- Precertification and Prior Authorization
- Lifetime Limitations
- Rehab Treatments
- Alcohol Detox
- Inpatient Rehab
- MAT Rehab
- Outpatient Rehab
- Bedrock Amenities
- Types of Insurance
- PPO Insurance
- HMO Insurance
- POS Insurance
- Employer Group Insurance
- Federal and State Health Insurance
- Medicare Insurance
- Medicaid Insurance
- Average Cost
- Cost out of Insurance Coverage
- Rehab vs Addiction Cost
What Does Insurance Cover for Alcohol Rehab?
Alcohol addiction is a disease that is unfortunately quite common. In fact, according to the 2019 National Survey on Drug Use and Health (NSDUH), over 14 million adults in the United States suffered from alcohol use disorder (AUD). Additionally, according to the 2018 NSDUH, only 7.9% of adults with AUD actually received treatment that year. As you can see, based on these statistics, it’s a serious issue in the country today.
AUD (or alcohol addiction) requires treatment by professionals. Otherwise, you may never be able to break the cycle of addiction and substance abuse. Since it’s considered to be a medical condition, your health insurance will cover all or part of the cost of treatment. The level of treatment insurance coverage will depend on a variety of factors, including your insurance policy and the type of treatment you need.
Since the cost can be a barrier for many people who desperately need treatment, it’s important to note that having health insurance can make the treatment affordable. Even if you have to supplement some of the coverage with out-of-pocket payments, it makes treatment overall much more financially feasible.
What Is Precertification and Prior Authorization for Alcohol Treatment?
Prior authorization (PA), also known as pre-authorization or precertification, is a requirement from your insurance company that any treatment needed must first be approved under your policy. In other words, the medical professional treating you (like a doctor, therapist, or addiction counselor) must first get approval. This can include medications, devices, treatment programs, or procedures. In the case of an emergency, this is not required as treatment must be provided immediately.
In order to get PA, your insurance provider will have to determine if your substance abuse treatment is medically necessary. This usually involves being examined by a doctor and having them fill out the necessary paperwork. Once approval is granted, you can move forward with the treatment. You can also find out ahead of time if some or all your treatment will be covered in order to plan for your private expenses.
What Are Deductibles for Alcohol Treatment?
With insurance coverage, a deductible is the amount you pay out-of-pocket before your coverage kicks in. In other words, if you have a $500 deductible, then you pay the first $500 of expenses until your policy takes over. If you have a $2,000 deductible, then you pay the first $2,000.
Additionally, your coinsurance is the amount your insurance policy covers once you’ve hit your deductible. For plans with higher premiums, this can be 100%. If you pay lower premiums, this can be 75% to 80%. That means you’ll still be responsible for paying a portion of your treatment. This varies from policy to policy, so you’ll have to check with your provider when choosing your alcohol rehab treatment.
What Are Copays for Alcohol Treatment?
Once you’ve paid your deductible, then you’ll only be responsible for your copayment (also known as copay). This is a small, fixed amount of money that you are expected to pay at the time of service or treatment.
For instance, if you’re going through medication-assisted treatment (MAT) rehab for alcohol addiction, then you’ll be taking medications on a regular basis. Depending on your policy, your insurance will likely cover the majority of the cost while you’ll be responsible for a copay each time you pick up the medications. In many cases, these are between $5 and $50, although some can be much higher if the medication is not available in generic form.
What Are Premiums for Alcohol Treatment?
The premium is the amount you pay per month for your insurance coverage. It’s important to note that the lower your deductible, the higher your premium. That means you’ll pay more each month (higher premium), but your plan will start sharing the costs sooner because you’ll hit your deductible sooner.
What Are Lifetime Limitations for Alcohol Treatment?
For most people, the greatest barrier to treatment is affordability. Substance abuse – including AUD – is a complex disorder with lots of underlying issues. This means that it’s not easily treated with a single procedure or medication. Instead, it must be tackled with a multi-level approach. There is no “one-size-fits-all” treatment – it varies from person to person.
As a result, you’ll have to work with your insurance company and treatment facility to find the ideal treatment plan for you. The best rehabs will offer customized treatment plans that have been specially designed for your needs.
What Factors into the Cost of Alcohol Addiction Treatment?
There are multiple treatments available for alcohol addiction as well as different kinds of facilities. The cost of your treatment will depend on where you go and your individual treatment plan.
Types of Rehab Addiction Center
With over 14,000 rehabs all over the United States, there are all kinds of options available. This includes anything from a public facility, usually funded by the state or county, to lavish “resort” rehabs with every amenity you could imagine. However, it’s important to note that there is no empirical evidence suggesting that these ultra-expensive, luxury rehabs have higher rates of success.
Whatever program you choose, it’s important that they use evidence-based treatments (EBT). These are methods that have been scientifically proven and used successfully in a clinical setting.
