Is Drug Rehab Covered by Insurance? - Dana Point Rehab Campus
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Is Drug Rehab Covered by Insurance?

An estimated 75% of adults in the U.S. who suffer from a substance use disorder do not receive any form of treatment, according to the National Institutes of Health. Financial barriers are a common reason many of these individuals fail to seek the professional help and treatment they need at drug and alcohol rehab.

In the past, many private health insurance plans did not cover rehab services. The Substance Abuse and Mental Health Services Administration reports that in 2011, an estimated 10.10% of people with substance use disorders did not receive treatment because their health insurance plans did not cover substance abuse treatment. Today, private insurance plans must cover at least a portion of the cost of rehab services as required under the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act.

If you have private insurance and need help fighting a substance use disorder, here’s what you need to know about your coverage and available treatment options at drug rehab.

Which Rehab Services Are Covered By Private Insurance?

The exact rehab services and coverage you receive under private insurance will vary based on the details of your plan. Some plans may cover drug and alcohol detox, inpatient drug rehab, and behavioral services such as dual diagnosis therapy and addiction counseling, while others may only cover detox and outpatient drug rehab. It’s also important to keep in mind that many private insurance plans will cover only the treatment itself and will not cover costs for amenities and services deemed medically unnecessary, such as gourmet meals, recreational therapies (e.g., horse therapy and music therapy), and holistic therapies (e.g., acupuncture and massage).

The best ways to find out which rehab services are covered by your insurance plan are to contact your insurance provider directly or ask the rehab center of your choice to perform an insurance verification check. Many treatment centers will happily take the time to check your insurance benefits free of charge and discuss your available treatment options. They will also inform you about the charges for which you’ll be responsible.

How Do Covered Rehab Services Work?

Addiction and substance use disorders are extremely complex and often require a wide range of treatments based on a person’s unique situation. Some people may only need behavioral counseling to overcome the root causes of their substance use disorder (such as trauma), while others may need counseling plus intensive care in drug detox to safely recover from drug and alcohol dependence. Many drug rehab centers will tailor treatment plans for each patient based on their unique recovery needs.

Here’s how rehab services covered under private insurance plans work to treat addiction.

Drug and Alcohol Detox

Medical detox is a treatment that helps people safely withdraw from drugs and alcohol to overcome physical dependence on these substances. Detox treatments work differently from one another based on the substance that was being used. For instance, people withdrawing from alcohol are often closely monitored to reduce the risk of seizures, and are given medications that reduce withdrawal symptoms. People withdrawing from benzodiazepines are usually put on tapering schedules during which their dosages are gradually reduced until they are no longer physically dependent.

Medical detox is usually the first stage of addiction treatment. However, not all people may need medical detox, especially those who are not physically dependent on a substance.

Inpatient/Residential Rehab

Inpatient and residential rehab programs allow patients to live at the treatment facility for the duration of their programs, which usually last a minimum of 28 days. Inpatient rehab takes place in a hospital-like environment and is for those who may need medical attention and constant monitoring and supervision. Residential rehab takes place in a more relaxing home-like environment without the same high level of medical care and supervision as inpatient programs.

Inpatient and residential rehab are ideal for those who may need a safe environment to recover in without easy access to drugs and alcohol, and for those who may have a severe case of drug dependence or health conditions that put them at risk for complications during detox.

Outpatient Rehab

Outpatient rehab programs allow patients to live at home while visiting the treatment facility for therapy one or more times per week. Outpatient rehab offers a lower level of care than inpatient/residential programs and is ideal for those who have safe home environments and who are highly motivated to stay sober.

Behavioral Therapy

Behavioral therapy includes a variety of therapies that help people identify, address, and overcome the root causes of their substance use disorders. Behavioral therapy is offered as part of a drug rehab program after patients go through detox. Behavioral therapies for addiction include cognitive behavioral therapy, motivational enhancement therapy, and 12-step facilitation therapy, reports the National Institute on Drug Abuse (NIDA). Dual diagnosis therapy is also available for those who also have a mental health disorder such as depression or PTSD.

