Will Your Insurance Provider Cover Addiction Treatment At An Inpatient Rehab?
Insurance and rehab can be a confusing topic. What does health insurance cover? Does insurance cover rehab?
Getting your insurance plan to pay for drug rehab or alcohol rehab should be easy, but in many cases, it is anything but easy. All insurance coverage is supposed to provide at least some coverage for substance abuse treatment, but the question is, what exactly is covered?
When you are experiencing active drug addiction, the last thing you want to think about is what is covered by your health insurance. You simply want to turn things over to a rehab center and let them help you to get better and recover from your addiction.
Many inpatient treatment programs try to make things easier by having dedicated services for verifying treatment coverage. On the homepage of many rehab and detox websites, there is a button for verifying rehab coverage, where an online assistant will ask for your health insurance plan information and report back on your specific insurance benefits relating to drug rehab services.
In some cases, full residential treatment is covered. treatment service may include many amenities, including holistic treatments.
You may be able to get equine therapy, where you interact with horses, or even massage, acupuncture, and other spa-type services. Some private insurance plans have excellent coverage, and the rehab facility will be able to establish early on what rehab treatment will be paid for by the health insurance plan.
What if your health insurance benefits do not cover as much of the treatment cost of a rehab program?
While you may have a health insurance provider with excellent benefits to cover the best addiction treatment program available, more likely, you will find that your insurance coverage is more limited in addiction treatment coverage. For example, your plan may only cover an outpatient program and not inpatient care.
While some residential rehabs will accept the lower payment intended for outpatient rehab only, in most cases, if your plan only allows for outpatient treatment, then that is what will be available for you. The benefit of inpatient rehab is, of course, a fully immersive program, where you do not have to worry about having any contact with the outside world for a period of time.
While outpatient rehab can provide nearly all of the same services as inpatient rehab, at the end of the day, you will have to go home, without the protective environment of a residential rehab program. For patients with alcohol addiction, this can be especially difficult, because alcohol is a legal drug that is readily available.
What happens when a rehab patient goes home and relapses?
When you go to detox, they provide medical treatment to get the alcohol or drugs out of your system safely. Then, if you transfer to rehab, you will spend at least the next month learning how to remain alcohol-free or drug-free long-term.
With various forms of therapy, provided in individual and group talk therapy settings, including cognitive-behavioral therapy, you will learn to address triggers in your life that lead you back to using drugs or alcohol. You will learn about yourself and your addiction, by working with experienced counselors and by listening and sharing in a process group at the treatment center.
When you graduate from rehab, you will likely be offered an aftercare program. If you choose, you may attend aftercare sessions, where you continue with group therapy, and possibly individual therapy, on a regular schedule. Aftercare supports your ongoing recovery after rehab.
However, even with detox, rehab, and aftercare, people still relapse after completing the program. In fact, relapse rates after inpatient rehab and outpatient rehab are fairly high. Some people only get one shot at rehab, so if they relapse, they will have to find other ways to get help.
Yet, for people with good insurance coverage, detox and drug rehab may be covered many times. On my podcast, I once interviewed a man who claimed to have gone through at least thirty rehab programs before attending one that worked for him.
His repeat rehab experience occurred in Florida, and he called it the “Florida Shuffle.” Unfortunately, many other patients have had similar experiences, especially in Florida, once known as the rehab capital of the world.
What does mental health have to do with relapse and returning to rehab?
Many rehab programs promise to address dual diagnosis issues. A patient with an underlying psychiatric disorder that may be responsible for their addiction is said to have a dual diagnosis.
That is to say that they have both a diagnosis of addiction, and they have a diagnosis of another mental health condition, such as bipolar disorder, anxiety, or depression. If the secondary mental health issue is not treated, with medication and therapy, the patient may return to using drugs or alcohol as a way of self-treating their mental illness.
The fact is that mental illness is often misdiagnosed early on. Sometimes, even a very good psychiatrist can take time and multiple sessions to be certain of all mental health conditions that a patient is experiencing.
Furthermore, it can take time for the psychiatrist to adjust medications to optimize the patient’s treatment. Unfortunately, most rehabs are not prepared to handle this process.
While there are some rehabs that offer daily psychiatry visits, this is the exception rather than the rule. In fact, many rehabs do not offer even one single visit with a psychiatrist. And, even if the patient has a visit or two, it may not be enough to get to the root of the problem.
How do medication assisted treatment programs address dual diagnosis patients?
