How to Pay for Rehab
In the American healthcare system, people can either pay for rehab through private health insurance, public health insurance, or payment plans set up directly with their treatment provider. While public insurance, payment plans or financing options are viable payment options, the high cost of treatment and the limitations and lack of accessibility to state-funded rehab have made private insurance the most desired method of paying for addiction treatment. This article will help you understand the cost of treatment, who the prominent insurance providers in the United States are, and how coverage for rehab through them is acquired.
The Affordable Care Act (ACA/Obamacare)
Before covering the basics of how to pay for treatment. it is important to understand the protections that are available to you provided by the Affordable Care Act of 2013. The ACA has made addiction treatment considerably more affordable and accessible in several ways. The ACA:13,14
- Extended healthcare coverage to millions of Americans that were previously uninsured.
- Bars insurance companies from denying treatment for pre-existing conditions like substance use disorder.
- Allows parents to keep their children on family insurance plans until age 26.
- Requires federal and private insurers to handle substance use disorder with the same level of care provided for surgeries and other medical procedures by establishing new coverage requirements.
- Requires coverage for pre-existing conditions to begin the date your plan starts.
- Marketplace insurance plans cannot require authorization before beginning treatment. Nor can they set limits on:
- The amount of money spent on treatment.
- The number of visits or days spent in treatment facilities..
How Much Does Rehab Cost?
Unfortunately, due to the many differences between facilities and their offerings, there is no one-size-fits-all answer to the cost of rehab. Detoxification services, inpatient care, partial hospitalization programs, intensive outpatient treatment, and standard outpatient programs all have varying costs. In short, a combination of the clinical needs of a patient and the facility in which they choose to attend will determine how much their addiction treatment experience costs. This is why most treatment providers accept some level of insurance and will also work with patients to establish payment plans. Rehab centers may also customize the care provided to best suit the individual patient’s financial needs.
Private Health Insurance Providers
In the United States, there are several major health insurance companies that provide coverage. The four largest are Blue Cross Blue Shield (BCBS), Aetna, Cigna, and United Healthcare (United HC).
Blue Cross Blue Shield covers a third of all Americans through 36 independent Blue Cross Blue Shield companies and is available in every region of the country.3 Aetna has been in operation since 1853 and is now owned by CVS Health Corporation. They focus on bringing cutting-edge care and treatment to enrollees.4 Cigna covers over 170 million people with a focus on providing tailored treatment solutions for physical and mental health.5 And lastly, United Healthcare covers millions of Americans and strives to incorporate effective, new treatments and collaborate with care providers.6
Does My Insurance Cover Rehab?
While there are a few exceptions, most private health insurance companies are required to cover substance use disorder treatment.1 The Mental Health Parity and Addiction Equity Act of 2008 was passed to ensure that insurance providers cover healthcare for mental illness and substance use disorders at levels comparable to physical health disorders.2 The aforementioned Affordable Care Act (ACA) of 2013 builds upon the Parity and Addiction Equity Act by requiring all new small group and individual market plans to cover ten “essential health benefit” categories in which mental health and substance abuse treatment is included.2 Parity laws apply to inpatient treatment, partial hospitalization programs, intensive outpatient and standard outpatient services, and residential services.1
In general terms, addiction treatment programs can be broken down into three major components: detox, inpatient treatment, and outpatient treatment. According to all four providers’ websites, they cover all these types of care though the specifics of treatment may vary.7,8,9,10
While the aforementioned legislation requires most insurance companies to pay for addiction treatment or rehab in some capacity, every insurance policy is different, so the coverage of rehab costs can vary considerably from patient to patient. A few of the factors that affect coverage levels are:
- Type of policy: HMOs, PPOs, HRAs, and HDHPs will all cover different percentages of the total cost of treatment. Your insurance card should indicate the type of policy, your co-pay amount, and offer a phone number and website where you can get your coverage information in detail.
- In-network providers: Most insurance companies have relationship with specific healthcare providers that are deemed “in-network.” Seeking treatment at an in-network facility will almost always reduce the out-of-pocket cost for which the patient is responsible.
- Public insurance plans: Medicare and Medicaid are both forms of public insurance available to select people who qualify. Coverage on these plans can be quite different than on plans provided through an employer or purchased on the health insurance marketplace.
How Coverage Is Determined
Each of these major providers has their own differences in terms of how they determine coverage for rehab. For the most part, however, they do follow a general pattern of acquiring either a referral or preauthorization before treatment can begin.7,8,9,10According to healthcare.gov, a preauthorization is defined as, “A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.”.11
In most cases, preauthorization is achieved by having a treatment center conduct an initial assessment to determine the appropriate level of addiction care necessary and identify any additional components that should be factored into the treatment process.8 While this component of determining coverage is mostly uniform across BCBS, Aetna, Cigna, and United Healthcare, the required information to complete these assessments may vary.
For instance, BCBS will ask the provider to assess how severe your substance use disorder is, along with the presence of any co-occurring physical or mental health disorders that can play a role in your treatment needs.7 In contrast, an assessment for Cigna includes learning more about your substance use patterns (both current and previous), medical history, social factors that can impair recovery efforts, and what you want to get out of rehab.9 In either case, the insurance providers will only support coverage for treatment offerings that are deemed “medically necessary.”
Check Your Insurance Coverage
BCBS, Aetna, Cigna, and United Healthcare–and most other providers not included in this article–offer member services portals or where you can review detailed information about your particular policy and insurance coverage for substance abuse treatment before you call a treatment provider though most treatment providers can verify your benefits very quickly if not instantaneously.
As one of the largest providers of addiction treatment in the United States, American Addiction Centers accepts all four of these major insurance providers and works with many others. To learn more about whether or not we may accept your insurance plan, call our confidential helpline at 1-888-439-3435 Who Answers? or use the form below.
Rehab Financing & Private Funding
Though rehabilitation treatment can be costly, there are still ways to afford it without insurance. If obtaining a personal loan from a friend or family member is not an option, you may be able to secure a low-interest loan from a bank or credit union. There are also several financing companies offering loans for addiction treatment–though you should carefully analyze these agreements and the interest rates associated before entering the agreement. Lastly, if none of these options permit, you could also raise money for their addiction treatment costs by using crowd-funding sources like GoFundMe.
Sometimes individual facilities or corporations that run multiple facilities (like American Addiction Centers) offer scholarship programs to help patients pay for rehab. Often, scholarships will only be considered for patients that can demonstrate they have exhausted other options and can prove they are committed to rehabilitation.
These programs vary greatly in terms of how much of the cost they cover. Usually, a budget for these funds is allocated once a year, making it important to apply for these scholarships early.
To find local treatment options that offer these other payment options, consider the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator, and don’t lose hope. There are treatment options available for you regardless of your financial capabilities.