Thursday, April 18, 2024

Does Health Insurance Cover Addiction Treatment

Health Net Vs Other Insurers

How Your California Insurance Can Cover Addiction Treatment Costs

Though Health Net offers many benefits that could assist you with the cost of treatment, a 2018 report states that Health Net received two warnings from the state of California for not paying providers that offer substance abuse treatment. This is a violation of federal law.

In a December 2017 exposé from the Los Angeles Times, patients such as James Millman mentioned they decided to use Health Net because of its extensive services for people dealing with substance use disorders.

In 2016, HealthNet stopped paying for treatment services to enrollees, and many treatment centers stopped accepting Health Net enrollees as patients. Health Net stated that they were trying to verify patients claims, but many of these had been preapproved beforehand.

The Affordable Care Act & Drug Rehab

Currently, concerns regarding insurance coverage serve as a barrier to people suffering from addiction receiving the treatment they need, despite increasing coverage.2 In fact, only one in ten people suffering from a substance use disorder get the appropriate treatment they need. Unfortunately, payment issues and lack of insurance are among the reasons for this disparity.3

Mental illnesses and, thus, mental health and addiction treatment, have become less stigmatized in recent years, partially due to the ACA. Still, a few insurance companies may still make it difficult for those suffering from addiction to receive the help they need.

In the past, many insurance companies did not cover substance abuse treatment of any kind. Insurance companies also used to be able to deny coverage for addiction treatment, either entirely or partially, to members based on whether their substance use disorders or other co-occurring mental health conditions were considered pre-existing conditions.

When President Obama signed the Affordable Care Act in 2010, it encouraged a wave of change that was already preemptively occurring within many insurance companies. The ACA requires that all plans it encompasses provide coverage for mental and behavioral health services, including substance abuse treatment.1

What If I Cannot Get Drug And Alcohol Rehab Insurance

Depending on your income and other financial obligations, you may not be able to afford the monthly premiums or deductibles of a commercial insurance plan, even one obtained through the ACA Marketplace. Some individuals also have other barriers to obtaining insurance, such as not having a current state or federal ID.

You still have resources that can help you to receive treatment for a drug or alcohol use disorder if you do not currently have the option to enroll in insurance, including: 7,8

  • Some states offer treatment funded by block grants from the Substance Abuse and Mental Health Services Administration . Call SAMHSA at 1-800-662-4357 for help locating a center that offers grant-funded treatment.
  • At, you can search for treatment centers that offer free care or a sliding-fee scale. You can also search for facilities that accept Medicaid or Medicare.
  • Certain treatment centers offer scholarships from affiliations with foundations or private sponsorships.
  • Some treatment centers offer payment plans or discounted rates for cash-pay clients.

For more information about addiction treatment, call to speak with a rehab specialist today.

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Health Insurance And Medical Detox

Medical detox can take place in a hospital, standalone detox facility, residential treatment facility, or even an outpatient facility. Services will be least intensive in an outpatient environment. Inpatient and hospital environments will offer the most support and supervision and are often recommended for those in opioid, alcohol, or sedative withdrawal.5

Medical detox is an incredibly important part of drug addiction treatment. In many cases, it is the first step of the journey, as helping an individual overcome their physical dependence on drugs and/or alcohol paves the way for long-lasting and effective therapy.

Insurance Companies Must Cover The Following Services If They Offer Plans On The Federal Marketplace:

Does Health Insurance Cover Drug Rehab?
  • Treatment for substances use disorders
  • Behavioral health treatment
  • Mental health services

Current laws stipulate that you cannot be denied coverage for preexisting conditions, such as a substance use disorder or mental health condition. Coverage for your preexisting condition must begin when your plan takes effect.

In addition, there can no longer be a lifetime cap on the services you require for your condition, including treatment for substance use disorders. This means that health insurers must cover at least some parts of your addiction treatment.

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How To Use Rehab Insurance Coverage

If someone has health insurance coverage and is in need of help with a substance abuse disorder, they must look at how their policies work. Health insurance that covers substance abuse constitutes the majority of policies in the United States. As such, the majority of insured individuals will have some level of rehab insurance.

It is important to note that each insurance provider will set its own limitations on coverage and determine different conditions that the insured must meet for rehabilitation to be covered. In most cases, for rehab to be covered by insurance, there must be:

  • prior authorization before the individual starts the program
  • in some cases, a referral from a doctor stating that rehab is needed

There are some standard steps that insured individuals should take before using their drug rehab insurance. These are:

Exploring Your Options At Behavioral Health Centers

When you seek addiction treatment at Behavioral Health Centers, our staff will help you in whatever way we can. You can call ahead to verify your coverage and explore your options.