Location of the Addiction Center
The location of the rehab facility will likely influence its price. For example, luxury rehabs that are located on scenic cliffs overlooking the ocean will almost certainly be exponentially more expensive than a nondescript clinic in a suburban area.
While it’s important to be comfortable and safe, your alcohol treatment rehab does not need to be a destination resort for you to benefit from treatment. On the other hand, addiction treatment is not supposed to be punishment, so it’s best to find a program that is well-balanced between cost, efficacy, and comfort.
Size of the Program
Smaller programs have much better staff-to-patient ratios. This means that the treatment staff can give you more personalized attention and you won’t become just another anonymous patient. Evidence shows that person-to-person contact and connection is crucial for successful treatment.
However, because of economies of scale, smaller programs are usually more expensive. This is another drawback of public programs – there are very few staff for huge populations of patients. In these programs, it’s easy to get lost in the shuffle and slip by without adequate treatment and attention.
Length of the Program
This is a crucial part of your treatment. For many recovering addicts, they want the program to be as short as possible. This is because they feel like they must return to their jobs, schooling, or families right away. In reality, it’s best to throw yourself into treatment for as long as it takes.
In fact, most experts agree that programs must be at least 90 days (three months) long.If possible, it’s better if the program can be even longer. That’s not always possible, due to expenses and/or outside responsibilities.
Alcohol Rehab Treatments Offered
The following alcohol rehab treatments are offered:
Alcohol causes both psychological addiction and physical dependence. This means that – if your drinking is heavy enough – stopping suddenly may cause withdrawals. In other words, your body has become accustomed to the alcohol and requires it to function, even if it is seriously damaging your organs and health.
What Is Alcohol Detox?
Alcohol detox treatment is the process of detoxification from alcohol addiction. Since it’s basically poison to your body, you have to flush it out under medical supervision. Plus, alcohol withdrawals are extremely dangerous – if you’re a heavy drinker and you quit suddenly (also known as cold turkey), you may have seizures that can be fatal.
In the case of detox, you have to be under 24-hour medical supervision. Due to the risk of seizure, you must be under the constant care of medical professionals. In most cases, they will give you medications to ease your withdrawals, treat severe dehydration, and avoid any seizures.
How Long Does Alcohol Detox Treatment Take to Complete?
This depends on the severity of your condition, but usually anywhere from three to 10 days. During this time you’ll be under constant medical supervision to monitor your vitals and overall health. If your condition is especially serious, then it may last longer – up to three weeks even.
Why Does Alcohol Detox Play a Critical Role in Addiction Recovery?
Detox is the first step in a very long and arduous process. It’s also terrifying for many addicts – the idea that you’ve become so dependent on alcohol that you may have seizures when you stop drinking is scary. Medically-supervised detox allows you to treat the withdrawals safely and effectively.
Alcohol Inpatient Rehab
Some people have more severe cases of addiction. For them, being under constant supervision of treatment professionals may be the only way to start breaking the cycle of addiction and substance abuse.
What is Alcohol Inpatient Rehab?
Inpatient rehab treatment for alcohol is when you live at the actual treatment facility. This includes room and board as well as the various parts of your overall treatment plan. This is expensive because of the additional costs of treatment. Of course, if you choose a more luxurious program, then it will be significantly more expensive.
How Long Does Alcohol Inpatient Rehab Treatment Take to Complete?
This depends on the severity of your condition, but most inpatient programs are between 30 days and six months. For many people, cost is a limiting factor in getting inpatient treatment, so you’ll have to check your insurance policy to see if it’s covered and – if so – for how long.
It’s always crucial to remember that the longer the treatment, the greater your chance at success.
Why Alcohol Inpatient Rehab Plays a Critical Role in Addiction Recovery?
Attending an inpatient program allows you to devote yourself 100% to your recovery. You can be free of any distractions, including work, school, family, and outside temptation. It may seem drastic to some people, but inpatient rehab is sometimes the only way a person can break the cycle of addiction. You remove yourself from outside triggers and stress and become totally devoted to breaking free of your alcoholism.
Alcohol MAT Rehab
Addiction treatment has come a long way in the past 100 years or so. At one point in time, alcoholism was treated as a moral failing. If you drank uncontrollably, you were punished or shunned by society. Once people started realizing that it’s an addiction, the whole treatment model changed and we now have medications to help treat alcoholism.
What Is Alcohol MAT Rehab?
Alcohol MAT rehab is the use of medications to treat alcohol addiction and/or dependence. These medications can do a number of different things, including:
- Decreasing cravings for alcohol by mimicking its function in the brain.
- Blocking the effects of alcohol in the brain, making it impossible for you to feel drunk.
- Treating underlying mental conditions as part of a dual-diagnosis program.
