Will Health Insurance Cover Private Rehab?

As you contemplate getting help for your addiction illness, you surely don’t want to worry about things like how to pay for rehab. You want to be able to put 100% of your focus on getting through withdrawal on your way to the therapy portion of treatment. It’s at that point that you want to focus all your efforts on working with your therapist to identify the causes of your addiction. That would set you up nicely to develop strategies to overcome your personal triggers and temptation, things that could derail your recovery.

Still, you are going to have to address how to pay for your addiction treatment costs. To be clear, your chances of recovery would be greatly enhanced if you were able to get yourself into a private rehab facility. It’s not that public facilities are lacking, it’s simply a matter of private rehab facilities having access to more and better addiction treatment resources.

Now, the conversation has evolved to the point where you need to be thinking about how to pay for treatment in a private rehab. If you have healthcare insurance as an individual or through your employment, the payment issue might not be as problematic as it could have been.

In 2010, the US Congress passed the Affordable Care Act of 2009 (ACA). Under the language of the law, healthcare insurance providers are required to cover addiction treatment costs in the same manner they would cover other medical costs. Furthermore, the ACA made it illegal for insurance companies to deny coverage to customers on the basis of preexisting conditions. That’s been a winning ruling for addiction sufferers because the presence of an addiction is assumed to have been a preexisting condition for a long time short of proof otherwise.

What all this means is you having healthcare insurance almost ensures a good portion of your addiction treatment costs will be covered by your healthcare insurance carrier. If it’s not clear on your insurance summary page, you should contact the insurance company’s customer service department for clarification. Or, you could request insurance verification assistance from the rehab facility’s administrative staff.

Will Health Insurance Cover Private Rehab?

The fact your are seeking treatment from a private rehab facility does not mitigate the insurance company’s responsibility to pay for your treatment costs. Your coverage is applicable.

However, the ACA states two other things. First, it doesn’t dictate the extent of addiction treatment costs that your insurance company is required to pay. Generally, you can expect to pay the same copay costs and deductibles you would be required to pay for other medical problems.

The other thing the ACA does limit is the types of treatment costs your insurance company has to cover. That list includes (but is not limited to):

  • Detox programs
  • Any prescriptions medications required during the addiction treatment process
  • Standard residential treatment costs
  • Outpatient treatment

Some further commentary about residential and outpatient treatment is warranted. The reference to “standard” residential treatment costs refers to the notion that your insurance only has to cover what would be considered traditional residential treatment. That would exclude the insurance company having to cover costs associated with modern treatment techniques like some evidence based therapies and holistic treatment options. That’s not to say your insurance won’t cover said costs, it’s simply left up to their discretion. Also, there’s a good chance your insurance company will only cover residential care up to 60 or 90 days.

As for outpatient treatment, this is an option insurance companies prefer. Why? The cost of outpatient treatment is about half of what residential treatment would cost. The differential is big enough that some insurance carriers will offer to pay 100% of outpatient care as a way to motivate customers to seek that option.

Here’s something else you need to know. The last thing your insurance carrier wants to see is your name coming up on the relapse rolls. With that in mind, you insurance company is going to be a lot more cooperative during your first treatment stint in the hopes they won’t have to pay for a second stint.

If you have healthcare insurance, you should be able to set your payment worries aside. That puts you in a position to worry first and foremost about getting yourself into treatment sooner rather than later. For more information about our facility and our addiction treatment services, we want you to call one of our reps at 772-266-5320.

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Essentials mission is to renew lives impacted by addiction through personalized and complete behavioral healthcare. Our main purpose is to provide services and education to the client and family that will support long lasting recovery of mind, body, and spirit.