Overcoming drug and alcohol addiction is challenging. But we believe everyone can experience sobriety. One common question we receive is, “Does insurance cover rehab?” The answer is yes and no. This page explains what you need to know about rehab insurance coverage, how to get the most from your benefits, and if you can get rehab treatment without insurance.
What Is Health Insurance?
Health insurance is a contract between a policy provider, typically an insurance company, and the policy owner to pay for healthcare-related costs. The insurance company and the policy owner have legally contractual obligations to each other. The policy owner must pay the insurance company premiums, a specified amount of money every month, to maintain the policy.
When the owner meets their obligation, the insurance company must pay for certain healthcare costs defined in the health insurance policy. In 2010, the Affordable Care Act mandated that all health insurance policies written after 2010 must include benefits for essential Healthcare services. Included in the definition are benefits for mental health conditions and substance use disorders.
What Is Addiction and Mental Health Rehab Insurance Coverage?
Included in every health insurance policy written after 2010, are benefits that cover treatment for mental health conditions and substance use disorders. This is often referred to as addiction and mental health rehab insurance coverage. While every insurance policy must offer coverage, not all benefits and limitations are the same.
For example, your policy may limit the number of therapy sessions you can receive per incident, per year, or over the lifetime of the insurance policy. The benefits are designed to help cover addiction treatment and mental health therapy to help individuals walk through rehabilitation and achieve sobriety from substance use disorder and alcohol abuse.
What Is Substance Use Disorder?
The American Psychiatric Association defines a substance use disorder as a complex condition in which there is uncontrolled use of a substance despite the individual experiencing harmful consequences. The person has such an intense focus on the substance to which they are addicted that their ability to function becomes impaired.
Even when the individual knows and understands that using the substance is causing problems, they continue. As a substance use disorder becomes severe, it is referred to as an addiction. Substance use disorders can trigger distorted thinking and change a person’s brain structure and function related to judgment, learning, and behavioral control. Repeated use can cause changes that last far longer than the immediate period of intoxication.
Does Health Insurance Cover Drug Addiction Rehab?
Yes, health insurance policies written after 2010 typically offer some level of drug addiction rehab coverage. This includes:
- Medication-assisted treatment
- Relapse prevention
- Residential or inpatient care
- A variety of therapeutic interventions, including cognitive-behavioral therapy and motivational interviewing
However, your insurance policy may have specific limits on what they cover.
When you have questions like does insurance cover drug rehab?, you can consider using the insurance company’s online web portal or customer service phone number to check your policy’s benefits and limitations. However, wading through insurance jargon can be challenging. For an accurate understanding of what your insurance policy covers and treatment options near you in San Diego, CA or Nashville, TN, call Apex Recovery at (877) 881-2689 or contact us online to start on your path to recovery.
Does Health Insurance Cover Alcohol Addiction Rehab?
Yes, all insurance policies after 2010 offer alcohol addiction treatment, but not all policies offer the same benefits. When you call Apex Recovery, our admission specialists can answer these questions:
- Does insurance cover alcohol rehab?
- Does insurance cover medical detox?
- What are the benefits of my insurance policy?
- What are the policy’s limitations?
Insurance policies may limit the number of therapy sessions per incident, per year, or over the policy’s lifetime. The policy may also offer benefits extending rehab into the community, such as outpatient care delivered in intensive or partial hospitalization programs. Your insurance policy may also cover aftercare and community-based skills training. The best way to know what your policy covers is to call Apex Recovery.
Does Health Insurance Cover Mental Health Treatment?
Yes, the Affordable Care Act mandates that all insurance policies offer treatment for mental health conditions. Treatment can include:
- Behavioral health therapy
- Recovery treatment
- Support groups in outpatient or inpatient care experience
Apex Recovery offers an evidence-based holistic approach to treatment, which includes aftercare.
Your insurance policy defines your out-of-pocket costs for mental health treatment. The easiest way to understand your policy limits and determine if prior authorization is required before treatment can begin is to contact Apex Recovery.
Does Health Insurance Cover Dual Diagnosis Rehab?
Health insurance offers inpatient and outpatient treatment for dual diagnosis rehab. Dual diagnosis is the term to describe an individual who has a substance use disorder and a co-occurring mental health condition. Frequently, those co-occurring mental health conditions include depression, anxiety, eating disorders, and post-traumatic stress disorder.
Although these are two separate conditions, the treatment for an individual with a dual diagnosis must specifically address both the substance use disorder and mental health condition simultaneously to increase your potential for successful and sustainable rehabilitation and recovery. This is part of relapse prevention, which offers the best option for long-term success.
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Ask us to check your insurance coverage.
Rehab Center in San Diego That Takes Insurance
Apex Recovery is a full-service mental health and substance use disorder treatment facility that accepts most major insurance company policies. Our programs include inpatient and outpatient care to help those struggling with substance use disorders and mental health conditions restore their lives.
- Apex Recovery
2810 Camino del Rio S #106
San Diego, CA 92108
Rehab Center in Tennessee That Accepts Insurance
For those seeking trusted rehab centers that take a wide range of TN insurance, Apex Recovery stands as a dedicated and accessible solution. Based just outside Nashville, it specializes in providing effective drug and alcohol addiction rehab and mental health treatment. The facility is committed to ensuring that individuals can start their journey to recovery with the support of their insurance coverage. Apex Recovery accepts health insurance, and offers individuals a pathway to comprehensive and quality care without unnecessary financial burdens.
