February 20, 2024

How to Get Insurance to Pay for Inpatient Rehab

therapist and client representing what is an addictive personality

Are you wondering how to get insurance to pay for inpatient rehab? If so, most health insurance policies offer coverage for inpatient rehab, but the amount and specifics of this coverage can vary by policy. 

Some insurance policies may also require pre-authorization or a healthcare provider’s referral as prerequisites for covering inpatient care. This means that you should be aware of any such requirements or coverage restrictions before starting treatment, to prevent unforeseen expenses or claims rejections.

If you’d like a real person to assist you in determining your coverage, call our friendly team today at 800-994-2184

Otherwise, read on to learn more about getting insurance coverage for inpatient rehab. 

In this blog, we will cover:

  • Does insurance cover rehab?
  • Will insurance cover my child’s rehab?
  • Does insurance cover rehab for alcohol?
  • Does insurance cover drug rehab?

 

Check My Insurance Coverage

Get a fast & free coverage check for inpatient rehab. Your insurance may cover up to 100% of treatment.

How Do I Check My Rehab Insurance Coverage?

Use our free insurance coverage check by clicking here, or calling our friendly team at 800-994-2184.

Or, read on to learn more about getting inpatient rehab coverage. 

Determining your insurance coverage for rehabilitation services is a fundamental step before commencing any treatment. Here’s how to check your rehab insurance coverage:

  • Review your insurance policy: Start by thoroughly reviewing your insurance policy documents. These documents often include detailed information about covered services, limitations, exclusions, deductibles, co-payments, and co-insurance.
  • Contact your insurance provider: Reach out directly to your insurance company for specific information about your coverage. Customer service representatives can clarify what types of rehab services are covered, the duration of coverage, any pre-authorization requirements, and out-of-pocket expenses you might incur. Make sure to ask specific questions related to both inpatient and outpatient rehab services.
  • Ask about network providers: Inquire if your insurance plan has a network of preferred rehab providers. Using in-network services typically results in lower out-of-pocket costs. Also, ask about the process and coverage implications if you choose a rehab facility outside the network.

  • Understand pre-authorization requirements: Some insurance plans require pre-authorization for rehab services. This means that you need approval from your insurance provider before starting treatment. Understand this process, as failing to get pre-authorization could result in coverage denial.
  • Consult with your healthcare provider: Your doctor or mental health professional can provide guidance on the necessary steps to take for insurance coverage. They might also assist with the pre-authorization process.
  • Check state and federal laws: Be aware of any state and federal laws that might impact your coverage. For instance, under ACA, certain essential health benefits, including mental health and substance use disorder services, must be covered.
  • Document all interactions: Keep a record of all interactions with your insurance provider, including dates, the representative’s name, and the information provided. This documentation can be helpful in case of discrepancies or disputes.
  • Seek assistance if needed: If you find the process overwhelming or confusing, consider seeking help from a healthcare advocate or a representative from the rehab center. They often have experience dealing with insurance companies and can provide valuable assistance.

By taking these steps, you can gain a clear understanding of your rehab insurance coverage, helping you make informed decisions about your treatment options without unexpected financial burdens.

Qualify for Inpatient Rehab Today

Call today to begin treatment at our world-class inpatient rehab. Our program works with a variety of insurance plans to get you or your loved one the help you need.

Is Rehab Covered by Insurance?

So will my insurance cover rehab? Many health insurance plans include coverage for rehabilitation services, but the extent and conditions of rehab insurance coverage can vary widely.

  • Type of plan: Private health insurance plans, employer-sponsored plans, and government-funded programs like Medicare and Medicaid all have different rules and coverage levels for rehab services.
  • Extent of coverage: Insurance plans may cover various types of rehab services, including inpatient, outpatient, and partial hospitalization programs. However, the proportion of costs covered – full or partial – and the duration of coverage can differ. Some plans may cover the entire stay at a rehab facility, while others may only cover certain aspects or a set number of days.
  • Pre-authorization and referrals: Many insurance providers require pre-authorization for rehab services. This means that the need for rehab must be medically justified. Additionally, a referral from a primary care physician or a mental health professional may be necessary to obtain coverage.
  • Coverage for different therapies: Insurance plans may also vary in terms of what types of therapies they cover. Traditional therapies, like individual counseling and group therapy, are commonly covered, while alternative therapies might not be.
  • Out-of-pocket expenses: Even if rehab is covered, individuals may still be responsible for certain out-of-pocket expenses like deductibles, copayments, or coinsurance.
  • Network restrictions: Some insurance plans have network restrictions, meaning that they only cover services provided by certain rehab centers within their network.
  • State and federal regulations: Insurance coverage for rehab can also be influenced by state and federal regulations. For example, under ACA (Affordable Care Act), insurance plans are required to cover mental health and substance use disorder services as essential health benefits.
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Will Insurance Cover My Adult Child’s Rehab?

