Will Health Insurance Cover My Addiction Treatment?

insurance coverage for addiction treatment

Once a person has decided to seek addiction and/or substance abuse treatment one of the very first questions asked is,

“Will my health insurance cover my addiction treatment?”

The answer is YES! Hopefully, this blog will help guide you to seek out the treatment that everyone deserves. This is especially important to those that really want to get clean and change their lives for the better. It does happen every day for thousands of Americans, and it can happen for you too!

Addiction: A Diagnosable and Treatable Disease

Addiction was not considered a diagnosable and treatable mental illness by the U.S. medical community until about forty years ago!  Alcohol and/or substance abuse didn’t start being considered a disease until early in the 19th century. In 1956, the American Medical Association (AMA) declared alcoholism an illness. In 1987, the AMA and other medical organizations officially termed addiction a disease (Leshner, 1997). That means for far too long, health insurance companies did not cover addiction treatment. This means millions of Americans went without addiction treatment due to the cost. That is not the way it has to be anymore. 

According to a 2012 National Survey on Drug Use and Health, over 21 million Americans struggled with a dependence on drugs and/or alcohol last year. However, less than 2.5 million received addiction treatment at a specialty facility. The report also points out that a full quarter of those that needed treatment did not receive it because they lacked health insurance. That is a huge problem for anyone facing addiction and/or substance abuse problems. 

How Do New Healthcare Laws Improve Addiction Treatment?

In more recent years, and under the new and “improved” healthcare laws, addiction treatment is now considered “an essential health benefit”. This means commercial health plans must cover it. Pushes for healthcare reform are continuing. The number of patients seeking addiction treatment could more than double over the next few years. With that now being the insurance trend, it’s easier now than ever to get the treatment so many seek and deserve.

You can get cost-effective and valuable addiction treatment. Especially to give you a real chance at lasting sobriety. Educate yourself on your health plan, your state’s laws and the steps to get covered treatment. Getting proper care can be a real and achievable goal. No more healthcare rules to hold you back from seeking inpatient or outpatient treatment. NOW is the time to seek help!

Understanding Your Healthcare And Addiction Treatment Coverage

Now that addiction is legally defined as a “diagnosable medical condition”, that means you can get your healthcare to cover your addiction treatment. Insurance companies do not tend to advertise this information. But, as of recent, 43 U.S. states require commercial group health insurers to cover addiction treatment.

Once you have decided to seek addiction treatment, make sure you have taken the time to read your insurance policy. You need to know exactly what your benefits are as a policyholder. Pay detailed attention to the wording within your policy. The policy should define a full continuum of addiction care. According to the National Alliance for Model State Drug Laws, includes “intervention, detoxification, inpatient rehabilitation, outpatient treatment, and intensive outpatient, family, and codependency treatment.”

The Mental Health Parity and Addiction Equality Act of 2008 makes it illegal for insurance companies to discriminate against patients because of addiction. (The MHPAEA does not require your insurance to cover specific addiction disorders or treatments, but it does require that coverage for mental and substance abuse disorders be offered at parity with standard medical conditions.)

There are two things you should do to find out about the addiction treatment options that are available to you as a policyholder. First, contact your health insurance company to verify your policy. Second, go to the National Alliance for Model State Drug Laws and locate your state’s lead agency for administering addiction treatment services. 

Addiction Treatment: Is It All The Same?

Addiction treatment is unique to each person. The length of stay in a treatment program really depends on certain factors. These are things such as the severity and length of the addiction and the rate at which progress is made. For example, some people with severe drug and/or alcohol dependencies, or those that co-occur with mental illness will require a much longer treatment time. While others may only need an outpatient detox and a brief outpatient treatment program to break the grip of addiction. It’s important that these types of decisions are discussed with medical professionals. Do you want people who are trained in finding the right program for YOU?

