Does Insurance Cover Drug Rehab? A Financial Guide

Understanding insurance coverage for drug rehabilitation helps families plan for treatment costs. The Affordable Care Act requires most insurance plans to cover substance use disorder treatment.

What Insurance Covers for Drug Rehab

Legal Requirements

The ACA provides protections:

• ACA classifies substance use disorder treatment as essential health benefit
• Mental Health Parity Act requires equal coverage
• Cannot discriminate against behavioral health
• Similar coverage to other medical conditions

Major Insurance Providers

Most major insurers cover treatment:

• Blue Cross Blue Shield
• Aetna
• Cigna
• UnitedHealthcare
• Kaiser Permanente
• Humana
• Medicare and Medicaid

Types of Treatment Covered

Coverage typically includes:

• Medical detoxification
• Inpatient/residential treatment (often 30-90 days)
• Partial hospitalization (PHP)
• Intensive outpatient (IOP)
• Standard outpatient therapy
• Medication-assisted treatment (MAT)
• Individual and group therapy

What Impacts Your Insurance Coverage for Rehab?

Network Status

Coverage varies by provider:

• In-network providers typically have lower out-of-pocket costs
• Out-of-network may require higher payment
• Some plans have no out-of-network coverage
• Always verify network status

Deductibles and Copays

Out-of-pocket costs include:

• Average deductible for single coverage: $1,669 (Kaiser Family Foundation, 2021)
• Copays for visits or services
• Coinsurance percentages
• Out-of-pocket maximums

Level of Care

Coverage may differ by level:

• Detox often fully covered as medical necessity
• Residential may have day limits
• Outpatient typically well-covered
• Length of stay may require authorization

Pre-Authorization

Many plans require:

• Pre-authorization before admission
• Documentation of medical necessity
• Regular reviews for continued stay
• Communication between provider and insurer

Medical Necessity

Insurers evaluate:

• Severity of addiction
• Failed previous treatments
• Co-occurring conditions
• Clinical recommendations
• ASAM criteria levels

How to Verify Your Insurance Coverage for Rehab

Step 1: Gather Information

Collect before calling:

• Insurance card
• Policy number
• Member ID
• Group number
• Policyholder information

Step 2: Contact Insurance

Call the number on your card:

• Ask about behavioral health coverage
• Request specific benefits for substance abuse
• Inquire about in-network providers
• Ask about pre-authorization requirements

Step 3: Ask Key Questions

Important questions include:

• What levels of care are covered?
• What is my deductible?
• Are there day limits on residential treatment?
• Which facilities are in-network?
• What documentation is needed?

Step 4: Work with Treatment Center

Most centers help:

• Verify benefits on your behalf
• Handle pre-authorization
• Communicate with insurers
• Appeal denials if needed
• Maximize coverage

Additional Financial Options

Payment Plans

Many facilities offer:

• Monthly payment arrangements
• Sliding scale fees
• Financial assistance programs
• Extended payment options

Financing

Options may include:

• Healthcare credit lines
• Personal loans
• Medical credit cards
• Family assistance

Scholarships and Grants

Some options:

• SAMHSA grant-funded programs
• State-funded treatment
• Nonprofit assistance
• Foundation grants

Final Thoughts

Most insurance plans cover substance abuse treatment as an essential health benefit. Understanding your specific coverage, working with treatment centers on verification, and exploring additional financial options makes treatment accessible.

Amity Behavioral Health verifies insurance benefits and works with all major insurers. Contact us for a free insurance verification.