How can I find out if my health insurance will cover drug rehab or alcohol rehab?
Addiction treatment in a rehab center can be very expensive. A typical stay at a 30-day residential rehab can cost as much as $30,000 or more.
Fortunately, drug rehab treatment is usually covered by health insurance. In fact, insurance coverage for substance abuse treatment is required by law.
The Affordable Care Act, also known as Obamacare, includes a law known as The Parity Act, that requires health insurance coverage of mental health conditions, including substance use disorders.
Which insurance is best for drug treatment?
While each insurance provider is required to cover treatment for substance use disorder, including alcohol addiction, the coverage may vary from one plan to another. For example, some plans may insist on outpatient treatment, even if inpatient treatment would be a better option.
When looking for an insurance plan on the health insurance marketplace, it is important to keep in mind that some plans are significantly better than others. If you pick a health insurance plan known for making it difficult to get addiction treatment covered, you may be facing a challenge ahead to get your treatment program reimbursed.
Regardless of if you have Aetna Insurance, Cigna Health Insurance, United Healthcare or Meritain Health, coverage of behavioral health and addiction treatment coverage can vary, depending on which plan within that company that you are subscribed to. Rehab insurance coverage can become a complicated issue.
Are there health care advocates to help get drug addiction treatment covered by insurance?
Is there someone you can call to help get you coverage for a treatment facility? How can you ensure that addiction rehab will be paid for?
Interestingly, you will likely not have to worry about finding or hiring a healthcare advocate to fight the insurance provider to get you into an addiction treatment center. Rehabs often employ billing specialists who have extensive experience in fighting for the rights of rehab clients.
For example, in my podcast interview with American Addiction Centers, the guest described difficult fights with insurance carriers in their conference rooms. Incredibly, some healthcare insurance company executives even laughed at the idea of following the Parity Act requirements.
Fortunately, drug rehabilitation facilities and patients have the power of the federal government behind them when it comes to enforcement of mental healthcare laws. SAMHSA, which is the mental health services administration for the US, ensures access to mental healthcare and addiction care throughout the country.
What addiction treatment service is not covered by insurance?
For clients entering addiction recovery, looking for a treatment option that includes more amenities, they may be interested in an executive concierge rehab treatment program. While insurance will cover standard drug rehabilitation, it will not cover VIP rehab inpatient treatment.
Executive private rehab can cost as much as $75,000, or more, for a 30-day stay. Clients will enjoy massages, horseback riding, art therapy, music therapy, and much more.
Often, these executive rehabs allow clients to continue having access to their smartphone and laptop. This is important, because addicted entrepreneurs and corporate executives often must continue working, even in rehab.
Additionally, new treatments that are off-label and not approved by the FDA may not be covered. For example, psychedelic therapy for addiction treatment is a new field, and generally not covered by healthcare insurance.
Will insurance cover ketamine infusion therapy for drug addiction or alcohol addiction treatment?
Ketamine infusion treatment is considered a psychedelic therapy, yet, it differs from other psychedelic treatments in that it uses an FDA-approved legal substance. Still, while ketamine is an FDA-approved drug, infusion treatment for addiction is considered to be an off-label therapy for now.
However, ketamine assisted therapy must also include extensive guidance and psychotherapy as a part of the treatment. It is likely that psychotherapy, provided by a licensed professional, will be covered by insurance.
Therapy provided by a psychologist for addiction care should be covered whether it is provided alone, or in conjunction with off-label medical treatment, such as ketamine infusion. Drug rehab and alcohol rehab facilities may be including psychedelic treatments more frequently in the near future.
Does insurance cover rehab for alcohol if The Sinclair Method is being used?
Is alcohol rehab covered by insurance when the client continues to drink? What about TSM, where ongoing alcohol consumption is a part of the treatment?
The Sinclair Method, or TSM, is a treatment for alcohol use disorder using the opioid receptor-blocking drug, naltrexone. Naltrexone is approved by the FDA for alcohol addiction treatment, yet TSM involves the client continuing to drink alcohol.
At this time, the only residential rehab facility that I am aware of that provides treatment for alcohol use disorder using The Sinclair Method is Deerhaven Gardens in North Carolina. This is a facility dedicated to treating women with TSM to help them control their alcohol consumption.
At this time, I cannot say that Deerhaven accepts insurance for their programs, but I do not see mention of it on their website. It may be worth contacting the facility if you are interested in residential rehab that uses TSM rather than the traditional 12-step abstinence model of addiction treatment.
Do outpatient doctors have to accept insurance for drug treatment or alcohol treatment?
While the Affordable Care Act does require that insurance companies pay for mental health and addiction treatment the same as they would cover any other condition, doctors and rehabs do not have to accept insurance. Insurance companies are, in most cases, private corporations.
A doctor may choose not to enter into a contract with an insurance corporation. If they have not contractual agreement, the doctor is not obligated to work with the insurance company.
It is possible for a doctor or rehab to still accept an insurance plan, even if they are not contracted with that plan. Yes, a facility can bill an insurance company out-of-network.
In fact, out-of-network has been a profitable source of income for many rehab facilities in the past. The rehabs choose not to be in-network, so they can bill for more money as an out-of-network entity.
In recent times, rehabs are now working harder to be in-network, to make the process easier for clients. By being in-network with the most popular insurance plans, rehabs are more likely to attract new clients.
What if I want to pay for addiction treatment, but I cannot afford rehab prices?
There are many addiction treatment options other than rehab. In fact, some outpatient treatments with private doctors are even more effective than rehab.
One excellent example is Suboxone treatment, which is used for medication-assisted treatment of opioid addiction, or opioid use disorder. Rehabs have a low rate of success in treating opioid addiction, but Suboxone treatment with buprenorphine is highly effective.
A patient can obtain buprenorphine treatment for an entire year at a much lower cost than even a single month of basic residential rehab. Suboxone treatment is affordable, even when patients do not use insurance to pay for it.
The Sinclair Method treatment is similar, because it is possible to get the treatment at a doctor’s office, with a prescription for naltrexone, and a basic treatment plan. While going away to rehab can be a great way to become immersed in recovery, medication-assisted treatment programs are much more affordable.
While it is great to use insurance for addiction treatment, it is not always essential. There are many people in the US who are uninsured. They may be small business owners, or part-time employees without health insurance benefits.
Addiction treatment is available at many levels, for people with insurance, and people who do not have insurance. Additionally, drug addiction and alcohol addiction treatments are available at all price levels, including sliding scale and free programs for people who cannot afford any other treatment option.