Which Rehab Services Do You Absolutely Need?

Detox and behavioral therapy in a drug rehab program are both needed to help people experience a successful, long-term recovery. Detox addresses the physical nature of addiction, while behavioral therapy addresses the psychological nature of addiction. Without detox, those who are physically dependent on drugs and alcohol could face withdrawal-related complications that lead to coma, organ failure, and/or death. Without behavioral therapy, patients may not receive the education they need to learn how to effectively manage triggers such as stress that allow them to live healthier, drug-free lifestyles.

The exact rehab services you need will depend on your unique situation. If you have a severe addiction to alcohol that started after you experienced a traumatic event, you may need alcohol detox and behavioral therapies that help you face and overcome your trauma. If you became addicted to cannabis after you started using it to relieve stress, you may need cognitive-behavioral therapy or education that focuses on healthy stress management techniques.

The doctors and staff at the drug rehab center you choose will assess your addiction type and overall health at the time of intake and develop a customized treatment plan based on what you need to experience a full, safe recovery.

What Is the Cost of Drug and Alcohol Rehab?

The cost of drug and alcohol rehab will vary based on a wide range of factors, such as the type and number of treatments needed, whether you choose inpatient vs. outpatient rehab, and the location of the facility. Inpatient and residential rehab programs typically cost more than outpatient programs. Rehab centers that offer a variety of high-quality amenities in luxurious settings will usually charge more than rehab centers that offer basic amenities in a hospital-like setting.

The NIDA states that the average cost of methadone maintenance treatment for opioid use disorder is approximately $4,700 per year. A study published in the Journal of Substance Abuse Treatment states that as of 2008, the weekly cost of a residential drug rehab program is between $607 and $918 per week.

The best way to determine the exact cost of drug rehab is to contact the treatment center directly. After confirming your insurance benefits, the drug rehab center can discuss which of its services and amenities are covered by your plan and which of those you can expect to pay for out of pocket.

Comparing the Cost of Rehab vs. the Cost of Addiction

Thinking about how to pay for drug rehab can be overwhelming, but it’s important to keep in mind that the cost of addiction treatment is often far lower than the cost of addiction itself if you do not seek treatment. You may also face extra costs for hospitalization and medical bills if your addiction leads to complications such as liver disease or overdose.

For instance, a person addicted to alcohol may spend $8 every day on a six-pack of beer, which equates to roughly $240 for a 30-day supply of beer, or $2,920 for a one-year supply. If that person enrolls in a 28-day residential treatment program, the total cost of treatment may range anywhere between $2,400 and $3,600. This is a relatively small cost to pay for treatment that could help that person stay sober for the rest of their life.

Drug and alcohol rehab is extremely cost-effective in countless other ways as well. The ability to stay sober can result in a higher number of job opportunities and promotions, and reduce medical costs generated on behalf of addiction-related health problems. Addiction treatment can also help people avoid legal costs and problems with the law that may occur on behalf of drunk driving or domestic violence.

What If Your Health Plan Doesn’t Cover Rehab Services?

Most private insurance plans cover rehab services, but if your plan doesn’t, you still have plenty of options when it comes to paying for treatment.

First, consider speaking with your employer. Your employer may offer special assistance for those with substance use disorders or be willing to pay for your treatment if it results in your becoming healthier and more productive in the workplace. If you are worried about discretion, stigma, or repercussions, your company’s human resources department can speak with you in private to discuss your available options.

Next, be completely upfront with the drug rehab center about your financial situation to learn more about your available payment options. Many treatment centers are willing to work with you financially so you can receive treatment as needed. You may be able to set up a monthly payment plan or be eligible for sliding scale fees in which the cost of treatment is adjusted to your income level.

If you still need help covering the cost of drug rehab, look into your options for other health insurance plans, if possible. You may need to choose another health plan that covers the cost of rehab services so you can achieve long-term abstinence and go on to live a more fulfilling, drug-free lifestyle.

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