How to Speak to Your Insurance Company About Addiction Treatment

addiction treatment center

Have you or your loved one taken the first step to recovery and decided to enter a program at an addiction treatment center? If so, it is important to know that the type of treatment and addiction treatment centers appropriate for you will depend on individual need and may vary in cost. And although treatment may be costly, most insurance policies include provisions that cover addiction treatment programs. However, you may not know which addiction treatment centers are covered by your plan, or which programs are available to assist in your recovery if you are uninsured.

If you are uninsured, or your plan does not cover the type of addiction treatment necessary for your recovery, a program that is entirely or partially subsidized by the federal government may be a viable option. Additionally, there are various nonprofit organizations (which help provide rehab services) that can arrange payments on more affordable installment plans.

If you are insured and your policy includes provisions for treatment at an addiction treatment center, figuring out the scope of addiction treatment ahead of time may prevent you from incurring unanticipated costs. The following tips can help you speak with your insurance provider about what your policy covers and how your plan can be used in a manner most beneficial to you.

  • Determine the type of insurance you have
    . Insurance plans are primarily divided into two types — public and private.

    • Public insurance is provided by the federal government, such as Medicare or Medicaid, and is partially or completely paid for with government funds.
    • Private insurance is paid for by you and/or your employer. You generally enroll with your employer, but you may opt to enroll in a private insurance plan and pay the entire premium yourself.
  • Identify the type of addiction that will be treated. Many times insurance plans will vary depending on the type of addiction treated. It is important to talk with your provider to ensure the type of addiction treatment needed is covered by your plan. If it is not covered, a nonprofit organization in your area may help cover the cost of treatment.
  • Determine the type of care appropriate for your recovery. Addiction treatment centers often provide treatment in one of two ways: inpatient care or outpatient care.
    • Inpatient care is provided in a hospital or at a residential treatment center. Inpatient care may be appropriate for dual diagnosis and more acute or long-term addictions.
      • Hospital-based programs offer more intensive therapies and around-the-clock medical services, monitoring and supervision by medical professionals.
      • Residential addiction treatment centers offer access to medical professionals and a variety of hospital-based services by arrangement. Around-the-clock care by facility staff trained in addiction recovery is available.
    • Outpatient care is similar to inpatient care except that the individual being treated returns home each day after their treatment session has concluded. Treatment plans still allow individuals to meet with doctors or therapists individually and participate in group therapy sessions before going home at the end of the day. Outpatient care is less intensive and may be appropriate for individuals who have more mild addictions coupled with significant responsibilities at home that are manageable and will not interfere with the recovery process.
  • Determine the duration of the treatment program. How long a treatment program lasts will depend on the type of addiction being treated and individual need. For instance, in the case of substance addictions, it takes time for physical treatment and detox to take place prior to dealing with the emotional and psychological aspects of addiction. Addiction affects many facets of an individual’s life and each area needs to be appropriately addressed. Addiction treatment centers often offer a variety of program durations to meet individual needs. However, many insurance plans have limitations on the duration of treatment that is covered. Be sure to talk with your insurance provider to determine any limits that might be present in your plan and how to make your treatment program work within any imposed time limits.
  • Confidentiality. Regardless of the type, duration, or nature of addiction treatment, any conversations with your insurance provider regarding treatment are considered confidential communication. You can obtain information and have your questions about treatment, addiction treatment centers and your policy, answered in a private, secure setting.

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