Insurance Coverage for Addiction Treatment

Find treatment and enjoy time together again.
Do you have questions about average treatment costs, understanding payment options, financial assistance, or rehab insurance coverage?
This insurance guide will provide answers to your rehab cost related questions, understand which addiction treatments may be covered, and most importantly, to see if your health insurance provider will cover your substance abuse treatment. In addition, this guide will educate you on the differences between HMO and PPO plans to help you determine which plan offers the best coverage for you during your substance abuse treatment and recovery.

Frequently Asked Questions


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How much does rehab cost?
The cost of rehab varies depending on the patient’s level of treatment, length of stay, insurance coverage, and other unique factors. Read more about how insurance can help cover some of the cost.
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Does insurance cover rehab?
Health insurance plans will cover treatment for addiction and mental health disorders. With the passage of the Affordable Care Act, more Americans now have access to these forms of treatment. Plans can vary in terms of what type of coverage they provide or how long they will cover treatment, so it’s best to check with your provider or the rehab program you’re interested in attending. Read more.
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How much does drug rehab cost with insurance?
The amount of coverage or insurance acceptance is based on the insurance policy that each patient is covered by. This means out-of-pocket expenses will vary. Read more.
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How to bill insurance for substance abuse treatment?
People with addictions and insurance should use their coverage to the fullest in order to get the care they need. Talking to your insurance plan administrator by calling the number on the back of your insurance card is a great place to start. The staff of addiction treatment facilities can also be of vital help, easing the path to payment so families have one less thing to worry over as they recover. Read more.
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How to get financial assistance for substance abuse treatment?
Financial assistance for substance abuse treatment can come from federal, state, and local governments. There are also grants available through SAMHSA, as well as insurance options for certain populations, such as veterans or low-income families. Read more.
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What is the cost of outpatient substance abuse treatment?
Outpatient treatment for substance abuse can cover many different services and levels of care. It is recommended that patients work with their insurance provider and the rehab facility directly to determine their out-of-pocket expenses. Read more and verify your insurance coverage here.
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Does insurance cover residential treatment?
Many insurance plans do cover residential, or inpatient, rehab treatment. Patients can determine which benefits they are eligible for by calling the phone number on their insurance card. You can also verify your benefits here.

Understanding Insurance Plans


HMO (Health Maintenance Organization) plans allow patients to choose their primary care physician and see that doctor for most of their medical needs. This allows them to form a relationship with a doctor who knows their whole health history.

When seeking a specialist or physician outside of the network, a referral is needed by your primary care physician.2 HMOs have lower or no deductibles and overall coverage is usually a lower cost than PPO.1 Pros of HMO coverage are for those that are not seeking a specialist and healthcare providers out of their network and paying lower premiums.1

PPO (Preferred Provider Organization) plans allow patients to see healthcare providers in and out of their network without referrals.3 PPOs can have higher deductibles than those with an HMO plan.1 One of the pros of PPO coverage is having the option see specialists and other healthcare providers outside of your network without a referral from your primary care physician.1

Plan Benefits
HMO
Health Maintenance Organization
PPO
Preferred Provider Organization
Overview
Most Affordable
Most Flexible
Primary Care Physician (PCP) required
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Referral required to see a specialist
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In-network benefits
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Non-emergency out-of-network benefits
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Emergency coverage
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Sources

  1. Masterson, L. (2019, October 23). Insurance.com, What is the difference between HMO, PPO, HDHP, POS, EPO?
  2. eHealth. (2018, March 23). HMO vs PPO for Individual Health Insurance.
  3. eHealth Medicare. (n.d.). What are the differences between Medicare HMOs and PPOs?
Insurance Disclaimer: American Addiction Centers may attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member's contract at time of service. Your health insurance company will only pay for services that it determines to be "reasonable and necessary." American Addiction Centers will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.