Insurance Verification for Rehab

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A Guide to Insurance Coverage for Addiction Treatment

In the past, one of the primary challenges of getting clients into rehab suffering from substance abuse into was the matter of insurance coverage. Fortunately, years ago, getting coverage for drug or alcohol rehab was far more complicated than it is currently.

Insurance wasn’t as widely available as it is today, and not having private insurance often meant paying cash for treatment. With the high cost of many facilities, many clients were left with few choices other than severely underfunded state facilities that lacked the means to provide up-to-date treatment.

However, things have changed, and the inception of the ACA Marketplace ensures that every man, woman, and child has access to affordable healthcare based on income. Even those with no measurable income are given Medicaid plans, which provide many options for substance abuse treatment.

Keep reading to find out more about insurance coverage and insurance verification for rehab, and what Resurgence Texas offers to make sure each client receives the care they need.

Does Health Insurance Cover Substance Abuse Treatment?

When the Obama administration began implementing the ACA Marketplace, part of the legislation included specific regulations regarding the coverage insurance companies provide. One of the provisions made it mandatory that each of the national insurance providers available through the ACA Marketplace offered coverage for substance abuse treatment.

It does not specify the level of care covered or the specific form of therapy. However, most insurance companies offer various policies that include different coverage levels, co-pays, premiums, and other specifics.

Typically, the lower your co-pay is, the lower the amount of overall coverage that’s provided. When individuals pay higher co-pays, the insurance agencies typically cover a more significant portion of the overall cost.

Addiction Treatment Coverage and Your Insurance Policy

In addition to providing coverage, one of the provisions highlighted in the Obamacare program is that all insurance companies must provide some form of coverage for substance abuse. The specific level of coverage varies based on several factors, but it’s led to a more advantageous scenario in terms of clients obtaining the help they need with substance abuse.

If you’re planning on attending a substance abuse treatment center, you must accomplish two things. First, contact our facility to ensure we accept insurance from your insurance provider. This insurance verification is completely confidential and will never affect your coverage.

Second, if you need to know the extent to which your form of insurance covers rehab services. Have no fear! During your call, and as part of the insurance verification process, our team will let you know any out-of-pocket costs associated with attending addiction treatment services.

What Types of Rehab Does Insurance Cover?

The type of rehab covered by your insurance company depends on the company itself and your specific policy. Typically standard forms of treatment are covered, including 12-step type programs and other evidence-based forms of therapy.

Typically inpatient, outpatient, and intensive outpatient are all levels of care that receive coverage. Most insurance providers also cover medically assisted detox.

However, you must still get insurance verification regarding a detox program, as many ACA marketplace carriers partially cover medical detox programs. Many national insurance providers extend coverage under the grounds that a pre-authorization form is submitted to your insurance company.

Insurance companies cover specialized rehabs that provide holistic treatment and dual-diagnosis rehabs on the same grounds. Pre-authorization must usually notify the insurance company regarding the treatment specifics and why you’re required to obtain that specific form of therapy.

Getting Insurance Verification for Rehab

Obtaining insurance verification for rehab usually entails the client contacting the insurance provider along with the insurance company to have the stay approved. A member of the admissions team at the rehab typically contacts your insurance agent.

Your levels of coverage are verified by your agent, allowing the representative from the rehab facility to determine what your co-pay or other out-of-pocket expenses are. Normally the rehab accepts this money directly, and the rest of the payment for your treatment services is billed directly to the insurance company.

Many out-of-pocket expenses can be avoided by actively having two separate insurance policies.

Can I Have More than One Insurance Provider?

Clients can receive coverage from separate providers. Usually, individuals will have private insurance through their employer and Medicaid or another form of insurance through the ACA marketplace.

This provides several advantages for clients, including:

• If one insurance company doesn’t provide coverage for a particular facility, the other one might
• If you have additional expenses after using one of your policies or have yet to reach your out-of-pocket maximum

One of the most common questions from individuals seeking rehab is whether they can attend rehab without insurance.

Can I Go to Rehab Without Health Insurance?

Many people inquire whether it’s possible to attend rehab without insurance. The most straightforward answer is yes. No requirement or law states that you must have insurance to attend rehab, nor will any rehab ever turn you down, assuming you have alternative means to cover the treatment.

