Paying For Rehab—Insurance Coverage

Recovering individuals have many options when it comes to paying for rehab. Some of these include insurance, scholarships and grants, rehab-specific scholarships, and sliding fee pay scales.

Paying For Rehab Insurance Coverage_

Finding the right addiction treatment program is one of the most important things a person can do to get clean and sober. Unfortunately, not everyone can pay the full cost of drug or alcohol rehab out of pocket. When it comes to paying for rehab, you have many options available. Here are just a few:

  • Cash pay
  • HMO or PPO insurance coverage (if you have it)
  • Entering a state-funded program,
  • Securing a scholarship or grant

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2015,

There were about 19.3 million people aged 12 and older who needed substance use treatment but did not receive substance use treatment at a special facility.

This number accounts for more than 89 percent of all people who needed treatment for substance use that year.

There are many reasons people don’t enter treatment, such as shame or guilt, not believing they need treatment, and largely financial reasons. Lack of insurance, connection to resources, or simply lack of information about the payment options of many drug and alcohol rehab centers may keep addicted individuals from getting the help they need.

With so many options available, financial distress should never be the reason a person does not receive treatment.

Drug and Alcohol Rehab Insurance Coverage

Drug and Alcohol Rehab Centers That Accept HMO Insurance

If you have an HMO insurance plan, and you’re considering drug or alcohol rehab, it’s important to know what’s covered under your plan before heading to treatment. To start, HMO plans tend to cover drug rehab for most individuals.

Plans vary, but most health plans now provide coverage for substance abuse/addiction and mental health services. This is largely due to changes in federal regulations for coverage plans under the Mental Health Parity and Addiction Equity Act (MHPAEA).

The Centers for Medicare and Medicaid Services (CMS) explains that the Act is a federal law that, “generally prevents group health plans and health insurance issuers that provide mental health and substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.”

In other words, treatment for substance abuse or mental health conditions must be covered to the same extent and provisions as other health conditions.

If your HMO plan provides coverage for drug rehab, the next step is finding a rehab center. HMO plans work by consorting directly with treatment centers and hospitals to create a network of preferred providers for treatment of covered individuals. This is known as a managed care system. After you contact your HMO provider, you can ask for a network list, and select a rehab center based on the list.

If you choose to seek treatment outside the managed care plan, you’ll have to choose an out-of-network rehab facility. This is where the process can get tricky, as many HMO providers impose strict limitations on out-of-network treatment, and may not cover treatment at all outside the network. Before entering treatment, you may need to provide prior authorization from a doctor stating that substance use treatment or mental health treatment is medically necessary in order to receive coverage.

Will My Insurance Pay For

Rehab?

Check Now

Once all the details are in place with your HMO plan, you simply need to review what your premiums will cost, what your out-of-pocket cost will be after insurance, and how to cover any co-pays.

Drug and Alcohol Rehab Centers That Accept PPO Insurance

PPO, or Preferred Provider Organization, plans operate within a small or large network of physicians, providers, and treatment centers. That means that with your PPO plan, you can seek treatment from any health care professional within the network, without getting a referral.

This type of plan differs from HMO in that HMO plans tend to have tight restrictions on providing coverage for out-of-network care providers. PPO plans offer more leeway in seeking treatment with out-of-network care providers, and will still cover your care if it’s not in your network, even if covering at a lower rate. For this reason, PPO plans tend to be more popular among consumers.

The following is a list of select PPO providers:

  • Aetna
  • Anthem
  • Blue Cross Blue Shield
  • Cigna
  • Humana
  • United Healthcare

PPO insurance plans tend to charge a copay for doctor visits, and you may have to reach a certain deductible before coverage will begin for rehab. The length of stay covered by PPO plans will also vary from plan to plan. With HMO plans, only medically-approved stays of a certain length are typically covered, but with PPO, the length of stay covered may depend on your needs, or could be determined according to your plan’s policy.

To know for sure, it’s best to contact your coverage provider, or speak to a treatment specialist who can help review your health benefits and limitations.

State-Funded Drug And Alcohol Rehab Programs

State-funded programs are drug and alcohol treatment centers funded by taxpayer dollars. This may be through Medicaid and Medicare or through grants. These programs help bring addiction recovery to people who may not otherwise receive it.

To get state-funded treatment, you first have to qualify. People may qualify if they have low income, no insurance, insurance that won’t cover the cost of rehab, or other financial issues. If you do qualify, you may receive entry into a treatment program with all or most of the rehab costs covered. You may be required to provide proof of residence, proof of income, or other documentation before entering treatment.

