Does insurance cover alcohol rehab?

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Insurance does cover alcohol rehab to some extent. Some insurance covers either pay partially or fully depending on your particular plan or selected addiction treatment. 

Alcohol addiction coverage typically covers some of the cost of treatment.

However, depending on the type of treatment, private funding from insurance may settle for co-pay terms. e.g., the insurance provider may cover medical detox, and you pay for the rest of the treatment. 

Independent health insurance may propose coinsurance. This is a percentage of the total cost of care.

For instance, if the policy states a 30% coinsurance fee, the health insurance providers will pay 70% of the fee, and you pay for the remaining rehab costs. 

Some may provide a cover that contains deductibles, e.g., The plan may not cover for relapses, or the plan may not cover for extras such as the use of recreational facilities in the rehabilitation centre. 

There are instances where the insurance company provides a comprehensive coverage. But in most cases, such plans come with a high premium cost which is the policyholder's responsibility. 

Your employer's insurance plan may also come with exclusions. For example, if you are part of a group insurance plan provided with your employer, you'll have to contact human resources to determine if the cover caters for alcoholism treatment. 

You can use your employer's insurance or private insurance to cover alcohol rehab.

Most alcohol rehab facilities accept insurance from U.K.'s major health insurance companies, e.g., Bupa, Aviva, Cigna, Axa, Blue Cross Shield, Aetna, plus many more. 

Does insurance pay for alcohol rehab? 

does insurance pay for alcohol rehab

Insurance does pay for alcohol rehab. In the U.S., the affordable care act (ACA) passed in 2010 rendered it compulsory for health insurance providers to cover alcohol addiction treatment.

This act also ensured that more than 50 employers with more than 50 workers provide insurance plans that provide drug and addiction coverage. This is referred to as the employee mandate.  

Plans must provide coverage for: 

  • Addiction treatment 
  • Inpatient behavioural health services 
  • Outpatient care, e.g., counselling and psychotherapy. 

The state you live in and the health plan you choose influence the extent of the coverage.

The ACA sponsors insurance plans listed in the health insurance marketplace. These plans offer addiction treatment coverage that's similar to private insurance. 

In the USA, the ACA also covers rehab for Americans with limited financial resources. They do this through Medicare and Medicaid. 

Medicare Part A and B include coverage for alcohol treatment, including rehab. Medicare A helps you pay for hospitalization for substance abuse treatment [1].

It covers inpatient and outpatient care on the conditions that:

  • Your provider states that the treatment is medically necessary 
  • You get services from a Medicare-approved facility 
  • Your provider sets up a treatment plan. 

Medicare Plan B helps you cover treatment for partial hospitalization or outpatient addiction treatment.

On the other hand, Medicare Plan D covers medications used in addiction treatment. 

Health insurance covers drug and alcohol treatment and mental health services. The Substance Abuse Mental Health Services Administration (SAMHSA) reports that in 2018, approximately 21.2 million people aged 12 years and older needed treatment for substance use [2].

The same report shows that about 139.8 million people aged 12 years and older used alcohol in the same year.

Out of these people, less than 2% received treatment, and less than 1% went to rehab. 

Alcohol addiction tends to occur alongside another pre-existing condition (including substance use disorder). This is known as a dual diagnosis and is common in cases of substance abuse treatment.

Many people struggling with alcoholism also exhibit mental illnesses. Dual diagnosis complicates treatment as both conditions need to be treated simultaneously. 

Under ACA, medical insurance covers: 

  • Inpatient care in an approved facility 
  • Outpatient care with an approved provider 
  • Medical detox 
  • Co-occurring mental health conditions 
  • Maintenance medication 
  • Follow-up counselling. 

The Affordable Care Act stipulates that insurance carriers should cover addiction treatment in the same way they would cover costs related to any medical condition.  

The law also prohibits insurance companies from discriminating against customers who have pre-existing conditions.

This clause ensures that people who experience relapse get treatment. However, there are still out-of-pocket costs in most of these plans. 

Since it's difficult to determine what you're covered from versus what's excluded, most rehab centres have insurance specialists to help you sort out addiction treatment services covered with your policy. 

Some of the costs not covered by the ACA can be covered using private insurance.

Leading insurance providers include Aetna, Cigna, Amerigroup RealSolutions, Humana, BlueCross Shield, Anthem, UnitedHealth Group, and many more. 

Insurance does cover rehab in the U.K. However, this is mainly done with private insurance.

Private insurance companies such as Bupa offer comprehensive coverage and residential treatment depending on the type of cover.

In addition, some employers offer private insurance coverage for alcohol addiction. 

You may be covered for all or part of your treatment. It all depends on the insurance company and the package you choose. 

Using Insurance to Cover Alcohol Rehab 

using insurance to cover alcohol rehab

You can use insurance to cover inpatient rehab, outpatient rehab, and other additional services.

In addition, some insurance plans cater for a variety of alcohol addiction treatments such as 12-step programmes, support groups, therapeutic, etc. 

