How to Use Insurance to Help Pay for Rehab

Good news if you have health insurance: it will likely cover at least a portion of your addiction treatment at a facility if that facility is in network with your provider. Learn step-by-step how to use your insurance for addiction treatment below.

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Is My Substance Abuse Treatment Covered?

Does Health Insurance Cover Addiction Treatment?

As of 2014, the Affordable Care Act requires most health insurance plans to provide some coverage for addiction treatment services. These services are now considered “essential health benefits,” so health insurance offered through the health insurance marketplace must offer mental health and addiction services. These plans are required to cover behavioral interventions, inpatient services, and substance use disorder treatment at least in part.

How to Use Insurance for Addiction Treatment

We know that using health insurance, and making sure it covers what you need it to, can be tricky. Below you can find the details on the steps to working with your health insurance provider to make sure your insurance is accepted by your treatment center and helps cover at least some of the cost.

The 7 steps to using insurance for your treatment are:

  1. Gather your insurance information.
  2. Call the addiction treatment center.
  3. Figure out your payment options: You can or take a look at other ways to pay for treatment.
  4. Determine out-of-pocket expenses.
  5. File a claim, or have your treatment provider file a claim.
  6. Follow up with your insurance provider.
  7. Come up with a plan to pay out-of-pocket expenses.
Where Do I Start?

Step 1: Gather your insurance information.

When planning to get in touch with a treatment center, you will need to provide your:

  • Insurance provider.
  • Insurance identification number, which can be found on your insurance card.

If you need to contact your insurance company with any questions or for approval for your treatment stay, you may need to provide them with your:

  • Full name.
  • Date of birth.
  • The name of the primary insured individual.
  • Your social security number.

Step 2: Call the treatment center.

You will need to ensure that the treatment center where you are receiving your rehabilitation accepts your health insurance, and provide them with your coverage information. Call the treatment center or provider to give them the necessary information.

Provide your:

  • Name.
  • Date of birth.
  • Insurance provider information.
  • Insurance ID number.

The treatment center will verify your insurance coverage and determine if you are responsible for a portion of your bill.

Step 3: Complete the insurance verification process.

Your treatment provider will be able to determine how much of your care is covered by your insurance. The amount your insurance pays will depend on your insurance provider and your specific plan.

Some plans may only cover outpatient services, or will only pay for a certain number of days of inpatient treatment.

The treatment center will call your insurance provider to find out which services your insurance covers. You can also find this information yourself by calling the phone number on your insurance card.

Step 4: Determine out-of-pocket expenses.

You will probably have some out-of-pocket expenses for your addiction treatment. Most insurance plans include a deductible, or an amount you need to pay before your insurance will cover the cost of your treatment.

You may also have a copay or coinsurance, which is the percentage of your treatment expenses you are responsible for.

To determine your out-of-pocket expenses, call your insurance provider and find out which services they cover, as well as your deductible. Get specifics on copay or coinsurance amounts you are responsible for.

How Do I Get My Insurance to Pay for Treatment?

Step 5: File a claim, or have your treatment provider file a claim.

In order for your insurance provider to pay for your treatment, they need to receive a claim. Most treatment providers will file the claim for you. Some providers may require that you file the claim yourself.

To file a claim, you will first need:

  • An itemized bill from your doctor. This bill will list every treatment, procedure, and medication you have received, along with the cost, and an insurance code. This code is what insurance companies use to determine what kind of procedure you received, and whether or not your insurance plan covers that procedure.
  • To fill out a claim form. Your insurance provider will supply you with this form. Make copies of the form and the bill before mailing, emailing, or faxing them to your insurance company. You may also want to call the company to make sure there’s nothing else you need to send in order for your claim to be processed.

Step 6: Follow up with your insurance provider.

Stay in contact with your insurance provider once you have filed a claim. Call to make sure they received your paperwork. Ideally, your insurance company will process the claim and pay your treatment provider.

If there is a problem with your claim, it can be denied, and your insurance company will not pay for the services you received. This can happen if the service is not covered by your insurance.

It is best to call your insurance provider before receiving any services to make sure everything is covered by your plan.

How Do I Pay for Out-of-Pocket Expenses?

Step 7: Come up with a plan to pay out-of-pocket expenses.

It is likely that you will have to pay at least a portion of the cost for rehab. Your treatment provider will give you a bill for your out-of-pocket costs.

Some treatment centers offer payment on a sliding scale, meaning the cost of treatment is based on your income level. Most private treatment facilities just offer straightforward pricing.

Some offer payment plans, so you can receive care now and pay for it slowly over time.

Talk to your treatment provider about payment options. It is likely they can help you come up with a plan to cover your portion of the expenses.

Learn more about the types of payment options Sunrise House supports for out-of-pocket expenses.

Check Your Insurance Benefits

To check and see if your health insurance would cover some of the cost of your addiction treatment, fill out the form below. It’s confidential, and you’ll receive results within minutes.

How to Pay for Rehab Without Insurance

If you don’t have health insurance, there are still options available to help you cover the costs of addiction treatment. First, it’s worth checking if you qualify for government healthcare benefits like Medicaid or Medicare.

Many states aid people who do not have private insurance and some have free, state-funded rehab options. In addition, scholarships and grants may be available for those that need treatment but don’t have insurance.

The Directory of Single State Agencies (SSA) for Substance Abuse Services, managed by the Substance Abuse and Mental Health Services Administration (SAMHSA) is a good place to find who to contact for the assistance programs available in your state.

Other options to help cover the costs of rehab include:

  • Personal loans. Many banks or credit unions will loan money for healthcare-related costs, including addiction treatment. Healthcare loans often have low interest compared to other loans and the amount may be enough to cover the full cost of addiction treatment; however, the amount they will loan you largely depends on your credit and other factors.
  • Payment plans. Treatment facilities often provide financing options allowing you to pay back the cost of treatment in small increments over time.
  • Scholarships. Certain treatment facilities, states, or government programs may have scholarship programs to people in need enroll in treatment.

 Qualifying Life Events

Sometimes, a qualifying life event may allow you to enroll in an insurance program outside the allotted open enrollment period. Qualifying life events (QLEs) may include:

  • Losing your health coverage. This may include losing your job; no longer being enrolled in school; no longer being eligible for Medicare, Medicaid, or CHIP; or aging out of your parent’s insurance policy (turning 26).
  • Household changes, like getting married or divorced, having a child (includes adoption), or experiencing a death in the family.
  • Moving to a new residence. This can include moving to a different county or postal code, moving to or from the place you work or go to school, or entering or leaving transitional housing.

Other possible QLEs may include:

  • Making more or less income that affects the coverage you qualify for.
  • Becoming a member of a federally recognized tribe or gaining status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
  • Gaining U.S. citizenship.
  • Getting out of jail or prison.
  • AmeriCorps members beginning or ending service.

If you think you underwent a QLE and want to get health insurance, call 1-800-318-2596 (TTY: 1-855-889-4325) to talk to an Affordable Care Act (ACA) marketplace representative about applying for insurance during a special enrollment period.

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