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

Although substance abuse has long been common in history, it wasn’t considered a disease until the early 19th century. The American Medical Association (AMA) officially declared alcoholism to be an illness in 1956, followed by addiction in 1987.

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. 

More than 21 million people in the U.S. struggled with a drug or alcohol dependency each year in 2011, as stated by the 2012 National Survey on Drug Use and Health. Unfortunately, less than 2.5 million of these people received treatment for it, and about 25% percent of them said it was because they didn’t have health insurance. This poses a large problem for people suffering from addiction.

How Do New Healthcare Laws Improve Addiction Treatment?

In more recent years, the U.S. government has made great strides in pushing healthcare reform. New healthcare laws now classify addiction treatment as an “essential health benefit” that insurance plans must cover. This means that the number of patients enrolling in rehab facilities could double over the next few years.

These days, you can get cost-effective addiction treatment that will help you achieve long-term sobriety. To fully understand your benefits, call your insurance provider and have them go over your healthcare plan with you. It’s possible for you to achieve your goal of full recovery from addiction.

Understanding Your Healthcare And Addiction Treatment Coverage

Since addiction is a medical condition, much like other diseases, mental illnesses, and behavioral disorders, your healthcare and insurance can cover addiction treatment and services.

As you begin your search for a treatment program that will work best for you, it is important to take the necessary time to review the details of your coverage. To do so, you can speak with a representative from your insurance company. You can also reach out to us here at Coastal Detox.

Currently, more than 40 U.S. states require commercial insurance providers to cover addiction treatment. If you decide to get treatment for addiction, make sure to review your plan first and know exactly what benefits you have. 

Your policy should define addiction treatment, which should include the following:

  • Intervention 
  • Detoxification
  • Inpatient rehabilitation
  • Intensive outpatient treatment
  • Family treatment
  • Codependency treatment

Under the Mental Health Parity and Addiction Equity Act, insurance providers cannot discriminate against patients if they have an addiction.

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 medical detox is the process of cleansing the body of harmful substances like drugs and alcohol under the supervision of licensed clinicians. Since detox abruptly stops drugs from entering your system, you’ll likely experience symptoms of withdrawal, which can be uncomfortable or painful depending on the severity of your addiction. In these cases, medication will usually be administered by professionals to mitigate any symptoms you have. Although detox will manage your physical dependence on a substance, it’s not a substitute for 

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 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.