Under the ACA (Affordable Care Act), insurance plans are required to offer dependent child coverage up to age 26. Even if your adult child has moved out or married, this rule applies to all individual and employer (PPO) plans. However, this rule does not apply to Medicare, and your child will require their own insurance if your policy is under this umbrella.

The ACA also mandates that insurance policies must extend coverage for substance use disorder treatment (rehab). This rule also covers dependents up to 26 years old. 

So yes, insurance will cover your child’s rehab treatment until they turn 26. However, the extent of that coverage will vary based on individual policies. 

How Many Times Will Insurance Pay for Rehab?

The frequency with which insurance will pay for rehab depends on several factors, including:

  1. The specific insurance policy, the type of coverage
  2. Individual circumstances.

 

Each insurance policy has unique allowances on the number of times they will provide rehab coverage. If you’re unsure whether your insurance will cover a second, third, or additional stay, call our helpline at 888-861-1658 to verify your coverage. 

However, as a rule, insurance companies typically cover rehab services that they deem medically necessary. This typically just requires a healthcare provider’s assessment and recommendation for treatment. 

If a person relapses and needs additional rehab, a new assessment may be required to establish the medical necessity for further treatment.

Coverage might also depend on the type of treatment. For example, an insurance company may be more likely to cover multiple outpatient treatment sessions compared to multiple inpatient stays, considering the cost differences.

Insurance coverage can change with each plan renewal, usually on an annual basis. Changes in healthcare laws and insurance policies can affect the extent and frequency of coverage.

For each rehab admission, pre-authorization might be required. Failure to obtain this could result in the insurance company refusing to pay for the treatment.

Laws such as ACA and MHPAEA (Mental Health Parity and Addiction Equity Act) can influence insurance coverage. These laws often require plans to provide coverage for mental health and substance use disorder treatments similar to other medical coverage.

If coverage for a rehab session is denied, individuals have the right to appeal the decision.

Understanding your policy’s appeal process is highly beneficial in these situations.

It’s essential for people to directly contact their insurance provider to understand the specifics of their coverage, including how many times rehab treatment will be covered. Each situation is unique, and policies vary significantly between different insurers and individual plans.

 

Man talking to counselor about how to get help for drug addict son

The ACA Act & Rehab Insurance Coverage

ACA was enacted in 2010 and brought significant changes to health insurance coverage in the United States, particularly impacting coverage for rehabilitation services. ACA includes provisions that directly affect how insurance plans cover rehab for substance abuse and mental health treatments.

Under ACA, mental health and substance use disorder services are classified as essential health benefits. This means that all ACA-compliant health insurance plans are required to cover these services.

ACA, in conjunction with MHPAEA, mandates that health plans offer coverage for mental health and substance use disorders that is no more restrictive than the coverage for medical or surgical services. This means that limitations on rehab services (like co-pays, deductibles, and treatment duration) should be comparable to those levied for other types of medical care.

ACA prevents health insurance plans from charging higher premiums or denying coverage for pre-existing conditions. This includes substance use disorders, ensuring that individuals seeking rehab services cannot be denied coverage based on their addiction history.

ACA led to the expansion of Medicaid in many states, increasing access to rehab services for low-income individuals. Medicaid expansion states must provide coverage for essential health benefits, including substance abuse treatment.

ACA emphasizes preventive services, including screening for substance abuse. Early intervention can be covered without cost-sharing, which encourages individuals to seek help before a full-blown addiction develops.

Under ACA, young adults can stay on the health insurance plans of their parents until the age of 26, providing broader coverage options for younger people who might need rehab services.

ACA established health insurance marketplaces, making it easier for individuals and small businesses to compare and purchase health insurance plans. These marketplace plans are required to cover essential health benefits.

Policy details like coverage limits, co-pays, and deductibles can vary, so direct consultation with the insurance provider is advisable for clarity on rehab coverage specifics under the ACA.

FAQs

Will health insurance cover rehab for drugs?

Most health insurance plans cover drug rehabilitation services, but coverage varies depending on the plan and the specific treatments required.

Does health insurance cover alcohol rehab?

Yes, health insurance often covers alcohol rehab, subject to the terms and limits of the policy.

Does insurance cover inpatient rehab?

Insurance may cover inpatient rehab if this is deemed necessary for the treatment of a severe substance use disorder or mental health condition. Again, the extent of coverage is contingent on the insurance plan and the nature of the inpatient rehab program.

Do you have to pay for rehab?