Because state-funded programs receive their funding from government sources, many limitations may be imposed on the facilities that operate these programs, or may arise as a result of the nature of the program. For example, state-funded programs may not have access to the latest evidence-based treatment modalities, or to provide the most up-to-date technology.

State-funded programs may not provide a vast array of services, and may not include individual counseling or support programs, two treatment components which contribute greatly to recovery success. Because many people need help in securing adequate treatment, these programs also tend to have long waiting lists, and may not provide a comfortable, accommodating environment in which to heal.

Getting addicted individuals away from the environment of abuse, and into a welcoming environment equipped with all the necessary resources and comforts needed to heal, is important to overcoming addiction and dependence issues.

If you are considering applying for a state-funded program, you may also want to look at private rehabs. You may have more options for paying for rehab than you even realize.

Paying For Rehab With Cash

Depending on the program, the total cost of an inpatient rehab stay can be extremely expensive.. Helping people change their lives for the better, and improve every aspect of their health, takes time and access to resources. Many rehab centers understand that paying the full cost of rehab upfront isn’t possible, and that’s why a lot of rehab centers offer payment plan options.

For those who qualify, or have lower socioeconomic status, cost of rehab may be income-based and include installment payments. This is known as a sliding-scale fee. Other options may include a down payment and payment schedule set in advance, so you can plan accordingly.

If you don’t have insurance, or choose not to use it for rehab, you may want to dip into your personal savings if you have one. Entering rehab is a decision that will change your life, and help you establish behaviors that will help you overcome addiction and manage the disease long-term.

People close to you, such as friends or relatives, may be willing to help cover the cost of rehab by way of support. If you have personal items of value, and can part with them for the greater good of your health, you may want to consider selling some things in order to contribute to your rehab funds.

Lack of insurance shouldn’t be a reason to not enter treatment. If you don’t already have an insurance plan, you may qualify for a scholarship, grant, or be able to apply to a state-funded program, or qualify for state aid in insurance. If you have insurance, it is always better to cooperate with your coverage provider to lessen your out-of-pocket cost.

Scholarships And Grants To Pay For Rehab

If you are unable to or not interested in applying for a state-funded rehab, do not have insurance, and have no other way to pay for the cost of rehab, you may still have options. There are many scholarships and grants available to help addicted individuals secure and complete rehab.

For example, the Sobriety Optimization League Scholarship Foundation (SOL) selects a number of need-based applicants every year and awards them with the funds to enter drug or alcohol rehab. The SOL also strives to provide addicted individuals with education, support, and resources. SAMHSA, a government entity, provides a number of grants every year for substance use treatment programs.

Certain rehab centers also provide in-house scholarships to a number of qualified applicants. Even if you believe you have no access to payment for treatment, help is available in any number of ways.

Is Rehab Worth The Cost?

After reviewing the cost of rehab, and the process of entering it (which can seem daunting), you may be wondering if rehab is even worth the cost you pay to complete it. Yes, a solid drug rehab program is worth the price you’ll pay for countless reasons. Here are a few:

Rehab changes lives: according to the National Institute on Drug Abuse (NIDA), “most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning.”

Rehab helps socioeconomic well-being: the NIDA states, “drug addiction treatment has been shown to reduce associated health and social costs by far more than the cost of treatment itself.”

Rehab restores health: many people with dependence issues will need detox, and people who have abused substances or struggle with addiction or dependence long-term may have vast health issues. All can be treated during rehab, and in continued aftercare.

Figuring out how to pay for rehab is but one hurdle on your journey to restored health and wellness. Don’t let it stop you from entering addiction recovery, regaining your health, and building the life you deserve, free from the pull of addiction.

Find A Rehab Center That Fits Your Needs Today

If you or someone you love is struggling with addiction or dependence issues, and you need help paying for rehab or would like more information on your options we can help.

At InpatientDrugRehab.org, we can connect you with rehab centers who will work with your insurance, help you design custom plans based on your treatment needs, and direct you to resources necessary for treatment. To learn more, contact us today.

 


Sources

Centers for Medicare and Medicaid Services—The Mental Health Parity and Addiction Equity Act
National Institute on Drug Abuse—How Effective Is Drug Addiction Treatment?, Is Drug Addiction Treatment Worth Its Cost?
Sobriety Optimization League Scholarship Foundation
Substance Abuse and Mental Health Services Administration—Grants, CBHSQ Report: America’s Need for and Receipt of Substance Use Treatment in 2015

Get Help Now

For Immediate Treatment Help Call:
(866) 904-9724