Does insurance cover outpatient rehab?

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Does insurance cover outpatient rehab? 

The short answer is yes. Many insurance providers cover the full or partial cost of outpatient treatment.  It is essential to check with your health insurance provider to determine what aspects of treatment are covered. You can contact your insurance company with your membership identification number ready.

There are extensive outpatient treatment programmes across the US and the UK. In the US, the American addiction centres have thousands of rehab centres that provide outpatient care services. 

In the UK, there are extensive outpatient treatment services, including the UK Addiction Treatment Centres (UKAT) 

Most people pay for treatment using private insurance. You can find an insurance provider who covers the full cost of outpatient. Since outpatient care is cheaper than inpatient treatment, it is possible to find an insurance provider covering the entire treatment costs. 

Enquire from your insurance company representative about the "levels of care" covered for addiction treatment. 

You can ask your insurance provider about in-network and out-of-network providers. Also, be sure to enquire about the level of payment covered by your health insurance plan for each. 

Other questions you should ask the company include: 

  • Co-pays and deductibles 
  • Out-of-pocket maximum expenses required from your part 
  • The criteria the health insurance company uses to ascertain medical necessity. 

People who don't have private insurance can look at the options available via public health insurance.

Scientific breakthroughs and medical advancements have proven that addiction is a medical condition that requires long-term care, similar to diabetes type II. Therefore, many public health insurance cover rehabs. 

Treatment costs should not keep you from getting the care you require when seeking treatment for alcohol or drug addiction. Whether outpatient care or inpatient services, you have various avenues that can help you cover the cost. 

Read on to learn what options are available for you with insurance or without. 

Does insurance cover 28 days of outpatient treatment? 

Health insurance can cover 28 days of outpatient treatment. However, you may get partial or full insurance coverage depending on your provider, type of insurance plan, location, and other factors.  

The leading addiction treatment providers such as American Addiction Centres and UKAT maintain strong partnerships with an extensive group of insurance companies at their outpatient addiction treatment programs.

You can contact one of their centres to verify your insurance coverage. In 2019 substance abuse and mental health services administration (SAMHSA) reported that 1 in 19 people suffered from alcohol abuse disorder  

This figure corresponds to 5.4% of the population. Similarly, 8.1 million people aged 12 years and older suffered from at least one substance abuse disorder [1]. 

Although the 28 days outpatient treatment offers an effective substance abuse treatment plan that's flexible and affordable, it is not for everyone.  

People with chronic drug and alcohol disorders are likely to benefit more by seeking more extended addiction treatment options (usually for 60 days or more).

Moreover, people with chronic substance are likely to lower their relapse rate by opting for inpatient rehab. 

You can go for public health insurance coverage for addiction treatment. The affordable care act (ACA) covers outpatient care for substance abuse treatment.

Medicare and Medicaid also offer coverage for outpatient addiction treatment, but you have to meet specific eligibility requirements. 

Outpatient addiction treatment allows you to seek treatment at a treatment centre while still residing at home.

This treatment option is flexible as it will enable you to continue with work, school, or other obligations while still seeking addiction treatment.  

The leading provider of inpatient and outpatient services is the American Addiction centres. You can get a complete 28-day outpatient treatment at one of their centres using public insurance coverage. 

In the UK, the NHS offers outpatient care in the community setting. 

Many private insurance providers cover substance abuse treatment. Some providers offer insurance coverage for GP-referred outpatient services only.

You must find out exactly what your insurance covers if you plan to pay for outpatient care with private insurance coverage. 

Related article: How does outpatient alcohol rehab work and it is right for you?

Does insurance cover inpatient care?  

There are two main types of insurance options for drug and alcohol rehab. They include: 

a). Public insurance coverage.  

Public health insurance providers understand that substance abuse is a medical condition. As such, they do offer insurance coverage for alcohol and drug rehab.

In the U.S., the Affordable care act of 2010 offers low-income earners a way to get affordable treatment.  

All you need to do is reach out to a health insurance coverage explorer to identify inexpensive insurance covers available in the health insurance marketplace. 

The treatment options covered under ACA include detox, inpatient and outpatient care services, counselling, and other services.

Medicare and Medicaid also cover care in an inpatient or outpatient treatment centre. However, you can only use Medicaid at a treatment centre that accepts this type of cover. 

Most Medicare insurance policies cover inpatient care. Medicare insurance policies vary depending on the state.

You are required to get up to 190 days of inpatient care at a rehab centre in your lifetime, with variable co-payments and a $1,260 deductible. 

The NHS is the only public health option in the U.K. NHS provides people access to free primary care services, including G.P. consultation and emergency treatments.

When it comes to rehab, you can get outpatient care services such as a partial hospital program (PHP) using NHS. However, when it comes to inpatient, it is recommended that you use private insurance. 

Anyone in the U.K. can access residential rehabilitation services through their G.P. The G.P. will list you on the NHS waiting list. But it could take months before you are considered for residential rehab. 

b). Private insurance for drug and alcohol rehab. 

Most insurance plans cover substance abuse treatment to a certain level. Insurance companies each have different offerings when it comes to mental health issues and addiction treatment services.

That's why you need to clarify what your insurance pay caters for before you enter a rehab program. 

Most insurance companies cover addiction treatment to the same extent that they cover other medical care needs. However, most providers may only provide insurance coverage for what is deemed "medically necessary."  

Some providers offer payment plans that cover the same essential health benefits provided in public health coverage. 

If you find a provider who covers residential treatment, you will likely pay high monthly premiums for that insurance plan. 

Drug and alcohol addiction treatment costs vary depending on the treatment provider. Typically, treatment centres charge about £8000 for a 30-day inpatient treatment programme.

