How to Get Drug and Alcohol Rehab Insurance Coverage

Identifying an alcohol or drug abuse problem in yourself or a loved one is the first step to recovering from the problem. Getting help to achieve recovery can be time consuming and expensive for most people, especially without rehab insurance. This guide can help you find the coverage you need. If the prospective patient is currently covered under medical insurance, the insurance carrier may provide coverage for alcohol treatment or drug abuse treatment. Many chemical dependency treatments will be covered under these types of insurance, regardless of the name. You can check directly with your insurance company or your human resources representative to confirm the type of coverage, if any, that is provided for substance abuse treatment under your current medical plan. Once you have determined that your medical plan offers drug and alcohol abuse insurance, you must learn exactly what is covered and the specific rules that must be followed so that your drug or alcohol abuse treatments will be covered.

Follow the Rules

Insurance companies apply myriad rules and regulations that must be followed. These rules can change depending on the type of treatment you are seeking, the treatment setting, and how many times you have sought drug or alcohol rehab insurance in the past. If you are seeking help for a loved one, know his or her substance abuse history and medical history before seeking coverage. Because the vast majority of health insurance plans carry drug and alcohol abuse insurance under the umbrella of mental health services, a patient with an underlying mental illness or a history of substance abuse relapse may be determined to have a preexisting condition and can be denied coverage on those grounds. Check your or your loved one’s evidence of coverage or certificate of coverage documents to find out what exactly is in the policy regarding drug and alcohol rehab. Above all, in order to be covered by insurance, you should choose a treatment plan given by providers that have been approved by your insurance carrier for your particular plan.

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Work with Your Treatment Center

It can be easy to think that, once you begin a treatment plan with an approved provider, everything will be covered by insurance. Sadly, this is not the case. Almost every substance abuse treatment program will have someone on staff charged with helping patients and their families navigate through insurance benefits. To ensure that rehab will be covered to your plan’s maximum benefit, you must work with the insurance specialist at your rehab center throughout the course of treatment. A change in the patient’s therapy methods, primary care provider, or even progression toward recovery can change the coverage levels offered by your insurance company.

Check Local and Federal Legislation

Laws governing private insurance vary from state to state, and you need to know what your rights are as a patient. In addition to state legislation regarding insurance companies’ rehab benefits, the Mental Health Parity and Addiction Equity Act of 2008 ensures that coverage for treatment of mental health illnesses, including drug and alcohol abuse treatment, is applied in the same way as for treatment of other medical and surgical conditions. What this means is that if you are covered by a medical insurance plan that offers drug and alcohol abuse insurance, the company cannot charge more or provide fewer services than they would for other medical care. Insurance specialists at treatment centers may not be aware of this provision, and insurance companies may not want you to be aware, so you must know your rights and assert them if your insurance company is in violation.

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Sign Up for Medicare

If the patient seeking treatment is not covered by private insurance, he or she may be eligible for coverage under Medicare. There are income requirements and eligibility rules regarding Medicare coverage, but for uninsured patients in need of drug or alcohol rehab, it may be a viable option. Under Medicare, insurance coverage for treatment is limited to 190 days in an inpatient program over the lifetime of the patient. Outpatient treatment is covered at 65% of Medicare’s approved amount, with the patient paying the rest. Recently, Medicare has introduced a new preventive substance abuse insurance benefit intended for individuals who misuse but are not necessarily dependent on alcohol. Although insurance under Medicare may not cover as much as private insurance, for many without private insurance, it is the only way they can afford to recover from drug and alcohol dependency.