Yes, you usually have to pay for rehab, but the cost can vary greatly depending on the type of rehab, the location, and whether or not you have insurance coverage.

An image of gratitude lodge, representing Will health insurance cover rehab

Ready to Take The First Step? Call Today to Begin Inpatient Rehab

When you are ready to begin your recovery journey, reach out to Gratitude Lodge and engage with effective inpatient treatment in Southern California.

Most people withdrawing from drugs or alcohol find that supervised detox streamlines the intensity of the process and helps them address physical dependence. Detox at our Long Beach or Newport Beach rehabs also acts as a transition to ongoing inpatient treatment.

All addictions are different and all treatment programs at Gratitude Lodge account for this by delivering individualized therapies that include:

  • Talk therapy
  • Holistic treatment
  • Individual counseling
  • Group therapy
  • Family therapy
  • Medication-assisted treatment
  • Aftercare

If you’re asking yourself, does insurance cover rehab? our friendly team of recovery experts can help check your coverage for free. When you are ready to begin your recovery from addiction using health insurance, call Gratitude Lodge at 888-861-1658.

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Joe Gilmore

Joseph Gilmore

Joseph Gilmore has been working in the addiction industry for half a decade and has been writing about addiction and substance abuse treatment during that time. He has experience working for facilities all across the country. Connect with Joe on LinkedIn.
Jenni Bussi

Jenni Busse MS, LPCC

Jenni Busse MS, LPSS is the Clinical Director at Gratitude Lodge. Jenni oversees the clinical program and the clinical team at Gratitude Lodge as a whole. Jenni has worked in treatment for almost 14 years. Her background as a licensed therapist and her passion for helping others intersected with addiction recovery when she started working primarily in detox residential treatment.

Drug detox can vary according to the patient’s addiction factors, including the substance abused, how long the addiction has lasted, the patient’s medical condition, if any other disorders are present, and more. Our skilled and credentialed team at Gratitude Lodge work closely with every patient going through drug detox, facilitating the beginnings of a successful recovery at our rehab addiction centers in Orange County, CA.

Drug detox can vary according to the patient’s addiction factors, including the substance abused, how long the addiction has lasted, the patient’s medical condition, if any other disorders are present, and more. Our skilled and credentialed team at Gratitude Lodge work closely with every patient going through drug detox.

Many patients don’t realize the toxicity of prolonged alcohol abuse and how it affects the body. Alcohol detox at the luxurious rehab addiction centers at Gratitude Lodge leeches your body of these toxins in preparation for successful treatment for drugs and alcohol abuse. Alcohol detox may not take as long or produce severe withdrawal symptoms, but it is still an essential beginning to your recovery.

Many patients don’t realize the toxicity of prolonged alcohol abuse and how it affects the body. Alcohol detox at the luxurious rehab addiction centers at Gratitude Lodge leeches your body of these toxins in preparation for successful treatment for drugs and alcohol abuse.

Holistic Therapy

Our holistic therapy treatments offer a full-scope approach to recovery, addressing your mind, body, and emotions as part of a comprehensive treatment plan. This therapy is designed to help address underlying issues and integrate alternative therapies to promote overall health and well-being.
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Psychotherapy

An essential part of your treatment experience, we offer individual (CBT and DBT talk therapy) and group addiction treatment counseling to help you explore and address the emotional component of addiction, providing you with the tools, self-awareness, and empowerment you need to maintain recovery.

Dual Diagnosis

Dual Diagnosis is a highly effective addiction treatment that addresses substance use and mental health disorders simultaneously. Often co-occurring, these disorders are best managed when treated together with specific and targeted therapy.
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Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment provides you with FDA-approved medications to help ease the symptoms of withdrawal while you’re in treatment. This makes the detox process easier and safer, as well as increasing the chances of a successful recovery.

Sober Living

Sober living provides a supportive and substance-free living environment for your ongoing recovery. We partner with a number of upscale and carefully vetted sober living homes that are available to our clients after inpatient alcohol and drug addiction treatment.
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Outpatient Treatment

Once detox and inpatient are complete, we provide an easy transition to outpatient care through our hand-selected partners. This program offers a more flexible approach, allowing you to ease back in to daily life while still receiving frequent & effective care.
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Inpatient
Treatment

Inpatient treatment provides an intensive and comprehensive addiction treatment program in a structured environment. You will receive 24/7 expert care, therapy, and support as you build your foundation for long-term recovery.

Drug & Alcohol Detox

A crucial first step in the recovery process, our detox program provides a comfortable, medically supervised environment that addresses the physical aspect of addiction and eliminates substances from your body.

Use Our 24 Hour text line. You can ask questions about our program, the admissions process, and more.