Payment Options for Partial Hospitalization Programs

Payment Options for Partial Hospitalization ProgramsPartial hospitalization programs for addiction fall between residential or inpatient treatment and outpatient programs in terms of how much time is spent at the treatment center. Inpatient programs require clients to be at the facility 24 hours per day for a couple weeks or longer, with possible exceptions for outings awarded for good behavior. Outpatient programs let people come in to the center a couple times per week, depending on the severity of the addiction, but spend the rest of time at work, school, or home.

In a partial hospitalization program, clients come into the facility daily and often spend most of the day there, going to therapy, attending support group meetings, and sampling workshops. They only go home at night to sleep. This is a good fit for individuals who have a more severe addiction disorder and need a lot of treatment and supervision but may not be able to afford the costs associated with a full inpatient program.

Unfortunately, partial hospitalization programs can still be expensive, particularly if your insurance doesn’t cover this kind of treatment or if you don’t have insurance; as of 2015, 33 million people in the US still aren’t covered by any health insurance plan. Many insurance programs do cover various treatment options for addiction, but even if your plan doesn’t, there are other options to pay for the care you, or a loved one, need.

Insurance Coverage

Following the passage of the Affordable Care Act, all insurance plans in states that accept federal monetary assistance for their insurance programs must cover addiction treatment. However, there is some leeway for companies to decide which forms of treatment they will cover. Standard inpatient and outpatient programs are almost always covered, at least partially, and partial hospitalization is also very often covered to some level.

However, many insurance companies will require customers to first contact them and undergo a doctor evaluation before a specific type of treatment program is recommended. If something other than partial hospitalization is recommended, the insurance company will usually only cover that treatment plan. It’s important to always contact your insurance company before enrolling in a program to find out their procedures and ensure that you’re covered.

Insurance may also not cover all costs associated with a partial hospitalization program. For example, although Medicare covers the direct costs of this type of treatment program, it does not cover:

  • Transportation costs to and from the facility
  • Meals served at the facility
  • Non-therapy support group fees
  • Job skills training or testing fees

Clients may also need to pay co-pays or a certain percentage of the treatment program costs.

Verify Your Benefits

You can check to see what your health insurance will cover of your addiction treatment below.

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Other Options

If insurance doesn’t cover all or any of a partial hospitalization program, there are alternative payment options. Many addiction treatment centers don’t require people to pay upfront, and if payment cannot be made in full once treatment is complete, they may be able to put you on a payment plan to pay back the fees over time. Talk to prospective treatment programs about their financing options.

Your workplace may also be able to help with costs. Many employers offer an Employee Assistance Program (EAP) for issues like addiction that can get you a number of program sessions or therapy sessions for free. Additionally, if your insurance is not accepted by the treatment center you’ve selected, you may be able to access some coverage if you have out-of-network reimbursement benefits.

If none of those options pan out, there are some free or very low-cost options available via government-funded programs. In many instances, the waiting lists are long, but social workers and other professionals can help you find more information on their offerings. Some treatment programs may also offer scholarships to those in need.

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Editorial Staff
Editorial Staff, American Addiction Centers
The editorial staff of Recovery First is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed thousands... Read More