Apex Recovery Franklin:
4601 Carothers Pkwy STE 250A Franklin, TN 37067
Apex Recovery Columbia:
2710 Trotwood Ave STE A & B Columbia, TN 38401
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- One of our staff members will contact your insurer to check your coverage.
- We will contact you promptly with the results and to discuss the next steps.
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How Much Does Rehab Cost With Health Insurance?
The cost of rehab with health insurance varies depending on several factors. The first factor that impacts your out-of-pocket cost is the intensity of the customized treatment plan for your recovery. The licensed professionals at Apex Recovery design a plan based on your needs. The second factor that affects your costs is your insurance policy’s benefits, limits, deductibles, and copay.
Insurance companies make financial decisions about how much rehab costs with insurance based on their liability and risk. Every policy has a deductible and copay. The deductible is the amount you must pay before the insurance policy begins paying for health care costs. The copay is the percentage of rehab charges you are responsible for after paying the deductible.
How To Check My Insurance Coverage Levels for Rehab Treatment?
Very simply, you can call the phone number that’s printed on the back of your health insurance card to speak with a representative. They can tell you your insurance policy’s benefits and the type of rehab treatment they cover. However, your insurance benefits are not always straightforward, and, in some instances, there may be loopholes that increase your coverage.
The easiest way to gain a full understanding of your insurance policy’s requirements to claim your benefits is to call Apex Recovery at (619) 458-3435 or contact us online. Our admission specialist will verify insurance coverage and determine if prior authorization for treatment is necessary.
How To Get My Insurance To Pay For Substance Addiction Rehab
The best way to get your health insurance policy to pay for substance addiction rehab is to understand your policy’s requirements and follow them closely. Your insurance company may deny coverage if you don’t meet all the requirements, and sometimes those requirements are a simple letter of medical necessity or evaluation by a third party.
When considering how to get insurance to pay for inpatient rehab, it’s crucial to use the claims process that the insurance company requires to receive benefits that help pay for detoxification, treatment, and addiction recovery. If you are unsure of your insurance policy’s requirements, call Apex Recovery today to speak with an admission specialist who can verify insurance coverage and the insurance policy’s requirements to submit a claim.
How Many Times Will Health Insurance Pay For Rehab?
The number of times your health insurance policy will pay for rehab is defined within your policy’s benefits and limitations and how long insurance pays for inpatient rehab. Some policies will pay for unlimited inpatient or outpatient care treatments, while others limit therapy sessions or admissions.
To receive all the benefits you are due under your insurance policy, you must know your benefits and meet the insurance company’s documentation and prior authorization requirements. The best way to determine how many times your insurance policy will pay for rehab and understand the documentation requirements to submit a claim is to call Apex Recovery at (877)881-2689.
Which Health Insurance Providers Offer Rehab Insurance?
All health insurance providers offer rehab insurance at some level of coverage. Most rehab centers that take insurance are familiar with the claims process and can help you determine the documentation required for treatment. The insurance company and the policy determine how much rehab costs with insurance.
For some insurance policies, a secondary requirement is that the treatment center is within the insurance company’s network of providers. This is typically called an in-network provider. Some of the major insurance companies include:
If you are searching for specifics such as, “does Humana cover rehab?” or “does Medi-Cal cover substance abuse treatment?” Contact Apex Recovery at (877) 881-2689, we are here to help!
Can You Go Into Addiction Treatment Without Insurance?
Another common question is, can you go to rehab without insurance? Yes, you can receive addiction treatment without a current insurance policy. There are several ways to help pay for addiction treatment without insurance, which our admission specialists can discuss with you. The mental health professionals at Apex Recovery recognize that the cost of rehab can be expensive.
However, the overall cost without rehab can be even more expensive. Our financial counselors will help you look for payment options, including applying for Medicaid, receiving scholarships through community organizations, or seeking a personal loan. Living with an addiction is challenging enough without worrying about how you will pay for treatment. The most important step is to get into addiction treatment and then work with our financial counselors to identify steps you can take to help pay for the program.
For some insurance policies, a secondary requirement is that the treatment center is within the insurance company’s network of providers. This is typically called an in-network provider. Some of the major insurance companies include:
Contact us to determine if Apex Recovery is in-network for your insurance policy.
Addiction and Mental Health Statistics in San Diego
- In the San Diego-Carlsbad-San Marcos area, an annual average of 426,000 people aged 12 and older used an illicit drug in the last year.
- The rate of marijuana use was 11.1% and the rate of nonmedical prescription-type pain relievers was 5.3%.
- In the San Diego-Carlsbad-San Marcos area, 323,000 people 12 and older were classified with a substance use disorder in the past year, which was a higher rate than the average across the country.
- In adults 18 and older in the San Diego-Carlsbad-San Marcos area, 4.8% or 120,000 adults had at least one major depressive episode in the past year, which was significantly lower than the national rate of 6.6%.
- In the San Diego-Carlsbad-San Marcos area, approximately 17% of people age 12 and older smoked cigarettes in the past month, and 24.3% participated in binge alcohol use.
Addiction and Mental Health Statistics in Tennessee
- In 2021, fatal drug overdoses increased 15% in Nashville/Davidson County
- In Nashville, roughly 70% of overdose related emergency room visits involved a male patient
- 34% of those males were age 25-34
- In 2016, Tennessee was the third highest state in Opiod perscription rate at 107.5 painkiller perscriptions per 100 people
- It is believed that the number of people addicted to opioids in Tennessee in 2016 was up to 70,000 people.
- Tennessee was also ranked 15th in the country in Fatal overdoses in 2016 at 24.5 fatalities per 100,000 persons