Does Insurance Cover Rehab? - Prosperity Haven

Does Insurance Cover Rehab?

Addiction isn’t easy, especially when you’re fighting against it alone without any support. Residential treatment can help you turn the tide and forge a new path forward with better, brighter days – but it does come at a financial cost.

Depending on your income and situation, these costs may seem prohibitive at first. But those costs do grant you access to one of the most valuable experiences the addicted person can ever have – healing. The ability to walk forward each day without using, feeling happy and content with your life, is priceless.

The problem is that even when something is valuable, it can still feel difficult or even downright impossible to afford. Patients often wonder if they can bill their stay to their insurance provider or if the provider will force them to pay out of pocket.

Every Insurance Plan Is Unique

First, a really important fact: every insurance provider and plan offers a unique range of coverage and services. Just because one person’s plan covers inpatient treatment doesn’t mean someone else on similar coverage with the same provider will also have coverage. Likewise, just because someone you know isn’t covered doesn’t mean you will be.

In truth, even your condition and the severity of your addiction, or other complicating factors like comorbid mental illness, can alter whether you are covered. An insurance company may, for example, agree to cover inpatient rehab for someone who is also bipolar because the facility can treat both conditions at once. They view this as the more cost-effective and results-effective choice for the patient.

Above all else, you shouldn’t make any assumptions. Doing so could leave you high and dry at the last minute. Instead, speak with your insurance provider directly in advance and ask for details about your plan.

Providers Who Commonly Provide Rehab Coverage

The previous cautionary note aside, there are certain providers who are more likely to include coverage for residential treatment than others. Some of these organizations work solely with businesses for group policies, while others are available to the general public.

If you have one of these providers, your individual plan may or may not include coverage. Check your benefits book carefully or log into your provider’s online portal to verify whether or not you are covered. Be sure to confirm if the provider allows direct billing or if they reimburse you after the fact; this will make a difference.

You won’t necessarily be denied coverage for residential treatment even if you have a policy with a provider not present on the above list. Even in situations where your provider allows coverage, but does not yet have an existing relationship with your chosen treatment facility, there may be options available to you. Your treatment facility can often help you fight for coverage or arrange direct billing on the spot.

What If I Don’t Have Insurance?

After the creation of the Affordable Care Act (ACA), most Americans were legally required to take out health insurance. If you never completed this step, or if your insurance policy has lapsed and you no longer have coverage, it may be cheaper to sign up for a new policy now than to pay for rehab outright.

You have two options for health care coverage: government or private. Private policies are, on the whole, far more likely to include coverage for addiction and other mental health support services. On the other hand, ACA-sponsored policies are much more likely to be accessible and affordable, especially if you’re low-income.

A note on Medicare and Medicaid: both can and do provide coverage for addiction services, but the range of coverage can vary significantly. Furthermore, it isn’t always clear whether treatment providers accept these plans, meaning you may need to do some digging in order to find out.

Even if you are covered, and the facility accepts either plan, you may be required to have a medical professional confirm your need for treatment.

Generally, the treatment facility will assist you with this process before you arrive to work out any kinks.

Other Ways to Pay for Rehab

You don’t have insurance, or you can’t afford insurance, and you certainly can’t afford to pay out of pocket. Now what? The good news is that all is not lost – not even close. You may, however, need to reach out to loved ones or various organizations for assistance. Try:

    • Asking Friends and Family. Parents, grandparents, and other loved ones may be more than happy to contribute towards residential treatment, especially if you are close to them already. Be respectful about it, but never be afraid to ask your loved ones for help.
    • Taking Out a Loan. If your credit is still decent, and you plan to return to work right after treatment, your bank may be willing to float you a loan to pay for treatment. This allows you to spread payments out over time to make residential treatment for affordable.
    • Credit Cards or Lines of Credit. The idea of charging treatment to plastic may seem a little absurd; after all, these credit options usually come with high interest rates. For this reason, they should never be your first choice – but they can help you access a facility if you have no other options available. Ultimately, it’s an investment in your future.
    • Scholarships and Grants for Rehab. Yes, they do exist – and many of them are highly likely to say yes! Some of these programs come from individual facilities, while others come from national or state-based non-profit organizations. You can find more information
    • Fundraising Online. If you belong to a few great online communities, you may want to consider an online fundraiser. Whether you use Paypal Pool, GoFundMe, YouCaring, or even just Facebook Fundraisers, many people are happy to donate towards a good cause – and getting clean certainly qualifies.
    • Asking for a Temporary Reprieve From Bills. Addiction treatment counts as medical hardship. Depending on your situation, you may be able to get relief from certain debts (such as loans or utility payments) for a short period of time if the creditor offers such services. This can help you free up precious dollars to use toward treatment.

Still feeling unsure about how to pay for residential addictions programs? Call the facility you’re considering directly. Telephone and email counselors specialize in helping patients overcome obstacles like these. No matter how impossible it seems, there is always an option available. You’ve got this.

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