Insurance Coverage For Addiction Treatment

Will My Health Insurance Cover Rehab? 

Many health insurance plans offer coverage for treating addiction and mental health disorders. The amount of coverage your project will provide for rehab depends on the type of plan you have, the level of care you’re interested in, and the specifics of your policy. 

If you’re interested in treatment at Tree House Recovery or have questions about insurance, call 855-202-2138. We can verify your benefits quickly and free of charge so that you’ll know the exact cost of treatment. 

Types of Plans that Cover Rehab for Substance Abuse: 

PPO (Preferred Provider Organization):

PPO’s like Blue Shield Blue Cross, also has a network of healthcare providers who will provide treatment at lower costs to their members. PPO’s lower costs by sharing the cost with you. You pay part, and your policy will pay the rest. And unlike an HMO, you can also get care out-of-network, and your costs won’t necessarily be higher. While it’s true that in most cases, going out of network will increase your expenses, we can offer payment arrangements or plans to help make treatment more affordable on a case-by-case basis. 

HMO (Health Maintenance Organization): 

HMO’s like Kaiser Permanente, have a network of health care providers who offer high-quality treatment at lower rates to patients with specific health insurance plans. This is called seeing an in-network provider. If you want therapy outside your network, the costs may not be covered.

Addictions Typically Covered by Insurance:

Every insurance policy considers care for addiction to be an essential category of healthcare and provide some degree of coverage for it. Meaning that if your plan covers addiction treatment, which falls under Mental Health Services, then you can get help if you struggle with

  • Heroin Addiction
  • Fentanyl Addiction
  • Alcohol Addiction
  • Benzodiazepine Addiction like Ativan, Valium, or Klonopin. 
  • Prescription pain pill Addiction like Vicodin, Oxytocin, or Norcos
  • Methamphetamine Addiction
  • Crack Addiction
  • Cocaine Addiction
  • Marijuana Addiction

Does Coverage Depend on The Abused Substance?

The short answer is yes. Coverage can depend on the type of addiction you struggle with. Different drugs may require more care. For instance, a long time heroin user may need more medical supervision or treatment than a short time marijuana user. This doesn’t mean your policy won’t cover treatment for milder substances. It means that it is less likely that they will cover higher levels of care like a medical detox for drugs that are not dangerous to quit.

Of course, every situation is different, and the insurance you have may make exceptions. The best way to see if this is possible is to call us at 855-202-2138.

Types of Addiction Treatment Your Policy May Cover: 

The amount of coverage your policy provides for rehab will vary depending on your policy and the level of care you need. Higher levels of care often cost more and may have fewer covered days of treatment. However, the best way to be sure is to call 855-202-2138 so that we can break down your costs. 

 

Medical Detox:

Detox ends the physical dependence on substances and is the first step to getting sober. Because this process can be dangerous, we recommend using a medical detox with 24-hour supervision. 

Inpatient Rehab:

This is a high level of care where you live in a medical facility that provides oversight as well as resources that help connect you to therapeutic resources like group meetings.  

Partial Hospitalization Program (PHP):

PHP focuses on teaching people to thrive without substances — this means addressing the cause and effects of substance abuse. PHP can be a starting for less extreme cases of Substance Abuse Disorder or a step down from detox. At Tree House Recovery, PHP is 5-6 hours of treatment per day for five days a week including

Group Therapies that Help:

    • Use writing therapy to uncover and heal possible sources of addiction
    • Reduce cravings 
    • Teach stress coping tools using yoga and meditation.
    • Build connections with others 
    • You will forge lifelong bonds treatment peers you can rely on after treatment

Our group therapies utilized scientific strategies or evidenced-based practices to get the best possible proven results in treatment. Examples are Dialectical Behavioral Therapy (DBT), Experiential Therapy, and Mindfulness-Based Cognitive Therapy (MBCT).

One on One Therapies that help:

    • Cement a positive self and world perspective
    • Teach relapse prevention strategies. 

One on one therapies at Tree House Recovery relies on many of the same evidence-based practices as our group therapies. However, in one-on-one treatments, you will also learn techniques from Motivational Interviewing and Cognitive Behavioral Therapy.

