Does Insurance Cover Rehab?

Clinically reviewed by Linda Whiteside

Medically reviewed by Dr. Ryan Peterson

phone-white (323) 307-7997

Verify Your Insurance

Yes, insurance can cover rehab services for substance abuse, including alcohol rehab. Under the Affordable Care Act (ACA), health insurance plans are required to include coverage for essential health benefits, which encompass substance abuse treatment. This means that insurance plans purchased through the Health Insurance Marketplace must provide coverage for behavioral health treatment, including rehab services.

Does Your Health Insurance Cover Substance Use Treatment?

Yes, insurance can cover substance abuse treatment. Each plan specifies the extent of coverage, which may include various treatments such as outpatient therapy, and medication-assisted treatment.

It’s crucial for policyholders to review their coverage details or contact their insurance provider to understand the specific treatments and services covered under their plan.

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What Types of Rehab Does Insurance Cover?

Insurance typically covers various types of rehab for substance abuse, but the specifics depend on the individual insurance plan. Commonly covered rehab types include:

Outpatient Rehab: Treatment involving regular visits to a clinic or facility, allowing individuals to maintain daily responsibilities.

Partial Hospitalization Programs (PHPs)A step down from inpatient care, offering intensive treatment for several hours each day, but allowing patients to return home at night.

Intensive Outpatient Programs (IOPs): Less intensive than PHPs, these programs still provide structured therapy while accommodating work or school schedules.

Medication-Assisted Treatment (MAT)Combines behavioral therapy with medications to treat substance use disorders.

Dual Diagnosis Treatment: Addresses co-occurring mental health disorders alongside substance abuse.

Coverage For Essential Health Benefits

However, it’s important to note that the extent of coverage may vary depending on the specific insurance plan and the insurance provider. Different plans may have different levels of coverage, including factors such as outpatient treatment, duration of treatment, and types of therapies or services covered.

To determine the exact coverage provided by your insurance plan, it is advisable to contact NuView Treatment Center directly. Our staff can provide detailed information about the specific benefits, limitations, and out-of-pocket expenses you may be responsible for.

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Can I Have Multiple Insurance Providers?

Yes, it’s possible to have multiple insurance providers, a situation often referred to as “dual coverage.” This occurs when an individual is covered by more than one health insurance plan. Here’s how it works:

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Primary and Secondary Insurance

One plan is designated as primary and the other as secondary. The primary plan pays first, and the secondary plan may cover some of the remaining costs.

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Coordination of Benefits

This is a system insurers use to determine which plan pays first. It avoids overpayment or duplicate payments.

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Increased Coverage

Dual coverage can reduce out-of-pocket costs, as the secondary insurance might cover expenses not fully paid by the primary insurance.

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Covered Services

It’s possible to have a broader range of covered services with two plans.

However, there are considerations:

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Cost

You may have to pay premiums for both plans.

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Complexity

Handling claims and understanding benefits can be more complicated with two insurers.

It’s important to understand the details of each plan and how they work together to ensure effective coverage and avoid issues with claims processing.

Behavioral Health Coverage and Cost

The cost of substance use treatment can vary significantly based on your insurance plan. It's important to understand how your plan covers various services.

Types of Covered Treatments: Most insurance plans typically cover a range of services, including outpatient rehab, therapy, and medication-assisted treatment. The extent of coverage for each can vary.

Cost-Sharing Elements: Your out-of-pocket expenses will depend on your plan’s deductible, copayments, and coinsurance. Some plans may cover the majority of treatment costs, while others require significant cost-sharing.

In-Network vs. Out-of-Network Providers: Costs can be significantly lower if you use in-network treatment facilities and providers, as insurance plans negotiate rates with these providers.

Preauthorization Requirements: Some plans require preauthorization for certain treatments or medications, meaning you need approval from your insurance company before they agree to cover the costs.

Affordable Care Act (ACA) Impact: Under the ACA, insurance plans offered through the marketplace are required to cover mental health and substance use disorder services as essential health benefits.

Medicare: These programs also provide coverage for substance use treatment; however, the specifics can vary depending on the individual plan (for Medicare).

Does Health Insurance Cover Mental Health and Anxiety Treatments?

The answer to this question depends on the type of health insurance plan you have. Some plans may offer some coverage for mental health and anxiety treatments, while others may not include any coverage for these services. It is important to review your health insurance policy carefully so that you understand what types of services are covered.