Each individual has unique needs, and some insurance providers have specialist admission officers to help you determine the right treatment and facility depending on your needs [3]. 

You can find out if you can use your insurance to cover alcohol rehab by reaching out to Addiction Helper treatment counsellors [4].

The treatment counsellor will provide medical advice and help you identify a rehab clinic that accepts your coverage. 

Alternatively, you can call your insurance customer service department to find out if you are covered under the policy you have.

Remember that different policies cover different conditions and to a certain degree. 

You need to: 

1. Consult your doctor to determine your treatment needs: Your first step is to determine whether it is medically feasible to seek treatment.

Next, your doctor will assess you to determine the degree of abuse or addiction plus the type of treatment you need. 

2. Find the right treatment program: Your doctor can suggest a rehab center, or you can find one using various resources. e.g., The U.K. Addiction Treatment Centre. 

3. Once you find your preferred treatment center, inquire whether they accept your insurance plan. 

4. Liaise with the rehab establishment to ensure coverage. Your preferred rehab should work with your insurance company and work out the details of the coverage. 

Some insurance cover inpatient treatment in a well-established rehab facility for some time. Others may only cover certain aspects of treatment, such as counselling. 

It would help if you reach out to your insurance provider directly and ask them: 

a) Exactly what drug and alcohol rehab treatment they cover, whether it's inpatient, outpatient, or counselling 

b) What substance abuse is covered under the policy and the restrictions that apply. 

c) Ask if they cover medicated detox if you need it. 

d) Ask about restrictions, i.e., do they cover specific rehab clinics, is there a time limit for the period of treatment they cover, will they cover additional expenses. 

e) Ask if any existing clauses may invalidate your claim 

f) Ask about their procedure for admission and whether they'll require you to see their own doctor first. 

g) Ask them if they cover residential rehab treatment services. 

Many rehabs offer inpatient and outpatient services. Inpatient treatment offers holistic care services such as detox withdrawal. They also offer recreation programs and other nonmedical amenities. 

The cost of rehab varies depending on location and length of stay. Residential care is usually paid for out-of-pocket. But there some insurance agents may fund treatment.

It is only in exceptional cases that the NHS or social services assist in paying for inpatient rehab. 

Alcoholism treatment in rehabilitation centres has a high success rate, with some of the best facilities reporting a 60% to 80% successful recovery rate [5]. 

You can also contact an addiction specialist to discuss your care and the available options suitable for you. 

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Find Rehabs That Accept Insurance 

You can find a rehab centre that accepts insurance near your home or in another location by contacting a treatment provider 

Alternatively, you can utilize various online resources, e.g., The U.K. Addiction Treatment Centre website

You can also be allocated to a drug rehab centre by contacting local authorities or local charity organizations that help people with substance addiction. 

Some insurance providers will refer you to an alcohol rehab program of their choice. 

Still, you need to investigate the treatment centre. You can find some information online or reach out to them and ask a few questions. 

How to get into alcohol rehab without insurance 

It is possible to get into alcohol rehab without insurance. You can talk to your employer to see if they may be willing to help you pay.

Some companies may be willing to give you an extended leave so that you'll have a job once you complete treatment. 

You can talk to a treatment provider and see if they have other payment options. For example, some providers may offer a payment plan to pay for the care in small instalments. 

You can seek aid from charity or support groups such as [6]: 

  • Alcoholics anonymous 
  • Alcohol Change UK 
  • Dan 24/7 

The NHS treatment options are free. However, this service is not intensive enough to meet the needs and demands for treating alcoholic addiction.

Most of the treatment is carried out in the community, which is challenging for someone trying to quit the habit.

Also, the procedure for enrolling into an NHS -approved rehab facility is lengthy. 

You can pay for substance abuse treatment from your personal funding. In addition, you can take out a personal loan or request friends and family for aid. 

Conclusion  

Alcohol addiction treatment doesn't have to be a hurdle. Most people use private insurance to cover the rehab costs.

Leading insurance providers such as Bupa and Axa offer comprehensive insurance packages.

The affordable care act also assists those with financial struggles through Medicare and Medicaid.  

In the U.K., its only in special instances that the NHS aids people to pay for certain holistic care services. In most instances, people make out-of-the-pocket payments or utilize private insurance.

Employers are also not legally mandated to offer insurance for substance abuse.  

Insurance coverage, in most cases, partially covers for care. That's why you need to reach out to a health insurance company to figure out how much coverage you get.

Then, if you still need more assistance, you can talk to your treatment provider to discover other financing options that would help.  

How to pay for addiction treatment

If you cannot afford alcohol rehab, all hope is not lost because there are several ways to pay for addiction treatment. Health insurance may cover the cost of treatment in part or whole, be sure to ask the facility ahead. You can also take advantage of local government-sponsored programmes that support people in need of addiction treatment.

Note that alcohol rehab costs vary from one individual to the next because each person experiences addiction differently and requires special needs. Other factors like the structure of the rehab facility may also determine the cost of addiction treatment. 

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About the author

Peter Szczepanski

Pete has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. To read more about Pete visit his LinkedIn profile.