Intensive Outpatient Program (IOP): 

IOP can be a starting point for less severe substance abuse cases, but at Tree House, it is a step down from PHP. Tree House IOP treatment is 3-5 hours a day for five days every week and focuses on fossilizing the habits from PHP. 

Outpatient (OP): 

Also called aftercare, OP is generally recommended for people who have finished a rehab program. At Tree House Recovery, we provide three one-hour sessions of OP a week. Sessions are at night to accommodate people’s work schedules.  

How Does Insurance Help Pay for Rehab?

Thanks to your insurance, some or many of your treatment costs may be covered so that you will pay a smaller amount in the end. HMOs, do this by reducing the price of certain providers while PPOs help you by paying a set portion of your treatment costs.  

PPOs: PPOs work by sharing the cost of treatment with you. After you’ve paid a certain amount of your own treatment costs (called a deductible), your PPO policy will begin covering a certain percentage of the remaining costs. This percentage varies depending on your plan but leaves you with a smaller payment — called a co-insurance. 

Some PPOs also have an out-of-pocket-maximum, which refers to the maximum dollar amount you contribute to healthcare costs before your policy covers 100% of treatments. 

HMOs: HMOs work by making mutually beneficial agreements for patients and healthcare providers. In exchange for sending people with HMO policies to certain providers, those providers agree to give quality discounted care. Depending on the plan you have, you may need to pay a certain amount of your healthcare costs (called a deductible) before receiving discounted care. The remaining price is called a co-pay. 

Can I Go to Out-of-Network Rehab? 

Whether you have an HMO or a PPO, going to an out-of-network provider does not necessarily mean your costs will be higher. Many policies will provide some coverage for out-of-network care. It’s also important to understand that after paying costs out of pocket, you can submit a claim to your insurance for reimbursement. Tree House Recovery also offers payment plans to people in order to provide effective care at reasonable costs.

Do you want to learn more about your coverage or hear more about our program or learn more about your coverage? Call us anytime at 855-202-2138. 

Insurance Terms to Know: 

Understanding how your insurance works can be challenging, especially when you are focused on getting into the best rehab. Knowing the key insurance terms can help you know what a coverage assessment means, what questions to ask, and ultimately make the best decision when choosing an addiction treatment center. Below is a glossary of insurance terms to help you. If you need any help understanding insurance, please call us. We are here to help.

Deductible: The amount of money you must pay if you have an HMO or PPO before your policy helps pay for treatment. Deductibles vary policy to policy. 

Co-pay: A set dollar amount you must pay after your insurance policy has helped cover costs. Co-pays vary depending on your policy and are determined by the type of care you desire. 

Co-Insurance: The remaining percentage of treatment costs you must pay out-of-pocket after your HMO or PPO policy has helped cover costs. Co-pays vary depending on the original price of treatment and your specific policy. 

Monthly Premiums: The cost to keep your HMO or PPO plan active every month. Costs depend on your plan. 

Out-of-pocket maximum: A dollar amount on certain policies that, if reached, triggers 100% coverage of all costs for a set amount of time. Not all policies have this, and the amount it takes to reach your out-of-pocket maximum varies depending on your policy. 

Private Insurance Carriers | Typically Accepted

Most addiction recovery programs accept policies from major and insurance providers. Below is a list of common private insurance plans that are typically taken at addiction treatment centers:

  • Aetna
    • Aetna (GEHA)
  • Anthem
  • Blue Cross and Blue Shield (BCBS)
    • BCBS Federal
    • BCBS Excellus
    • BCBS Highmark
    • BCBS Premera
  • Beacon
  • Cigna
    • Cigna (Allegiance)
    • Cigna (Healthcomp)
  • Tricare
    • Tricare East
    • Tricare West
  • Triwest
  • United

Start Your Recovery Today:

According to the U.S. Census Bureau, 91.5% of Americans have some form of health insurance. That coverage exists to make healthcare needs more affordable and more available when you need it. If you are struggling or someone you love needs help with Substance Abuse Disorder, don’t wait to reach out. Call 855-202-2138. Our staff can help explain our program and your insurance coverage. Click here to learn more about our program. 

Are You ready to get help?

Call (855) 202-2138

More Addiction Resources

Ready for change?

Start your journey today!
Call (855) 202-2138