Types Of Treatment Programs

Detoxification (Detox)

A structured detoxification period (detox) entails a duration of time wherein the addict starts the withdrawal process. This part of recovery can be very uncomfortable, painful and even deadly depending on the severity of the addiction but it doesn’t have to be this hard when you seek medically assisted detox. During this detox process, you will be monitored and treated with medications by a medical professional to help manage the symptoms of withdrawal and can be done on an inpatient or an outpatient basis. It is important to note that detoxification services are not a substitute for addiction treatment. In order to fully recover from addiction, additional treatment services will be needed. 

Insurance companies may require that you use an approved provider, so it’s important to know your detox options so you can make an educated decision. Once you have decided that detox is right for you, contact your insurance company and ask for a detox providers list. If you have chosen a program and it is not listed as an approved provider, contact the detox center and speak with an insurance counselor so that they can help to try and get you approved at your program of choice. Program staffers who are trained to deal with insurance companies, and they can answer questions about coverage quickly and efficiently.

Inpatient Addiction Treatment

Inpatient addiction treatment will happen once your detox is complete. It requires you to live full-time at a treatment facility. Inpatient treatment is the preferred option for those looking to get away from their current triggers and completely focus on treatment and reaching sobriety with as few distractions as possible. The around-the-clock care at an inpatient addiction treatment program may provide a more immersive treatment experience. Also called “Residential Addiction Treatment” or “Rehab”. 

Insurance typically covers inpatient treatment so if the addiction does not require a detox program, then you can either contact your insurance company and request a list of approved inpatient addiction treatment providers or you can contact the program you prefer and have their program staffers assist you with getting an approval for inpatient treatment at their facility. 

Outpatient Addiction Treatment And Outpatient Detox

Outpatient addiction and outpatient detox treatment programs generally entail some amount of daily treatment at a program. Outpatient detox programs can start the medically assisted process of detoxification and then comfortably transition the addict into an outpatient addiction program. These outpatient programs usually allow the addict to return to their home or other living arrangements during non-treatment hours to try and give the addict a chance to integrate parts of one’s life whilst still having the support system in place to aid in the goal of long term sobriety.

Outpatient addiction treatment (including outpatient detox) is offered in close to 10,000 addiction treatment centers across the U.S. Many accept payments from insurance companies, but not all policies offer complete coverage. Again, this is why it is a good idea to work with either a program staffer at the treatment center of your choice or to work directly with your insurance company to help get you the treatment you want and need. 

Twelve-Step Program/Principles/Treatment

The 12 step program incorporates the 12 steps of Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and other 12 step support groups into addiction treatment, focusing on spiritual principles such as acceptance, surrender, and active involvement in 12 step meetings. The type of treatment involves attending meetings regularly, working the 12 steps, and building a sober support network, while also providing incentives for sustained sobriety, such as chips or key tags to celebrate recovery milestones. Individuals who participate in 12-step programs while receiving addiction treatment, and continue to participate in the 12 step program after completion of addiction treatment, are more likely to maintain long-term sobriety.

Success is not guaranteed, but seeking any kind of treatment is always better than not seeking any type of help. However, a majority of people with substance abuse and/or addiction, unfortunately, do not seek help especially because they do not know if whether or not their insurance covers the type of treatment they need/want. Largely because of this fact, is why so many people struggle to the point of homelessness or even death. That’s why seeking treatment is imperative so once you’ve made the decision to seek treatment, find out what your insurance company will and can approve because it can literally mean the difference between life or death.

If you are ready to seek help in addiction, allow the South Florida addiction experts at Coastal Detox to help you with your journey. Call us now at (877)978-3125 to start the road to recovery and getting your life back on track TODAY!



Content Reviewed by Jacklyn Steward

Jacklyn StewardJacklyn is a Licensed Mental Health Counselor (LMHC) and an EMDR trained trauma therapy specialist with over 6 years of experience in the field of addiction. She has a Masters Degree in Mental Health and Substance Abuse Counseling from Nova Southeastern University.