Does Health Insurance Cover Rehab?

Every year, more than 22 million people need substance abuse treatment, but only about 10 percent actually get help (SAMHSA 2013). It’s an alarming statistic, but we believe fear about the cost is partly to blame. Fortunately, there’s usually a solution, and we’re here to help find it.

Getting Into Rehab with Affordable Care Act Insurance

The Affordable Care Act of 2010 (a.k.a. Obamacare) was a significant change for health care in the United States, especially for addiction treatment. The opioid epidemic has brought a unique challenge for health care professionals and those with ACA insurance.

Before ACA began in 2010, addiction treatment was usually paid out of pocket, meaning insurance rarely came into play. Since then, many addiction treatment centers have adjusted their business models to accept insurance.

ACA Insurance Policies for Addiction Treatment

Although ACA has helped cover addiction treatment more often, many insurance policies purchased through the exchange have deductibles and out-of-pocket costs exceeding $40,000. This poses a severe hurdle for many seeking treatment, so much so that it can stop them from getting the help they need.

ACA also spurred a push for free treatment options, with a focus on helping stem the opioid crisis. Free treatment centers across the U.S. often have long waiting lists just to get in and require pre-admission drug tests, meaning individuals basically need to detox on their own. For alcohol and benzodiazepine users, this policy is potentially dangerous because the withdrawal process presents a high risk for seizure and other complications that could otherwise be mitigated by medical supervision.

Opioid users don’t face this same risk, so if they can get into a free treatment center or can afford five-figure copays, and don’t drink or take a benzodiazepine they’re in luck. Alcohol and benzodiazepine users may find ACA less suited to their needs.

Private insurance on your own or through an employer is usually a better bet. Premiums are higher but copays and deductibles are often lower than ACA policies.

Will My Health Insurance Pay for Treatment? Find out Here

The answer is usually yes, because substance abuse is a medical condition. As you look into treatment, it’s a good idea to call your insurance carrier and ask if freestanding residential substance abuse treatment is covered. Likewise, if you’re shopping for an insurance provider, ask questions when in doubt! A good insurance policy can really help offset the high cost of rehab and reduce your financial risk.

If your insurance policy covers substance abuse treatment, find out if your policy will cover both in and out of network. This latter question is important to know, especially if you have an HMO.

Will Insurance Pay for Treatment if I Have an HMO Policy?

Yes! HMO policies usually require patients to go to their network of providers to receive help, whereas PPO policy members can go almost anywhere. The difference between both policies can sometimes be substantial. In general, staying in-network is the best way to keep costs down.

Is Treatment Really Worth It?

When considering the cost of treatment, consider also the cost of remaining an addict. We have heard countless stories of manipulation, stealing, bribing, lying, and spending thousands of dollars throughout the career of a practicing addict or alcoholic. Cocaine, designer opiates, and other illegal drugs are expensive. There’s also the cost to your health, personal life, reputation, relationships, credibility, and other aspects of addiction that are difficult to quantify.

Think about you or your loved one’s use history. Figure in the cost of the drugs, the cost of missed days at work, if working, the cost of going to jail, DUI, or other factors and weigh that against the cost of getting help. If you do, you’ll often see that you can actually save money in the long run by going to rehab.
Using your insurance policy to get help can save you thousands of dollars. By checking into rehab you can also reduce medical bills from potential overdoses, emergency room visits, and ambulance rides, all of which can add up fast.

Call Balboa Horizons Today

Balboa Horizons is here to help individuals recover. Even if we don’t take your particular insurance policy and/or you decide you can’t afford treatment with us, we can still help with a referral to other providers we know and trust. We’ll do whatever we can to help you or your loved one get the treatment you need.

Balboa Horizons is an in-network provider for First Health, HumanaMultiplan, PHCS, Value Options, and Beacon Health. Contact us day or night and we’ll get help for you or your loved one. Let our caring staff help walk through your options to see if Balboa is a good fit for you (866) 316-4012