On arrival, we provide a dedicated caseworker who can help you work out exactly which services your insurance covers, identify alternatives if your present insurance company doesn’t provide as much support as some alternatives could and determine further resources and plans that can reduce your treatment costs.

Once you’re at ease about the cost of care, your case manager will help guide your registration into detox and stabilization treatment, intensive residential care and our wide variety of other drug and alcohol rehab programs, all administered by a caring and expert team.

Your case manager also helps with a wide range of aftercare programs for peer support, medications, ongoing assessments and private therapy and more. Again, the compassionate staff at Behavioral Health Centers will always work with you to ensure all phases of care are as affordable as possible.

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What Types Of Drug Rehab Does Health Insurance Cover

The types of drug rehab that a policy covers will vary depending on the provider and even the tier of coverage the insured person has selected. Rehab insurance can be severely limited or comprehensive. In nearly all cases, health insurance that covers substance abuse will cover at least some form of rehabilitation.

Insurance providers can limit which rehab facilities they will cover. In many cases, they only extend drug rehab coverage to treatment at facilities that are classified as being within their network. Even when looking at in-network facilities, care could be restricted to certain types of rehab and duration of treatment.

This means that rehab covered by insurance could include all types of treatment a given facility offers, or it could be limited to exactly what is required by law and nothing more.

Does Insurance Cover Drug Rehab

Does insurance cover addiction treatment – The Addiction Hotline

Nowadays, it is important coverage to have drug rehab insurance. Approximately 21.7 million Americans are either in recovery or are in need of addiction rehabilitation program. Even if someone does not foresee themselves suffering from addiction, few addicts pictured themselves suffering from their disease until it became a reality. However, this brings up the question of if rehab is covered by health insurance. As it so happens, there is no one answer to this question.

When the Affordable Care Act was put in place, it established ten elements of essential health benefits. Substance use disorders are among them. This means that any policy sold on the Health Insurance Exchanges or that is provided by Medicaidor Medicaremust cover services for substance use disorders.

This might sound like all policies are required to be health insurance that covers substance abuse rehabilitation, but there is room within this policy for coverage to be still denied:

First, these requirements only govern policies offered by the government or that are sold on the Health Insurance Exchanges. Private providers that do not put a policy on the exchange do not need to follow this requirement.

  • Clinic visits
  • Alcohol and drug testing
  • Addiction treatment medication

Notable here is that rehabilitation itself is not explicitly mentioned. Clinic visits are, which could be interpreted as outpatient rehab. However, this certainly leaves a loophole.

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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 dont 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 youre 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 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:

Avoid Issues With Coverage

To avoid issues with coverage, ask thorough questions of Health Net and their subsidiaries to make sure you will be covered under their plans. Consult with a representative from your chosen rehab facility as well to confirm coverage. Make sure you are fully aware of any out-of-pocket costs you may incur.

Written by: Staff Writer

About Staff Writer: Serenity at Summit is staffed with a team of expert writers and researchers that are dedicated to creating well-written and accurate content to help those that are seeking treatment find the help they need.

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Types Of Rehab And Recovery Programs Provided By Insurance

Treatment programs vary and will largely depend on individual preferences or arrangements. Some programs offer hospitalization care and medical supervision, while others provide outpatient services. Some facilities provide intensive outpatient programs where addicts attend daily meetings but return home at night. Others have inpatient rehab.

Does health insurance cover substance abuse treatment and all different types? In 2014, close to 91% of Americans had health insurance. Depending on the plan specifics, those with insurance were able to use their coverage for:

  • Inpatient care in an approved facility
  • Outpatient care with an approved provider
  • Medical detox, including medications
  • Follow-up counseling
  • Maintenance medication

Health insurance was once considered a bit of a luxury. People with tight budgets and low-paying jobs may not have had the extra cash they needed in order to buy expensive health care plans, so they tried to save up enough money to allow them to get care for problems deemed life-threatening. Anything else went unaddressed. Often, that meant addictions went untreated. For people without health insurance, getting medical care for addiction was just too expensive to consider.

Healthscope And Addiction Treatment Services

Does Insurance Cover Drug Rehab?

HealthScope understands that no matter what substance a person was addicted to, it is essential for them to get help. Just as HealthScope does not distinguish between different types of addictions, it is also willing to cover treatment for individuals suffering from substance use disorders at all levels of severity. In fact, it is often cheaper for them to provide coverage to people who are in the early stages of addiction, since dealing with the disorder early is likely to prevent additional complications. Whether you have suffered from addiction for years or only just beginning to recognize the signs, HealthScope can help you devise a treatment plan that meets your needs.