One argument on behalf of going to rehab is that a patient will get comprehensive addiction treatment services while checked-in. If a patient does not go to a treatment facility and goes, instead, to a private doctor for medical addiction treatment, how are psychiatric issues handled.
The solution here is very straightforward. While seeing an outpatient private addiction doctor for medical addiction treatment, the patient may also see their private psychiatrist. Rather than engaging in the rehab experience, a patient can simply continue seeing their private psychiatrist for their mental health care.
Outpatient psychiatrists often accept private insurance, HMOs, such as Medicare Advantage and Medicaid plans, as well as straight Medicare and Medicaid. Some psychiatrists also provide treatment of opioid or alcohol addiction with medications such as Suboxone or naltrexone.
If the psychiatrist does not provide medication-assisted treatment for substance use disorders, the patient may also see a separate treatment provider for that service. When a patient and their family are able to make the usual choices in which doctors they are going to use, there is more flexibility than being locked into a rehab program.
Is it possible to go to rehab without private health insurance?
There are rehabs that take state insurance, rehabs that accept ambetter insurance, and rehabs covered by Medicaid. For people with Medicare, it is also possible to find a drug rehab that accepts medicare.
It is also possible to go to rehab without insurance. One way to do this is by looking for drug rehab scholarships.
What exactly is a rehab scholarship? Is it similar to a scholarship to go to college? Usually a scholarship is financial assistance for an educational program.
When we think of rehab and other addiction treatment programs as providing educational curricula to help people learn to live drug and alcohol-free, it makes sense. Many rehabs provide several beds at little or no cost to the patient if they qualify for financial assistance.
What is the best way to find out about rehab scholarships? Unfortunately, there is no rehab scholarship guide that I am aware of. While there are services, such as Needy Meds, that provide information on free and sliding scale programs, scholarships are often provided by for-profit rehabs which would not be listed in a guide such as Needy Meds.
I believe that one of the best ways to discover scholarship programs at various rehabs is to call around to rehabs in your area to ask what they might have available. You might be surprised at how many programs are out there with availability now, or in the near future.
In addition to rehab scholarships, other types of programs in the addiction treatment rehab hierarchy may also provide scholarship beds. For example detox, partial hospitalization programs (PHP), intensive outpatient programs (IOP), outpatient (OP), and even sober living homes may provide addiction scholarship spaces. In fact, scholarships for sober living are fairly common in many areas.
How can insurance cover long-term treatment beyond rehab?
Fortunately, many rehabs now offer aftercare programs that can provide continuing support of sobriety for their clients for months after graduating from rehab. Additionally, for the best chance for success, if a patient has either an opioid addiction or alcohol addiction, there is medication assisted treatment which has a very high rate of success.
If possible, start the planning for long-term treatment at the beginning, before even going to rehab. Some rehab programs include long-term medical treatment beyond the relatively short stay in residential rehab.
Other programs may initiate medical treatment in detox or rehab, but then either end the treatment quickly, before the patient is discharged, or they simply instruct the patient to seek ongoing care in their community. The problem with this lack of continuity, when a rehab starts medications and then tells the patient to find a doctor, is that it may not be easy to find local doctors who accept the same insurance and will work within the same guidelines of treatment.
For example, if a rehab starts a patient on Suboxone, there may not be available doctors in the community who both prescribe Suboxone and accept the particular insurance plan of the patient. Ideally, rehab facilities should research and arrange for partnerships with community doctors if they are not providing long-term medical treatment themselves.
If a rehab accepts a specific list of insurance plans, and they start patients on medication-assisted treatment, the rehab outreach staff should make arrangements to refer the patient to doctors who accept those same insurance plans. It is not difficult to maintain a database of community doctors, their availability to continue medical addiction treatment, and what insurance coverage they accept.
Health insurance plans often provide an unbalanced approach to covering addiction treatment. In most cases, insurance companies prefer evidence-based treatments with the highest level of efficacy, and relatively low cost.
In the case of addiction treatment, the system seems to be almost upside-down. Insurance often covers very expensive rehab programs, which can cost $20k, $30k, or more for just one month of treatment. Yet, they balk at the idea of covering an outpatient Suboxone MAT program that can cost under $10k for an entire year of treatment.
Medication assisted treatment for addiction is often far more successful, and less expensive, than rehab alone.
When we consider that Suboxone has a success rate of at least 50%, and abstinence-based rehab programs have success rates of below 15%, the decision of insurance companies to spend the bulk of their money on short-term, low-yield rehab programs seems nonsensical. While rehab may be the best option with regards to addictions that do not have medical treatments, it does not make much sense to avoid covering long-term medical treatment when it is proven to work very well.
