Using Insurance for Drug Rehab

Once you’ve made the decision to seek treatment for substance abuse, one of the first questions you may have is how you’ll pay for drug rehab.

Media images of celebrity rehab facilities may give you the impression that rehabilitation centers are reserved for rich and famous clients who can pay cash for their care. In fact, most facilities offer a number of different payment options for clients from all socioeconomic backgrounds. If you have health coverage through your employer, through the military or through a government program like Medicare or Medicaid, you may be able to use these benefits to pay for drug rehab.

What Does Insurance Pay For?

If you had trouble getting adequate coverage for a substance use disorder in the past, check the most recent updates to the terms of your policy.

Many of the major private health insurance companies will pay for certain drug rehabilitation services; however, coverage for substance abuse treatment varies from one provider to another and from one insurance plan to another. Some policies will cover only substance abuse counseling or other outpatient services, while others will cover all or part of the costs of medically assisted inpatient detox that utilizes supervising physicians as well as residential rehab.

In 2008, the Mental Health Parity and Addiction Equity Act required health insurance providers to expand their benefits for the treatment of mental health and substance abuse disorders.

Insurance carriers that cover mental health and substance abuse treatment must cover these conditions at the same rate as other medical conditions. This federal act doesn’t require companies to cover mental health treatment or drug rehab, but those insurers who do cover these services are prohibited from:

  • Charging higher copayments or deductibles for substance abuse services
  • Setting more extensive network restrictions on substance abuse and psychiatric treatment
  • Setting lower coverage limits for substance abuse and mental health care
  • Failing to disclose the reasons why substance abuse treatment is denied

Until 2014, the Mental Health Parity and Addiction Equity Act only applies to employer-sponsored insurance policies, state-regulated plans and managed care Medicaid programs; small business insurance policies and private policies are temporarily exempt. Ultimately, the goal of lawmakers who support this federal act is to give the American public fair and affordable access to substance abuse treatment.

Questions to Ask Your Insurance Company

You may have policy documents from your insurance provider that describe the services that your carrier covers. Even if you do have these documents, insurance jargon is often hard to understand, and you may not be aware of the scope of your benefits.

To find out whether your provider covers substance abuse treatment and which services are covered, take the following steps:

  • Call the customer service number on your insurance card (some insurance cards have a separate number to call for mental health and substance abuse treatment services) to ask about your benefits. If you don’t have a copy of your card, ask your human resources department for the number.
  • Ask a benefits representative about which services are covered, how long these services are covered and whether there are any network restrictions. Under some plans, you may be limited to treatment centers in your policy’s network.
  • Ask whether you will need to be referred by a primary care doctor or another medical professional in order to have your expenses covered.
  • Ask about whether you’ll be charged a copayment, and whether the expenses will apply to a deductible.
  • Ask whether there are any other restrictions on your substance abuse benefits that might affect your final bill.

Getting Help With Insurance Issues

If you don’t get the answers you need from your insurance provider, or you’re not able to make that call, ask for help from an addiction treatment professional.

If you’re under the influence of alcohol or drugs or you’re going through withdrawal, making these phone calls may seem like an overwhelming task. Health insurance coverage isn’t easy to understand under the best of circumstances, much less when you’re scared, confused or depressed about the future.

An intake counselor at a treatment facility can provide valuable help in analyzing your benefits. Reaching out for help is the most important step in initiating the recovery process — once you’ve made a call to a reliable facility, you can ask for help with payment solutions.

Your primary care doctor’s staff or your therapist’s office may be able to help you determine whether your insurance benefits will cover the services you need, such as:

  • Partially supervised outpatient care
  • Intensive inpatient rehabilitation
  • Medical detoxification
  • Residential treatment at a recovery community

Health Insurance and Privacy

When you’re weighing the pros and cons of entering treatment, you may be worried about how your employer will react, especially if your boss isn’t aware that you have a problem.

Many high-functioning alcoholics and addicts are able to continue performing their jobs, even as they struggle with the physical and psychological effects of substance abuse. On the other hand, your employer and coworkers may know more about your problems than you think.

The Health Insurance Portability and Accountability Act (HIPAA) offers a certain amount of protection for employees who are concerned about the confidentiality of their medical care. According to HIPAA privacy rules, healthcare providers cannot disclose any information about your treatment to your employer without your written consent. Although records of your treatment are protected by federal law, the act doesn’t prevent your employer from asking you to provide information about your condition or your care if you are asking for a leave of absence or insurance coverage.

The National Business Group on Health encourages employers to provide comprehensive, confidential insurance coverage for substance abuse treatment in order to protect their employees and minimize the costs of drug and alcohol addiction.

Maintaining the privacy of substance abuse treatment increases the chances that employees will get the help they need to overcome addiction. Encouraging employees to seek help benefits employers by reducing costs such as:

  • Absenteeism
  • Reduced productivity
  • Increased risk of workplace accidents
  • Increased number of workplace errors
  • Employee theft or dishonesty
  • Damage to the company’s professional reputation

It’s in your employer’s best interest to maintain your privacy when you go to rehab, but more importantly, it’s in your own best interest to follow through with this important decision.

Getting the treatment you need may mean protecting your job, keeping your family together and literally saving your life.

Taking the First Step

Don’t let the lack of money or information prevent you from getting the help you deserve for drug or alcohol addiction.

What if you’ve lost your job and your health insurance, and you have no way to pay for drug rehab in the foreseeable future? The lack of money doesn’t have to be a barrier to treatment. Many treatment centers offer sliding scale payment options that match your income. You may also qualify for assistance through government-sponsored programs.
You can start your search for recovery by calling The Canyon’s helpline. Our intake counselors will provide a free, confidential assessment of your needs, including your insurance status and your financial resources. During your phone intake, a counselor will make a preliminary assessment of your situation to help determine which level of treatment is appropriate for you.

Making that free phone call to our intake team may be the most important thing you can do to improve your health and secure a more stable, positive future.