How Long Does Alcohol MAT Rehab Treatment Take to Complete?
This depends entirely on the severity of your addiction as well as the presence of additional conditions or factors. However, in most cases, MAT should last as long as the inpatient and/or outpatient treatment and then continue for as long as necessary after the patient completes their program(s).
For some patients, this may be years. In fact, if the medications are part of a dual-diagnosis treatment program for underlying medical conditions, then the patient may have to take them for the rest of their life.
Why Alcohol MAT Rehab Plays a Critical Role in Addiction Recovery?
Treatment has come a long way. There are so many more tools now available, making your likelihood of success that much greater. MAT can be one of the tools in your recovery toolbox, used in combination with other aspects of your treatment plan. The whole goal is to get you back on your feet and healthy so you can live happy and free of alcohol.
Alcohol Outpatient Rehab
Finally, there are outpatient programs available. These can be used independently of any other residential program or can be done following a stint of inpatient treatment.
What Is Alcohol Outpatient Rehab?
Outpatient rehab is the opposite of inpatient rehab – instead of living at the facility, you live elsewhere and attend treatment at the rehab. If inpatient is too expensive, you can always opt for outpatient rehab since it’s almost always significantly less expensive.
You attend the facility anywhere from 10 to 40 hours per week, depending on the level of your outpatient program. MAT can be given throughout your entire process of treatment, but if you’ve already finished detox and inpatient treatment, then it’s significantly less expensive.
How Long Does Alcohol Outpatient Rehab Take?
This depends on the type of program you choose and the severity of your alcohol use. If you’re attending outpatient in combination with inpatient, then the outpatient should be at least as long as the inpatient. In other words, if you do 90 days of inpatient, do at least 90 days of outpatient.
If you decide to only attend outpatient, then you should confer with treatment professionals about how long you should attend. These programs can be anywhere from 30 days to six months, however more severe cases can require outpatient treatment longer than a year. It’s less expensive and time-consuming than inpatient, so many recovering addicts use it as a long-term treatment.
Bedrock Addiction Rehab Amenities
Bedrock Recovery Center (BRC) is a treatment center with all the necessary tools and amenities to treat your alcohol addiction. With our professional and compassionate help, you can learn to be happy and free from your substance abuse.
These amenities include:
- Beautifully Remodeled State-of-the-Art Facility
- Movie Theatre
- Fitness Center
- Outdoor Recreation
- Yoga Studio
- Salon (Pictures to come)
- Laundry Services
- 5 Star Food Service
- Gluten, Vegetarian Options Available
What Types of Health Insurance Cover Rehab Treatments?
There are all kinds of alcohol rehab insurance plans and policies. Depending on the premiums you pay and the coverage plan you’ve chosen, most or even all of your alcohol addiction treatment can be covered. Additionally, if you suffer from underlying mental health conditions and need dual-diagnosis treatment, your insurance may also cover those costs.
Do Private Health Insurance Plans Cover Rehab?
Yes, they do. It all depends on the type of plan you have and the coverage you’ve chosen, but the following types of private health insurance will cover some or all of your alcohol addiction treatment:
- PPO Health Insurance
- HMO Health Insurance
- POS Health Insurance
- Employer Group Insurance Health Insurance
Do PPO Insurance Plans Cover Rehab?
PPO insurance plans will cover alcohol addiction treatment, although the specifics will depend on your plan and details of your policy.
What Is A PPO?
(PPO) means you have a network of medical providers and you pay less if you choose a provider that’s in-network. This gives you a certain degree of flexibility in choosing your treatment plan since you can, although the premiums and deductibles tend to be higher than other plans.
Do HMO Insurance Plans Cover Rehab?
HMO insurance plans can also cover rehab, but you’ll have to double check just how much and what providers are in your policy. Plus, they offer little to no coverage if the provider is out of your network, so it’s absolutely vital that you get prior authorization (PA).
What Is An HMO?
A health maintenance organization (HMO) limits coverage to care from providers who work for or are contracted with the HMO. Out-of-network care will only be provided in cases of emergency.
Do POS Insurance Plans Cover Rehab?
Just like PPO and HMO plans, POS insurance plans can also cover rehab and treatment costs. With a PPO plan, you can go out-of-network for an additional fee and you don’t need a referral for specialists.
What Is A POS?
A point-of-service plan (POS) is a hybrid of PPO and HMO, with similar rules to an HMO for choosing an in-network primary care provider. Because it has elements of PPO plans, its premiums and deductibles tend to be higher than other programs.
Employer Group Insurance
Do Employer Group Insurance Plans Cover Rehab?
Yes, they can. However, this will depend on the specifics of your policy, so you’ll need to get prior authorization (PA) before choosing a treatment facility.
What Are Employer Group Insurance Plans?