Alcoholism, or alcohol use disorder, also responds very well to medical treatment. Naltrexone has helped many people to reduce or eliminate alcohol consumption. Yet, insurance companies continue to cover upscale rehab programs that do not provide medical treatment for alcohol addiction.
Recently, I have met several new patients who have attended some of the top premiere signature rehab programs in the country. These rehabs have names that almost anyone would recognize, even if they do not know anyone who has considered going to rehab.
Incredibly, these patients did not find success at these programs. While some people do remain sober after rehab long-term, the dark secret of rehab is that the relapse rate is very high, even just months after graduation.
No wonder insurance companies do not want to continue paying for medical addiction care after rehab. Imagine paying $30k for a month of intensive rehab, and then the patient requests ongoing medical care for the same condition. There is a mistaken idea that rehab can “fix” people within a month, and usually without medical treatment.
What if insurance companies stopped paying for rehab altogether?
Since 2008, there has been a law commonly known as “The Parity Act.” It is a part of the Affordable Care Act. This law states that insurance companies must cover addiction and mental health treatment just like they would cover any other medical condition.
I find it hard to believe that such a directive was necessary, but apparently insurance companies were pretending that mental illness and addiction were not real medical problems, even though the medical community has thoroughly established that they are. For example, depression is as serious a condition as having a heart problem.
Unfortunately, many people still have the attitude that addiction is a moral deficiency. Alcoholics Anonymous and Narcotics Anonymous, the major 12-step programs, perpetuate this idea by talking about “addicts” and “alcoholics” as having defects of character and shortcomings that must be worked on with a sponsor.
Often, family members believe that their loved-one can simply “snap out of it” if they are put under sufficient pressure. Apparently, many health insurance executives feel the same way.
In fact, even with the Parity Act of 2008, insurance companies still find ways to avoid paying for addiction treatment. While some rehabs have become very adept at fighting for reimbursement from insurance, others have struggled with insurance companies wiggling out of their responsibility, sometimes by simply saying to rehab executives, face-to-face, that they simply refuse to pay.
Insurance-related abuses in the rehab industry have made getting insurance coverage for rehab more difficult.
The situation has not been helped by some abuses that have occured in recent years by a small number of rehab programs. Overbilling for services has not helped the industry.
It is very possible that backlash in the insurance industry, due to the billing abuses of some rehabs, may lead to a more difficult environment, where patients can not get their insurance to pay for rehab. What would people do if their insurance did not cover rehab at all?
While it would be great if rehab programs would lower their prices to make the service more accessible to people who want to pay cash, it is unlikely that they will bring the prices down that low. The cost of providing staff, facilities, and supporting the pricey marketing programs used by many rehabs would make affordable rehab a difficult concept for most facilities.
Fortunately, medical treatment programs for specific types of addictions, for example, opioid addiction, alcohol addiction, and even cocaine and meth addiction, are proving to be highly successful. Often, there is no need to sit in a rehab, attending daily group meetings, for an entire month.
Even when insurance refuses to pay for outpatient, private doctor addiction treatment programs, they are far more affordable, compared to a month of residential rehab. And, in many cases, they are also far more successful long-term.
The fact is that addiction is a chronic condition that can take many months, and in some cases, at least a year or more, to treat successfully. A couple of weeks of detox, or a month of rehab, can get the drugs and alcohol out of the patient, but it takes longer for the brain to heal and drug cravings to subside.
Advances in medical treatments for addiction continue to develop.
As the traditional rehab advocates continue to fight against medical treatment for addiction, claiming that abstinence-based treatment, without the use of medications, is the one true way, medical science marches on. There are new treatments on the horizon which will soon be available, in addition to the very successful medical treatments that are already on the market.
Hopefully, the health insurance industry will get on board and focus more on scientifically proven medical treatments. There is also an opportunity for rehabs to develop solid long-term programs that integrate evidence-based medical therapies in a way that work better than rehab or medical treatment alone.
I recommend listening to some of the interviews available on my podcast, which I believe is the best addiction recovery podcast available. I have interviews with experts in the field, including a rehab executive who addresses the issue of comprehensive long-term care, including medical care. In fact she also discusses the difficulties with insurance companies fighting the Parity Act, avoiding their financial obligations to cover addiction treatment.
If you are interested in learning more about this subject, or about other programs available, such as concierge online addiction treatment, telemedicine, and telehealth programs, please use our contact page to reach out. We look forward to providing more excellent podcast episodes and more useful information that can help you to make an informed decision.