Last Edited:

08/25/2022

Can I Use Insurance for Rehab?

There are a lot of barriers people need to overcome when seeking treatment for addiction. Some of these barriers are largely internal; in order to accept help and treatment for addiction, people need to be able to accept that they are struggling with addiction and need treatment in order to get better. This is much more easily said than done, there is a long history of criminalization and demonization of drug users in the United States which can lead people who struggle with addiction to not seek help due to fear of legal reprisal, as well as contribute to an internal sense of shame or guilt about their drug use, both of which may keep someone with addiction from reaching out for help. Other barriers are external and can be much more difficult to overcome, such as the financial cost of rehab. 

 

For those without insurance, rehab can be very difficult to afford, but many rehab facilities will offer financing options to help as many people as possible get into rehab. It may be that some uninsured people are not able to afford inpatient rehab at all, in which case there are other options. There are plenty of great outpatient treatment options across the country, and these are much more affordable than inpatient programs as clients only need to pay for the treatment, as opposed to room and board on top of treatment. There is of course a trade-off with outpatient programs, which are less effective than inpatient rehab as people still have potential access to drugs and alcohol, as well as spending significantly less time per day on treatment. 

 

Some states with a more progressive approach to drug abuse and addiction may have state-funded rehab centers to provide treatment to the uninsured, underinsured, or those who may not otherwise be able to afford it. These programs can be free, or accessed at a very low cost, though many of these programs have strict eligibility requirements, typically: proof of US citizenship, proof of state residency, income, and proof of lack of insurance. While these public programs are vital in addressing drug abuse and addiction, there are also significant downsides to these programs, namely that high demand and low space lead to extremely long wait times even once people qualify. These programs are also typically pretty underfunded for the scale of the problem they’re addressing, meaning conditions at these facilities are often not great, especially when compared to private rehab. Some of these programs may only provide space for clients during the detox period, and then refer them out to counseling services and peer support groups, rather than providing those options as a part of inpatient treatment, as is typical of private rehab facilities. While these downsides definitely point to room for improvement for these public rehab programs, the work they do is still important and has a real impact, and any treatment is better than the alternatives of no treatment or incarceration. 

 

For those with insurance, attending rehab can be much more affordable. The Affordable Care Act or ACA dramatically improved coverage of addiction treatment across the board, banning insurance providers from denying coverage due to pre-existing conditions which include substance abuse and addiction, as well as preventing them from jacking up premiums due to addiction and substance abuse disorder. Historically, insurance either did not cover treatment for substance abuse at all or offered extremely limited coverage with high copayments. The ACA required insurance plans to offer coverage for substance abuse and addiction treatment on par with coverage for medical and surgical procedures, which dramatically expanded coverage across the board. Between requiring coverage for substance abuse and addiction treatment, as well as expanding coverage to previously uninsured Americans through Medicaid expansion and state insurance exchanges, millions more Americans now have access to addiction treatment through insurance. The extent of what insurance will cover and what the individual is responsible for themselves will of course vary by the specifics of the insurance plan they have, as well as on other factors such as the length of stay at an inpatient rehab facility. Many insurance programs only agree to cover the first 30 days of inpatient substance abuse treatment programs, despite the fact that the recommended minimum length of stay by the National Institute on Drug Abuse is 90 days. Some inpatient rehab programs will work with clients to make the case that a longer length of stay is medically necessary to treat the client’s addiction, but that will not always work. Longer lengths of stay are especially beneficial to those with a dual diagnosis, where the client struggles with a mental illness that compounds and contributes to addiction, such as PTSD. The cost of treatment that the individual is responsible for is calculated by adding the co-pay, deductibles, and co-insurance. Soldiers and veterans can have their treatment subsidized by the Veteran Affairs Office. Alternative forms of health care funding such as health savings accounts (HSAs) and flexible spending accounts (FSAs) may also be used to pay for addiction treatment services. If clients are still unable to afford the cost of inpatient drug rehab, many facilities will work with them to find a payment plan that allows clients to access the care they need without clearing out their bank accounts. 

 

While insurance coverage for substance abuse disorders has been greatly improved by the ACA, there is no doubt that it can be a bit of a convoluted mess to figure out what exactly is covered and by how much. Luckily, most inpatient rehab centers have tools on their website to help potential clients find out exactly how much their insurance plan covers, like at Sunshine Behavioral Health. Sunshine Behavioral Health has five luxury rehab locations in California, Texas, Colorado, and Illinois, and each location offers a unique experience with their own perks, but every location is staffed by a dedicated team who utilize their knowledge and expertise to offer best-in-class treatment and care for each client. To learn more about Sunshine Behavioral Health and how we can help you or your loved one recover from addiction, visit us today at www.sunshinebehavioralhealth.com.

 

Sources: 

https://americanaddictioncenters.org/insurance-coverage

https://drugabuse.com/treatment/state-funded-rehab-centers/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308192/

https://unsplash.com/photos/mCqi3MljC4E   

  



Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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