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Drug addiction is one of the most challenging problems an individual can face. It can drastically affect the physical & mental health, as well as the entire life of the individual who has become addicted. Not only that, but the lives of those close to the addicted individual can be dramatically affected as well. Facing drug addiction is hard, and even when someone decides to enter drug rehab, there can be considerable concerns over how they are going to pay for it.

What is Drug Rehab?

Drug rehab is another term for addiction recovery. It is a combination of different therapies, counseling methods, and educational activities that are designed to help someone not only diagnose their illness and understand it more but recover from it as well. Drug rehab can be used to treat single drug addiction, polysubstance abuse, and even dual diagnosis for co-occurring diagnoses. There is a wide range of rehab services available to those who need them, and the most common include:

  • Inpatient treatment where the individual lives at a treatment center for anywhere between 30 and 90 days. These are opportunities to not only complete the detox and withdrawal stage but to receive psychological help at the same time. Often after inpatient programs, the individual can begin living in transition homes.
  • Outpatient treatment is highly flexible and allows the individual to live at home during the treatment period. They attend treatment at a facility for several hours a day, getting counseling and medical detox assistance.
  • Partial hospitalization is seen as one of the most rigorous and intensive versions of outpatient treatment. The individual will spend most of the day, at least five days a week, at a treatment facility.

Will Insurance Pay for Drug Rehab?

One of the most common concerns for individuals entering drug rehab is if their insurance will pay for the treatment program. In most cases, private insurance will offer some degree of insurance coverage for the treatment of substance use disorder or alcohol use disorder. Most people don’t know this, however, and that is part of the reason that 89% of the people who need treatment may not get it.

The Affordable Care Act & Drug Rehab

The Affordable Care Act or ACA compelled most insurers to offer some degree of coverage for addiction treatment and drug rehab. That said, many insurers will require proof that the treatment is “medically necessary,” and even then, the level of treatment required can vary. Often this will require a referral from a doctor prior to obtaining treatment at an approved facility. 

How Long Does Insurance Cover Rehab?

Not all insurers will cover drug rehab, but those that do have coverage will often have time limits to that coverage. There will also usually be coverage limitations based on what stage of recovery the individual is in. 

There will be the detox phase and potential inpatient treatment, and then there will likely be a stage of outpatient treatment needed as well. In some cases, the individual will need ongoing therapy or counseling, but it will be rare that insurance will cover a significant portion of that, even under the Affordable Care Act.

For the detox stage, insurance will often cover the first 3-10 days of drug detox, though this will depend on the facility’s assessment of the individual upon arrival. Following the initial detox phase, insurance will frequently cover at least 28 days and sometimes up to 60-90 days of inpatient treatment. Sometimes, the insurance company will commit to a set number of covered days up front, then require an additional assessment of the individual’s needs following that period.

If the insurance company has allowances for outpatient care, they will generally be separate from the rest of the treatment. The average coverage period for continuing care options like outpatient is six months, though coverage does vary, and some insurers will even cover expenses at sober living facilities or halfway houses.

Factors That May Determine If Insurance Will Cover Rehab

One of the biggest factors that will determine if treatment will be covered is whether the insurance is provided through a private insurer, or through a source such as Medicare or Medicaid. Generally, private insurers will have more stipulations for coverage as well as more limitations in some cases.

Another significant factor that will affect the coverage of drug rehab by insurance is whether the treatment is obtained at an “in-network” facility. Facilities that are not considered in-network will likely place a much greater portion of the treatment cost on the individual, in some cases even the entire cost. 

Verify Your Insurance Benefits

If the individual needing drug rehab services does have insurance and the insurance company has provisions for covering some form of addiction services, it’s important to have all the information possible before entering treatment. Contact the insurer and get specifics on what services are covered, for how long, and if there are any contingencies or caveats involved. 

Some insurers will only cover services if they require inpatient rehab or partial hospitalization, while some will only cover outpatient. Some may only cover services for up to 30 days, while others may cover the full treatment for up to 90 days. Knowing what the insurance will cover is a vital part of creating a functional and effective treatment plan.

How to Pay for Rehab Without Insurance

If you or someone close to you needs help overcoming drug addiction, and you don’t have insurance, or your insurance isn’t able to cover the necessary drug rehab costs, there are still some options that will help the individual get treatment. Not only are there options for sliding fee scales, or income-based payments, there may be additional options for payment plans and even free treatment services. No matter what it takes, it’s important to get treatment as soon as possible.

To see what options are available to you, reach out today to your local addiction experts. You can discuss your needs, as well as get information on the cost of treatment. A treatment plan that is tailored to the individual’s needs, as well as their ability to pay, can be created, and the journey to recovery can begin.