When someone doesn’t have insurance, the cost of treatment must be covered in cash. However, certain alternative situations exist depending on the specific treatment center and where you live.

Some cities offer rehab programs free of cost and are considered complimentary programs funded by the state. though these often do not offer immediate help and may require a waiting list. It’s also possible for rehab to work out some form of payment plan with a client, but typically, some down payment must be satisfied up front.

Specific organizations also award users with grants for treatment. Certain state governments also allocate a certain amount of their budget to use in grant programs to pay for substance abuse treatment for residents.

Seeking one of these alternative methods is far more realistic for most people, as the average user doesn’t have the money to pay for the tens of thousands of dollars it costs out of pocket. However, with the inception of Obama Care and the ACA, lack of insurance is becoming an issue of the past.

The ACA Marketplace for Rehab

The ACA Marketplace, or Obama Care, is a network of insurance providers offered to every United States citizen based on their budget. Individuals sign up during an open enrollment period and are provided insurance plans from various providers based on their income levels.

If an individual has little to no income, Medicaid is usually the typical determination. Medicaid clients typically cover all their treatment costs because of their lack of income.

While this has its advantages, recipients are typically limited to physicians and treatment centers in the insurance company’s network. These treatment options vary depending on your coverage, where you live, and the company that provides your policy.

Common Types of Plans and Benefits for Addiction Treatment

Typically insurance companies provide coverage for multiple forms of treatment and various levels of care. Clients initially entering a treatment facility may need to enter medically-assisted detox to ease the discomfort of withdrawal.

Many insurance companies provide coverage for this form of treatment, although a pre-authorization form could be required. Beyond detox, most providers cover inpatient, outpatient, intensive outpatient, and partial hospitalization programs for rehab.

Typically, plans provided through the ACA Marketplace have three coverage levels – bronze, silver, and gold. Gold offers the most coverage but has a higher copay. Bronze has a lower copay but provides a lower amount of overall coverage.

How Can I Find Out the Coverage of My Policy?

To find out the coverage of your policy, all you need to do is contact your insurance company and agent. A quick conversation will reveal your level of coverage.

You can also find your co-payment amounts and any other out-of-pocket expenses you may incur. This will help you decide your total cost of addiction treatment.

What Is the Cost of Addiction Treatment?

The cost of addiction treatment varies depending on the specific facility. Receiving an exact answer to this question ultimately rests on the program you enter.

For example, some high-end facilities with luxury amenities charge upwards of six figures for a 30 to 45-day stay in rehab. On the lower end, the price still hovers somewhere in the tens of thousands, depending on the facility.

What Mental Health Treatments are Covered by Insurance?

Insurance companies must provide mandatory coverage for mental health disorders as they do for substance abuse disorders. This occurs when the mental health disorder is separate from substance abuse.

Because of these provisions, it typically means that dual diagnosis disorders are covered during treatment. This is the occurrence of a mental health disorder in conjunction with a substance abuse disorder.

Because these issues are so complex, a specific treatment is required to treat them properly. In addition to dual diagnosis therapy, counselors may prescribe alternative forms of treatment using holistic-based methods.

Are My Medications Covered During Treatment?

Most of your medications are covered during treatment in the rehab facility. This is considered part of your care or individual treatment plan that your insurance company covers.

However, it’s worth noting that if you’re sent home with prescriptions after treatment, your insurance company may not provide the same level of coverage before you leave rehab. That said, most providers cover at least a portion of medication or give some type of discount program.

Insurance Coverage for Aftercare Programs and Sober Living

Many clients receive a recommendation to enter a sober living house or aftercare program after they complete treatment. None of these facilities are free; many people leaving treatment haven’t worked and cannot pay for these programs out of pocket.

Luckily, many providers DO cover aftercare programs and sober living facilities. It’s essential to know exactly what your provider is covering. Rent costs are usually covered as long as the sober living house is considered a part of the treatment you’re receiving.

Effective Treatment Programs That Accept Insurance: Found Here

At Resurgence Texas, we work with multiple insurance providers to ensure you receive the treatment you need. If you have any questions regarding insurance acceptance or becoming a client, please contact a member of our Admissions staff today.

All calls are completely confidential and will never affect what your policy covers or your monthly premium. Take advantage of your benefits and reach out for immediate help!