Well-known treatment centres and celebrity status treatment centres can charge about £15,000 to £60,000 for a 30-day drug and alcohol treatment programme. 

Some drug and alcohol rehab insurance coverage only covers addiction treatment to a certain level. Moreover, getting comprehensive insurance coverage for inpatient care can be problematic due to the high costs. 

Steps for admission to rehab with private health insurance 

The best way to cover addiction treatment is using private health insurance. Since most insurance companies know there's a demand for mental health and addiction services, they are likely to provide you with an insurance policy that covers essential treatment services.

 These include: 

  • Medical detox: This is the first phase of addiction treatment, and it entails 24/7 supervision as you go through the withdrawal symptoms. A medical professional will provide you with medication to help ease the symptoms. 
  • Medication-assisted treatment (MAT): This involves a combination of therapy and medication to further treatment goals, manage cravings, and treat underlying mental health problems if needed. 
  • Group, individual, and family therapy. The treatment centre will provide you with these therapy options to help you develop coping skills that you can leverage to avoid relapse. Therapy also helps the patient solve problems, manage triggers, and develop healthy hobbies. 

Many of the leading insurance companies are covering addiction treatment.  

Still, it is important to reach out to your provider to verify coverage before engaging a treatment provider. You can begin by calling the member services number located on the back of your insurance card.

Alternatively, you can reach out to your provider via their website portal. 

The American Addiction Centres and UKAT are in-network with the leading insurance providers. You can reach out to one of their treatments centres to discover what your private insurance policy covers. 

Once you have clarified with your provider the services available depending on your policy, your first step is to reach out to the admissions personnel at the rehab facility.

Typically, the rehab facility will liaise with your private health insurance source to arrange for admission. 

Admission is fast with private insurance as it typically takes place within 24 hours. 

In most cases, you may have to complete an intake evaluation on the phone to help your treatment provider understand your care needs.

If it's inpatient rehab, the admissions team will inform you of what is required from your end, e.g., what you should carry to inpatient rehab. 

You can fill out a coverage disclaimer form found at the American Addiction centres website to determine exactly what your insurance covers [2].

If you are located in the UK, you can find a similar form at the UKAT portal [3]. 

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Other ways to pay for private rehab treatment 

The substance abuse and mental health services administration reports that out of the 9.2 million adults with a mental illness co-occurring with substance use disorder, only 4.7 million received treatment at a speciality facility [1].  

One of the reasons people fail to seek treatment is because of a lack of insurance. But there are other ways to cover rehab if you don't have insurance. 

Some of the ways that you can pay for treatment include: 

Checking out job-based insurance coverage plans 

You can begin by going through your employee handbook to learn about your company's policy concerning substance abuse.

Some employers recognize treatment for mental illnesses and substance use disorders as critical human services.

You can talk to your employer or reach out to the human resource representative to learn what options are available for you. 

Rehab payment plans 

Leading treatment centres such as the American addiction centres, UKAT, plus other treatment providers offer flexible payment options.

One option that may be available for you is spreading your fee structure over a pre-determined amount of time until you complete treatment. 

Alternatively, your treatment provider may propose a sliding scale payment method. This option is convenient as it's based on your income.

The substance abuse mental health services administration has a facility locator to help you find treatment centres near you with payment assistance programs [4]. 

COBRA coverage 

Lost income due to job loss can be a cause for stress. Most people handle stress by engaging in alcohol or drug abuse which makes the situation worse. In addition to this, it will be hard to get treatment because of unemployment. 

But there are cases where your employer may provide you with a COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage. This coverage allows you to maintain your health coverage temporarily.

To be eligible, you must have insurance that COBRA covers. Your former boss will also inform you if you're eligible for COBRA, and you'll have 60 days to choose if you want this coverage. 

Enrolling for COBRA is beneficial as you'll enjoy the exact coverage you had while employed. With COBRA, you'll be required to pay for your premium. 

Rehab scholarships 

Most rehab centres have scholarships where they cover part of your treatment. You can find out if a treatment centre offers scholarships by contacting them.

Most rehab centres’ representatives work solely to help clients create comprehensive, individualized plans that meet their needs depending on your budget.

If you feel that you'll need a bit of financial assistance, you can explain your situation to them. The admissions team may enrol you in their rehab scholarships. 

If the facility cannot fund you, you can ask them to refer you to a rehab centre that offers grants. Alternatively, you can also ask your GP for guidance on the same. 

SAMHSA grants 

You can seek to pay for treatment by applying for a SAMHSA grant. This grant can cover part of the whole sum for your treatment. In some cases, you can get reimbursed for treatment expenses. 

To conclude  

Most insurance companies understand there's a growing demand for a provider that covers your medical bills and treatment for addiction.

Most private insurance firms offer comprehensive coverage for the essential services that you need for recovery. 

Most private insurance firms are willing to cover part of your treatment expenses. Moreover, if you search for a treatment provider that's in-network with the insurance firm, you have a higher chance of getting treatment at highly reduced prices. 

What's important here is that you need to realize that costs should not keep you from achieving a sober life. There are extensive treatment options available for substance abuse.

If you need help and are willing to begin the journey towards recovery, you start by consulting your doctor to assist you in finding the right treatment plan. 

Leading addiction treatment providers such as the American addiction centres and UK Addiction treatment centres are in-network with leading private insurance firms.

You can contact them today using their free, confidential helpline to chat with a trained addiction treatment counsellor. 

Abbeycare Pricing Bot

Last Updated: December 7, 2021

About the author

Peter Szczepanski

Peter 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. Peter also co-authored the new 6th edition of Drugs In Use by Linda Dodds, writing Chapter 15 on Alcohol Related Liver Disease. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.