In many cases, you may be able to purchase additional coverage for mental health and anxiety treatments if needed. Additionally, some insurance companies are beginning to offer more comprehensive plans that include coverage for mental health services. It is important to shop around and compare different policies to find the plan that best fits your needs.

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Does Insurance Cover Comorbid Mental Health Conditions and Treatment Medications?

According to the National Institute on Drug Abuse, approximately half of all people with substance use experience a mental health disorder at some point, and vice versa. Mental illness and substance use are so intertwined that it can be impossible to treat one without treating the other as well.

The Affordable Care Act not only requires health insurance companies to cover substance abuse treatment, but the legislation also guarantees that people with mental health conditions get the same level of care as they would normally get for a physical ailment. This policy, which is known as parity, means that if a visit to a doctor for cold costs a patient $20, then visiting a doctor about depression must also cost $20. Parity laws apply to all kinds of health insurance plans, including employer-based health insurance plans, CHIP, and plans bought through health care exchanges.

One of the most common questions is whether a specific mental health disorder will be covered by insurance. Parity laws do not specify exactly which mental health conditions must be covered. However, similar to substance use treatment, it is generally impractical for health insurance companies to make fine distinctions between conditions when determining coverage.

Rather than specifying which conditions are covered and which are not covered, plan administrators generally provide blanket coverage. While it is generally best to discuss the specifics of your case with your case manager, any diagnosed mental health issue is almost guaranteed to be covered.

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Health insurance companies also recognize that many people who need behavioral health treatment are dual diagnosis. The term dual diagnosis refers to clients diagnosed with a substance use disorder and one or more additional mental health disorders. Covering treatment for comorbid conditions is in the client’s best interests, but it is also in the insurance company’s best interests.

If a mental health disorder is left untreated, it can easily cause a client to relapse and return to substance abuse. This means they will need to return to treatment again — costing the health insurance company more money. For clients with comorbid conditions, health insurance companies strive to treat both conditions simultaneously.

Many outpatient treatment centers for behavioral health offer comprehensive care for co-occurring mental health conditions, commonly referred to as integrated treatment. Integrated treatment provides dual-diagnosis clients with evidence-based behavioral therapies to address both substance use and mental health conditions simultaneously. In many cases, medications are also prescribed to help manage the symptoms of these conditions, promoting a more holistic approach to recovery.

Southern California Rehabs and Insurance Coverage

There are many types of treatment available for substance use disorders, each catering to different levels of severity. Individuals with co-occurring mental health disorders often require specialized, integrated treatment. Substance use treatment is delivered in a wide range of settings, and health insurance companies are required to cover a variety of treatment approaches.

With over 14,500 treatment centers across the United States, it’s no surprise that there is variation in their methods and approaches. Southern California, in particular, is an ideal place to seek recovery, as it has the highest number of treatment centers per capita, offering diverse and specialized options for individuals in need.

Treatment at these centers typically involves a combination of behavioral therapies and medical interventions. Rehabs also aim to address various aspects of an individual's life to ensure comprehensive recovery from the effects of substance use. These components include:

  • Addressing substance use issues
  • Healing and building healthy relationships
  • Long-term aftercare and continued therapy
  • Assisting with employment opportunities
  • Securing safe and stable housing
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It is important to choose a rehab that offers this kind of comprehensive treatment. For most people, simply getting physically sober is rarely enough. It is crucial to develop coping skills and relapse prevention techniques, to address underlying mental health issues, and to rebuild one’s life from the ground up. Quality rehabs covered by health insurance provide effective, integrated, and comprehensive treatment to ensure that clients get sober and stay sober.

Find Outpatient Treatment Covered by Insurance Near You

If you or a loved one suffers from a substance use disorder, getting treatment as soon as possible is important. Many people are reluctant to seek behavioral health treatment because they believe they must be “strong” and manage their substance abuse independently. Others feel intense shame around their substance use disorder — or around the idea of asking for help.

It is important to recognize that substance use disorders are not personal failings; they are legitimate mental health disorders that are covered by health insurance plans. While there are many reasons why people are sometimes reluctant to get help, finances should not be one of them.

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Given the number of rehab programs in the United States, and in Southern California in particular, it is important to choose one that meets your unique needs. NuView Treatment Center, an outpatient rehab in Los Angeles, is an outpatient rehab that offers all levels of care, including acute care in our partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs), and more flexible care in our outpatient programs (OPs) and aftercare planning.

At NuView Treatment Center, we believe that there is no one-size-fits-all approach to behavioral health treatment. We provide clients with individualized treatment plans that are designed to address their personal history and circumstances.

