as you think about entering treatment.
Top Questions to Ask About Drug and Alcohol Rehab Insurance Coverage
- What specific care does my insurance cover? Does it cover detox, outpatient, inpatient, aftercare, etc.?
- What are the details of my coverage (for example: length of stay, stages of treatment, levels of care, in-network providers).
- Do I need pre-authorization, pre-approval, or a referral?
- What is my maximum out-of-pocket expense?
- Do you use provider networks?
- Can you send/email me a list of in-network providers?
- Will my insurance pay for any prescription medication?
- What is my copay?
- What is my deductible?
- Can I receive specialty care or luxury rehab services?
- Will coverage be denied if I’ve been in rehab before?
- How is my coverage affected if I need to go multiple times?
- Does coverage change due to the type of addiction?
- Do my benefits include out-of-state rehabs?
What if I’m Not Covered?
You still have options if your provider tells you that you are not covered.
– Ask the treatment center about payment plans. At Footprints, we provide financing when insurance won’t cover your rehab services.
– Talk to you employer. They may be willing to help pay for treatment and/or give you an extended leave.
– Ask the rehab facility about scholarship programs or other financial aid. Some have funds from generous donors available for these situations.
– You can consider appealing if you are denied coverage.
Appealing for Coverage
Many experts will tell you to appeal if you are originally denied coverage. In fact, more than 20% of appeals are successful. Other helpful hints for this process include:
- First time appeals have low success rates so you should appeal to a higher level once that is denied.
- The rate of success increases with more appeals.
- An appeal must be officially denied before you can appeal to a higher level.
- Appeals range in length from 30-60 days unless it is an urgent case.
- Preserve all coverage information, call notes, correspondence, and representative names you spoke with when filling out appeals.
Be Prepared, Take Action
Handling addiction and deciding to start treatment can be stressful enough. Don’t let poor communication with your insurance company leave you or your loved one with a surprising bill at the end of therapy. Because Footprints understands the importance of receiving critical addiction treatment, we have a large list of insurance companies we work with. Contact us today and start getting our top of the line drug and alcohol treatment.
Addiction Treatment Insurance Guide. www.recoveryanswers.org. (Accessed Sept 28, 2018).