Will My Rehab/Detox be Covered by Private Insurance?

April 29, 2022
Rehab Center

Using addictive substances can cause changes to the brain that make it difficult to practice self-control, resulting in a difficult time for individuals wanting to give up their addictions on their own. As an individual seeking options for help with an addiction, one option you have is to enter into a rehab facility but cost can be a hindrance for many. An important first step is to look at payment or insurance options to pay for your recovery treatment. This begs the question, “Will my rehab/detox be covered by private insurance?”

What is Private Insurance?

A private insurance plan is marketed by the private health insurance industry as opposed to government run insurance programs, according to Healthinsurance.org. These plans are provided by an employer/place of employment, or private individual/family plans are also available. Private insurance companies still have to abide by state and federal regulations. It is important to do research on private insurance plans to make sure they cover the type of treatment you are seeking because providers can differ in what they will cover.

Are you covered with addiction?

Substance Use Disorder Covered

With the launch of the Affordable Care Act in 2010, coverage for rehab/detox treatment is now required with all healthcare plans purchased through the Healthcare Marketplace. Addiction recovery is considered part of the essential health benefits and pre-existing conditions cannot disqualify an individual from eligibility. That act had an effect on private insurance plans as well.

Many private insurance providers started following the Mental Health Parity and Addiction Equity Act. The MHPAEA of 2008 is a federal law that prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. This essentially means that this act made it possible to include substance use disorders in private insurance coverage.

Most private and group insurance providers do follow this law, except for smaller group insurance plans where an employer with fewer than 50 employees is not required to provide substance use coverage. If you are insured under your place of employment, it is best to check with your employer about what your insurance policy covers.

What is the Best Private Insurance for Rehab?

Private Insurance companies offer two different options for coverage: Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO). Of the two, PPO is the best option when considering entering a rehab facility because PPO gives the individual more freedom. A PPO is flexible because it allows you to go out-of-network with doctors and you don’t need referrals to visit specialists, as opposed to an HMO that requires in-network doctors only and referrals are required.

PPOs allowing out-of-network treatment gives the individual more rehab options. There may be more costly premiums and you may be required to pay a high deductible before becoming eligible for treatment, depending on your policy. Gratitude Lodge accepts most PPO insurance plans. You can use our easy Insurance Verification Check Form to see if your coverage is accepted.

drug and alcohol

Addiction is a Disease

According to the American Medical Association (AMA), alcoholism was classified as a disease in 1956 and addiction was classified as a disease in 1987. The American Society of Addiction Medicine (ASAM) added in 2011 that addiction is considered a brain disorder.

They defined addiction as, “a treatable chronic medical disease involving complex interactions among brain circuits, genetics, the environment and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

Prevention and treatment are possible, given these circumstances and since it is treatable, addiction can be considered a disease just like heart disease, diabetes or cancer. Therefore, private insurances typically will provide coverage for the medical treatment of this brain disease.

What is Covered?

It is important to note that private insurance generally will cover rehab, either fully or partially, depending on what plan you have. Here is a list of things that are typically covered:

  • Inpatient rehabilitation
  • Outpatient care
  • Medical detoxification
  • Medication-assisted treatment
  • Dual diagnosis and co-occurring mental health treatment
  • Continuing care like therapy or counseling
  • Maintenance medication to help sobriety

In turn, the cost of rehab varies, depending on the severity level of treatment, length of stay for inpatient care and your insurance coverage. Most nationwide insurance providers follow these guidelines and some will even offer individualized help based on the need of the individual. It is best to check with your insurance provider or the recovery center you are considering to find out what type of treatment options are covered in your plan.

Overall, there is no clear “yes” or “no” answer on whether private insurance will provide coverage for a rehab/detox treatment center. It depends on the insurance provider and whether or not they deem the addiction case as medically necessary to cover.

Way to addiction recovery

Gratitude Lodge, with luxurious recovery centers in Long Beach and Newport Beach, California, accepts most PPO insurance plans for treatment. Contact us today with your questions about insurance coverage, or use our easy Insurance Verification Check Form to determine if your insurance coverage is accepted.

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We accept most PPO insurance

Drug and alcohol rehab should be accessible to everyone. At Gratitude Lodge,
we work with most insurance plans to cover the costs of treatment.