If you’re dealing with a substance abuse disorder, rehabilitation treatment may be the only way to commit to sustained recovery. But does health insurance cover rehab and, if so, what kind of rehab facilities will they pay for? Keep reading to understand the different types of rehab facilities and their insurance coverage.
Does Health Insurance Cover Rehab?
There are many different types of rehabilitation facilities, and insurance coverage of them depends on several factors, such as your specific plan and the kind of facility you are hoping to attend. The easiest way to discover whether or not your plan includes substance abuse rehab is to call your insurance provider and ask.
In general, insurance coverage of rehab varies in the following ways based on the type of plan you subscribe to. Medicare and Medicaid cover substance abuse treatment, but whether or not rehab is included in that treatment depends on your plan. Because substance abuse disorders are classified as pre-existing conditions under the Affordable Care Act (or ACA), ACA marketplace insurance plans are required to cover some form of rehab. Most private plans should also cover addiction treatment, although, unlike government-sponsored ACA plans, they are not obligated to do so.
Keep in mind that, just because rehab is covered, doesn’t mean you owe nothing for it. You may be responsible for a copay, coinsurance, or deductible before you’re eligible for rehab coverage.
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Types of Rehab Facilities
If you are discussing substance abuse disorder treatment with your doctor, you may have to choose among the following types of rehabilitation facilities:
Outpatient rehabilitation programs take place in a doctor’s office or similar setting, where you are taken care of without having to stay overnight. This is one of the least intensive substance abuse treatment options, to treat either patients with mild issues or those who have a strong support system behind them. Outpatient rehab may include classes, counseling, or detoxification. Your doctor will determine the treatment type and length depending on your unique case.
This is perhaps the most likely form of treatment to be covered by your health insurance, as it’s the least intensive and the first stepping stone on the way to more thorough care.
Intensive Outpatient or Partial Hospitalization and Day Treatment Care
If you need a slightly more hands-on approach to your substance abuse disorder care, you may opt for intensive outpatient or partial hospitalization, which often includes the same services as outpatient care just in a more intensive setting or with longer sessions.
Intensive treatment may mean that you stay in the hospital for a good part of the day, where you have access to all the resources you need away from the temptations of daily life, but you are still free to go home.
If you’re dealing with severe substance abuse issues or have not responded to milder forms of care, you may be placed in or opt for a residential treatment center, where you will have round-the-clock professional care. This is the type of rehab most often featured in movies, although the real-life facilities may differ from what you’ve seen on the silver screen.
There are many different types of residential substance abuse programs, ranging from hospital settings to something more along the lines of a spiritual retreat. Not all of these treatment facilities accept health insurance, and not every health insurance plan will cover the high cost of residential treatment, so be sure to check with your insurance before committing to a stay in this type of facility.
Intensive Hospital Treatment
When doctors are extremely concerned for your wellbeing, especially if you have additional mental or physical issues that also require intensive care, you may be placed in a hospital for long-term inpatient treatment. There, you will be closely monitored by professionals and may receive medical interventions such as medication. If this type of rehab is medically necessary, or if you’re in an emergency situation, your insurance should cover this kind of treatment.
Medical Billing for Substance Abuse Rehabilitation
When on the road to recovery, you want to make sure that your insurance covers all necessary treatment and rehab centers. In some cases, you may receive a prior authorization denial that means your insurance won’t cover an upcoming inpatient stay, or you may receive a health insurance claim denial once you’ve already attended rehab if a prior authorization was not required.
These denials can come as a surprise, and may leave you in a bad situation financially or health-wise. The last thing you need on your path to recovery is financial pressure or extra worry!
What Happens if Your Insurance Doesn’t Cover Substance Abuse Rehab
Receiving an insurance claim denial for substance abuse rehab can throw you off course and threaten your recovery. In the wake of a prior authorization or claim denial, your options narrow. Suddenly, you need to take on the confusing appeals process in order to have a chance at getting the denial overturned, or you need to quickly study the complicated medical billing system in order to figure out how to negotiate your bill. The good news is you don’t have to take all of this on by yourself.
How aJust Can Help You With Your Rehab Bills
Luckily, you can rely on aJust’s expertise as a medical billing advocate to get you out of a tough situation. Whether you’re facing a claim denial or have trouble getting a prior-authorization approved, aJust is there for you. They may take over the denied claim appeals process for you, giving you the best possible chance at a successful outcome, or they may use their expertise to get your substance abuse rehab bill lowered.
While you focus on the opportunities for recovery at your disposal, aJust takes on the time-consuming process of dealing with your medical provider and insurance company in order to find a solution. Get started today!