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Does Insurance Cover Drug Rehab – Difficulties in Paying for Treatment

Does insurance cover drug rehab? This is one of the most common concerns for addicts who are seeking treatment for their substance abuse problems. While the medical establishment has indeed changed its views on addiction over the last forty years, paying for rehab can still be extremely difficult. Addicts who are struggling financially need to understand the difficulties they’ll encounter with their insurance claims – and the solutions that may be necessary.

Working with Current Coverage

Addicts with existing insurance contracts may be able to find coverage, but there are a few problems they may encounter. People who contract with health management organizations will usually find their treatment options to be very limited. HMOs are known for having low premiums and deductibles, but their networks are relatively small. They also tend to offer little or no coverage for treatments obtained outside their networks.

People with PPO insurance may actually run into the same set of problems. While preferred provider networks are generally far more willing to pay for treatments outside their networks, they also charge higher deductibles and co-pays. In addition, they may only offer partial coverage for the inpatient and outpatient rehab programs that do exist within their networks. Given the current state of drug treatment insurance, many addicts will need to compromise on their ideal treatments and seek the lowest-cost options available.

Detox and Partial Care

Another problem addicts often encounter is that their insurance companies will pay for detox – but not for the additional therapies they need to stay sober in the long term. The importance of clinical detox is relatively unambiguous in the medical community, but many insurance companies still view psychotherapy as an optional “procedure.”

In other cases, insurance companies may only pay for very limited therapies. It’s common for people to get ten or fifteen days’ worth of coverage for inpatient treatment, even when the shortest full program available is supposed to be thirty days long. In these situations, it is often best for addicts to pay for add-ons to their insurance contracts – or to switch companies altogether. Switching insurance will lead to greater short-term costs, but it may save people money in the long run.

Is Addiction a Pre-Existing Condition?

It’s rare for insurance companies to penalize people who develop addictions during the course of their contracts. However, drug problems may be treated as pre-existing conditions when former rehab patients seek new insurance plans. This can lead to higher premiums, but it may also help people get coverage for additional treatments if they relapse.

Unfortunately, some insurance companies will deny coverage to people who have previously attended rehab. For these situations, many states offer insurance pools for “high-risk” individuals. They may not provide the ideal amount of coverage, but given the rising costs of healthcare – any coverage is better than none.

Recent Legal Reforms

In 1996, Congress passed the Health Parity Act. The act made it illegal for insurance companies to discriminate against people with mental health disorders – a legal category which includes drug addiction. Until recently, the common interpretation of this law was that insurance companies were only required to cover detox. However, 2008 revisions reduced the limits that companies could place on their employees’ inpatient and outpatient substance abuse programs. Given the rapid rise of prescription drug addiction in the workplace, these reforms have made it somewhat easier for people to get the long-term care they need.

No matter how dire your situation is, you can get help paying for rehab. Fill out the insurance verification form to the right of this page to find out more about the payment programs available to you. Addiction is a life-consuming disease, so don’t wait any longer to get the help you need.

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