At NuView Treatment Center, our highly qualified and compassionate staff make use of the latest evidence-based treatment modalities. Our services include:

  • In-depth substance use assessments
  • Substance abuse counseling
  • Progress assessments
  • Cognitive-behavioral therapy
  • Substance Use education
  • Medication-assisted treatment (MAT)
  • Dialectical-behavioral therapy
  • Drug screening
  • Dual diagnosis treatment
  • Group therapy
  • Court-ordered/DUI rehab
  • Life Skills Training
  • Mindfulness-based therapy and other holistic therapies
  • Telemedicine
  • Relapse Prevention

Frequently Asked  Questions

Does Health Insurance Cover Outpatient Rehabilitation and Alcohol Treatment?

Yes, health insurance can cover outpatient rehabilitation and alcohol treatment. The coverage may vary depending on your specific insurance plan and provider. It is recommended to contact your insurance company or review your policy to understand the details of coverage for outpatient rehabilitation and alcohol treatment services.

What are Some Common Barriers to Getting Insurance Coverage for Rehab?

Common barriers to getting insurance coverage for rehab include:

  • Limited coverage for mental health and substance abuse treatment,
  • High deductibles and Out-of-pocket expenses,
  • Preexisting condition exclusions
  • And limitations on the number of covered days or sessions.

What are Some Health Insurance Providers That are Known to Cover Substance Use Treatment?

Some health insurance providers known to cover substance use disorders treatment include

  • Blue Cross Blue Shield,
  • Aetna,
  • Cigna,
  • UnitedHealthcare,
  • and Humana.

However, coverage can vary depending on the specific plan and policy.

How Does Preauthorization for Treatment Work With Insurance Providers?

Preauthorization for treatment is a process where the insurance provider reviews the treatment plan to determine its medical necessity. The treatment facility or healthcare provider usually submits the necessary documentation and obtains approval before proceeding with the treatment.

What if My Insurance Claim for Rehab Treatment is Denied?

If your insurance claim for rehab treatment is denied, you can appeal the decision by providing additional information, documentation, or medical necessity evidence. Working with the treatment facility and seeking guidance from an advocate or healthcare professional can help navigate the appeals process.

How Can I Find Out Exactly What My Current Insurance Plan Covers in Terms of Rehab?

Contact NuView at 323-307-7997 directly to find out exactly what your current insurance plan covers regarding rehab. Our staff can provide information on coverage, network providers, deductibles, copayments, and any limitations or exclusions specific to your plan.

Will My History of Substance Use Impact My Life Insurance Coverage?

Yes, a history of substance use can potentially impact your life insurance coverage. Life insurance companies may consider substance use as a risk factor when determining premiums or coverage eligibility. Factors such as the type and duration of substance use, current treatment or recovery status, and overall health condition will be taken into consideration. It is advisable to disclose your history of substance use accurately and honestly when applying for life insurance to ensure transparency and avoid any issues with coverage.

How Much Does It Cost for Alcohol Treatment Without Insurance?

The cost of alcohol treatment without insurance will vary depending on the type of program, services offered, and location. Generally speaking, a comprehensive residential alcohol treatment center can cost anywhere from $2,000 to $25,000 or more for a 30-day stay. Outpatient programs are typically much less expensive than inpatient treatments but may still cost several hundred to a few thousand dollars.

Can I Choose Any Rehab Center With My Insurance, or is There a Network I Must Select From?

Insurance plans often have a network of preferred providers or facilities. It’s important to check if a rehab center is in-network with your insurance plan to maximize coverage. Out-of-network options may result in higher out-of-pocket costs.

If My Insurance Doesn't Cover the Full Cost of Rehab, What Are Some Strategies to Manage the Remaining Cost?

If insurance doesn’t cover the total rehab cost, strategies to manage the remaining cost can include negotiating payment plans with the treatment center, exploring financial assistance programs, seeking grants or scholarships, or considering personal loans or assistance from family and friends.

Will Insurance Cover Aftercare or Follow-up Appointments Post-rehab?

Insurance coverage for aftercare or follow-up appointments post-rehab can vary. Some insurance plans may cover continuing care services, including therapy or support groups, while others may have limitations.

Can I Use Insurance for Outpatient Treatment or Partial Hospitalization Programs?

Insurance can typically be used for outpatient treatment or partial hospitalization programs, but coverage details may vary. It’s essential to review your insurance plan to understand the coverage and any limitations for these types of programs.

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