Treatment services covered by HealthScope include:

  • Medical detox centers
  • Group therapy, family therapy, and individual therapy
  • Inpatient rehab
  • Medication-assisted treatment

HealthScope will generally arrange an assessment to determine what addiction treatment services should be incorporated into your custom plan. As a third-party-administrator, HealthScope is an advocate for you. They will fight on your behalf to ensure that all of your needs are covered. Factors that determine which of the above services will be covered include:

  • Your desire to recover from addiction
  • The likelihood of a relapse
  • Your need for withdrawal management
  • Whether or not you suffer from comorbid physical or mental health conditions
  • How supported you are in your home environment

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How Long Does Insurance Cover Rehab

Insurance companies will utilize several criteria when determining the coverage they provide to a patient.7The insurance company will likely work with your doctor or treatment provider to determine the necessary treatment and decide what they will cover and for how long.

There are multiple levels of care involved in addiction treatment, and you may be covered for one or more of these programs. Some plans will only cover a detox stay, while others may provide coverage for many levels as a patient moves through the continuum of care .7

Detox and rehab providers will perform a thorough assessment of the needs of someone suffering from a substance use disorder. Throughout a patients treatment stay, they may be routinely assessed by their clinical team to determine where they are experiencing improvement or struggling in treatment.8 Based on these assessments, along with their own criteria for payment approvals, insurance companies may decide to extend someones treatment coverage.9

Humana Coverage For Drug Rehab

Drug rehab services are covered through several of Humanas health insurance plans. Whether you have a PPO or an HMO, behavioral health services are included in your coverage. The degree to which these services are covered will vary based on your plan, however. You must speak with Humana directly to confirm what types of treatment are available to you and at what costs.

Typically, Humana covers mental health and behavioral services that are received at in-network providers. Health care treatment facilities, such a drug rehab programs, fall under this category. Preventative services, such as counseling on drug prevention and reduction, are also typically covered. People who require residential treatment programs are also likely to have costs covered by their PPO plan.

  • Routine outpatient services
  • Psychological testing

The catch to receiving coverage for most of these services is that preauthorization is often required. Individuals must demonstrate a need for services, and the services being provided must be considered to be medically necessary.

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Blue Cross Blue Shield In

BCBS insurance is connected to a large network of providers. These providers are referred to as in-network. Providers outside of this network are out-of-network.

If you or a loved one has a BCBS HMO plan, you may be required to obtain a referral from your PCP to receive drug rehab services, and you must use drug rehabs that are only in-network.4 With a BCBS PPO plan, you may not need a referral, and you may use any in-network or out-of-network facility.5

To check if a drug rehab center is in-network, contact BCBS directly by calling the number designated for mental health/substance abuse on the back of your insurance card or visit the BCBS website. You can also contact the drug rehab center directly. Many, including AAC, can verify your drug rehab coverage.

Cigna Coverage For Drug And Alcohol Rehab Centers

How Much Does Addiction Treatment Cost? Does Insurance Pay For rehab?
  • Paying For Drug Rehab Treatment
  • Cigna Coverage for Drug and
  • Health insurance firms have developed an understanding that addiction is a treatable condition. Insurers have taken the responsibility to cover the cost of addiction treatment as they recognize how alcohol and drug use can affect the life of an individual. Besides this, the long term use of a toxic substance can cause a range of physical and psychiatric consequences down the line. If left untreated, the consequences can turn into various mental and behavioral health conditions. In severe cases, addiction may lead to medical conditions such as diabetes and heart disease. Considering these effects, utilizing Cigna insurance coverage for drug and alcohol rehab centers is undeniably a positive and productive tool. It works in favor of people who are struggling to get professional help in order to achieve sobriety.

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    How Long Does Blue Cross Blue Shield Insurance Cover Rehab Program

    There is no specified period that BCBS insurance or any insurance will cover drug rehab services. This is because many factors determine coverage, such as the specific plans parameters, the drug rehab program chosen, and the persons treatment needs. However, some study results have shown that people who remain in treatment for 3 months or longer are more likely to have positive treatment outcomes .7

    To learn more about your BCBS coverage for drug rehab, call the number designated for mental health/substance abuse on the back of your BCBS insurance card or visit the BCBS website. You can also verify your coverage by contacting the drug rehab center directly. AAC can verify your Blue Cross Blue Shield coverage, too visit their website or call .

    Do I Need Health Insurance To Receive This Service

    The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

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