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Understanding Insurance Coverage

One of the most challenging parts of enrolling in addiction rehab is finding out the costs associated with it, figuring out how you will pay for it, and understanding what insurance will and will not cover. It would be a shame to let cost or confusion about insurance hinder anyone from getting effective addiction help, but it happens everyday. We are here to help you figure all that stuff out, sort through the insurance jargon, and come up with a real plan for recovery.

Insurance Coverage is Confusing

Insurance coverage for addiction treatment is better today than ever before. The Affordable Care Act requires insurance companies to offer equal coverage for addiction and mental and behavioral health care as for any other medical care. This means that if 90% of your surgeries, emergency room visits, and wellness checks are covered, you should also receive 90% coverage for mental and behavioral health services. The Affordable Care Act also states that addiction cannot be considered a pre-existing condition for coverage purposes. However, insurance companies are always trying to save money, and there are many, many exemptions and loopholes to the rules. Just because you think your insurance company should cover something does not mean it will. Companies can get around certain rules by putting restrictions on where a person can get treatment, how long treatment can last, what kind of licensing the treatment facility must have, and making requirements about treatment history.

The bottom line is, it would be helpful for you to have someone who is experienced in the ways of insurance coverage for addiction services help you understand your unique plan and help you get the most out of your insurance coverage.

What You Can Expect From Your Insurance

So what will your insurance cover? In general, major insurance companies cover much of detox, usually the level of care as determined by your doctor, and for a set period of time. After detox, when you still need 24 hour care and supervision, most insurance plans will cover a portion of inpatient rehab. This gets tricky, though, because they might restrict type of therapies covered and how long you can stay in residential treatment, and they might not cover incidentals like travel, outings, certain individuals therapies, and extended care. It is up to you (with our help) to find out what extra costs you can expect.

Finally, insurance usually covers most of outpatient care. Since this level of care is generally much less expensive than detox or inpatient, insurance companies often prefer this type of care. However, some will still only cover the outpatient phase if you have already completed a residential program.

Get an Accurate Assessment

Another important thing to know is insurance companies will often determine your need for care by an assessment conducted at the start of treatment. Most people are embarrassed or ashamed about their addiction, and try to minimize it even with their rehab facility staff. If you are open and honest during your assessment, you will be recommended a plan for treatment that will address all your issues and concerns, and if it is in your medical history, you have proof to take to the insurance company that you need a specific level of care.

Insurance coverage will vary from person to person, so depending on your benefits plan, certain things may or may not be covered for you that apply to others. This is another reason you should look into your benefits at the start of your rehab search, so you know what to expect.

Sober Helpline can help you sort through your insurance plan. Contact us at (888) 907-8039 today to learn what treatment facilities accept your insurance, and what you can expect your insurance to cover.