They can be a PPO, HMO, or POS, depending on what the employer offers and what level of coverage you’re willing to pay for.
Federal and State Health Insurance
Do Federal and State Health Insurance Plans Cover Rehab?
Just like private insurance plans, federal and state health insurance plans can also cover rehab. These are governed by the Patient Protection and Affordable Care Act (ACA) that was passed in 2010. Under the ACA, alcohol addiction is not considered a pre-existing condition and must be covered.
Yes, they can, but your doctor must certify that you have a medical condition (like alcohol addiction) that requires rehabilitation, including alcohol detox treatment, inpatient treatment for alcoholism, medical supervision, and coordinated care.
What Are Medicare Insurance Plans?
Medicare is a federal health insurance program for adults over the age of 65 or younger people with serious disabilities. It is usually contracted with a private insurance company to provide four types of Medicare coverage:
- Part A - this includes inpatient/hospital coverage.
- Part B - this includes outpatient/medical coverage.
- Part C - an alternate way to receive your Medicare benefits.
- Part D - this includes prescription drug coverage.
Depending on the facility, they can cover alcohol treatment. However, not all facilities accept Medicaid as a form of treatment.
What Are Medicaid Insurance Plans?
This is a public insurance program for low-income families. To be eligible, you must be:
- Over 65 or under 19
- Pregnant or a parent
- In a low-income bracket
Under the ACA (also known as Obamacare), Medicaid providers must cover all the basic aspects of alcohol and drug addiction treatment. However, it’s extra important to make sure if the facility you want to attend will accept Medicaid as a form of payment.
What Is The Average Cost of Alcohol Addiction Treatments with Insurance?
This depends on a number of factors, including type of treatment, length of treatment, and type of coverage. For instance, inpatient will always be more expensive than outpatient, even more so if it’s a luxury facility. Plus, longer stays of treatment are more expensive.
What If You Don’t Have Insurance That Covers Alcohol Rehab?
In some cases, you may not have insurance that covers alcohol rehab. Unfortunately, this happens sometimes and it means that people who desperately need treatment may not be able to get it. However, there are some other tactics you can try to still get the treatment you need.
Talk To Your Employer
If you’re nervous about talking to your employer about your alcohol addiction, just know that you are protected by federal law and can not be discriminated against based on your health condition. In fact, the following laws mean that you can not be punished for seeking out treatment for alcohol addiction:
- The Rehabilitation Act of 1973
- The Rehabilitation Act of 1973
Additionally, you may need to speak to your employer to try and arrange some means of getting the treatment you need. This may include asking for a leave of absence (paid or unpaid) as well as salary advance to pay for part or all of your treatment.
Talk To The Addiction Rehab Center
Most rehab facilities want to help those in need. If you don’t have the necessary insurance to cover alcohol addiction treatment, you might be able to arrange an alternate payment plan. They may even have a sliding scale for those in need, where the patient pays what they can. Finally, they may have some funds earmarked for lower income patients, similar to a scholarship system for college.
Talk to Family and Friends about Your Struggle with Addiction
Your loved ones want to see you succeed and overcome your alcohol addiction. If you come clean and be totally transparent, you might be surprised by the offers of help that come pouring in. If you don’t have the health insurance to cover the treatment, it’s possible that you could arrange for your family and friends to all pitch in and cover part or all of your rehab expenses.
The True Cost of Alcohol Rehab vs the Cost of Alcohol Addiction
Looking at all the expenses, it may seem overwhelming. You may even think that it’s just not worth it – treatment is just too expensive. But if you crunch the numbers, you’ll see that rehab is the most cost-effective option.
Consider the following:
- The cost of addiction - Having an alcohol addiction is expensive. If you drink everyday, your annual expenses for just buying the alcohol can number in the thousands of dollars. If your alcohol addiction has been going for years, it can even be tens of thousands of dollars.
- Loss of income - Alcohol addiction makes it so that you just can’t function properly. You’ve almost certainly suffered at work and may have even lost a job or two. Finally, if your alcohol consumption is coupled with legal issues, then your criminal fines may have already affected you financially.
- Health problems - Addiction ruins your health. The longer you drink, the more your health suffers. You may end up with a host of chronic health issues, including heart disease, alcohol-related dementia, diabetes, and liver/kidney damage. All of these can cause massive medical expenses to pile up. Finally, nearly 40% of all fatal car accidents are caused by alcohol.
If you or a loved one is struggling with alcohol addiction, it’s important to know that you can pay for some or even all of the treatment with your insurance plan, depending on the specifics of your coverage and policy as well as the type of treatment you need. Don’t let the price tag for rehab keep you from getting the help you need to live a life free of addiction and alcohol abuse.
Bedrock Recovery Editorial Team
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This page does not provide medical advice.