Does Insurance Cover Detox Treatment?
Stopping any kind of substance use can be psychologically painful, and for many substances, physically painful too. In fact, withdrawal is the time that you’re most vulnerable to relapsing if you don’t get help.
Detox rehab programs give you a safe place to go through withdrawal with the help of addiction and medical care staff, and your insurance often covers them. You’ll receive 24-hour care that includes monitoring and any support that you need.
Your insurance company may cover detox services like:
- Medication to control symptoms of withdrawal, which are different for everyone
- Intravenous (IV) hydration, or fluids administered through a needle inserted into your vein
- Behavioral and emotional health support, which might include optional therapy or counseling (but not everyone is ready for counseling during detox)
Anyone can be a candidate for detox treatment programs, as long as you:
- Are ready to start recovery, and
- Are discontinuing a drug that causes a physical discontinuation syndrome, the medical term for the withdrawal phase.
If you’re a candidate, the next step is to confirm whether insurance covers detox treatment so you can make a plan to pay for treatment.
The good news is, almost all long-term health insurance plans and policies cover medical detox for substance use disorders.
Detox is considered an essential medical service, so the Affordable Care Act of 2010 requires health insurance companies to cover detox programs.
The only exceptions are insurance policies that have been active without changes since 2010, and emergency or short-term health policies. Substance use disorders are considered a pre-existing condition, and (only) those two types of plans are not required to cover it.
Even though most insurance policies cover detox, it’s important to check the details of your insurance policy as early as possible.
There are some critical differences between plans that you should confirm before detox starts. You don’t want to spend any time on hold with insurance companies after you arrive at detox!
Before you arrive at detox, you should:
- Read up on what to expect from the insurance process
- Check the details of your detox insurance coverage
- Find out your financial responsibility and plan to cover it
Understanding Detox Coverage
Detox rehab insurance coverage is the same as other types of healthcare coverage in most ways.
The process for getting detox treatment covered begins with checking your coverage. From there, your healthcare and detox treatment providers should help you handle the rest of the process—but it’s still important to know what to expect.
Checking Your Detox Rehab Insurance Coverage
Your coverage for detox rehab is impossible to predict without confirming it.
It’s true all long-term health insurance plans must cover detox as a medically-necessary treatment for a pre-existing condition. However, the actual coverage can vary drastically from plan to plan.
For starters, insurance policies can offer full or partial coverage, and they can dictate which treatment centers are in their network and eligible for coverage.
You can check your detox treatment coverage by checking the company’s online portal, calling your insurance company, or calling your detox center.
Be sure to find out details such as:
- Full vs. partial coverage
- HMO vs. PPO
- Referral requirements
- Pre-authorization requirements
- Whether your treatment center is in-network
- How to calculate your financial responsibility for rehab treatment
Getting a Referral for Detox Rehab Treatment
Most insurance companies require you to visit your family doctor to get a referral before they’ll pay for detox.
Your family doctor will discuss detox with you and send the treatment referral.
The referral usually goes straight to the treatment center you’re being referred to, but you may still need to contact them to follow the next steps. In most cases, you don’t have to do anything about the referral besides visit your doctor.
Getting Prior Authorization for Detox Rehab Treatment
Most insurance companies require that you follow a prior authorization process before you can get coverage for detox. Prior authorization is an extended approval process used to decide if a treatment is medically necessary.
Most procedures and treatments that require a multi-day stay are subject to prior authorization, and detox is no different. The average detox length is 3 to 5 days, so your insurer will want proof that it’s medically necessary.
The prior authorization process is similar to the claims process on your part. You’ll need to talk to:
- The doctor who referred you
- The treatment center you’re attending, or
- The insurance company
Your medical care team and insurance company will work together to get prior authorization on your detox insurance coverage. You shouldn’t have to take any action yourself besides calling someone to get the process started.
Filing a Claim for Detox Rehab Treatment
Like other types of addiction treatment coverage, your treatment center will most likely handle filing a claim to get your detox program covered.
Filing a claim is simply the process for letting your insurer know that you want to use your coverage. After your insurer processes the claim and approves your coverage, it’s time to start treatment!
Finding Your Financial Responsibility for Detox Rehab Treatment
Once your claim is fully processed, your insurance company will send you an Explanation of Benefits document, which details:
- Your coverage details
- The listed cost of detox treatment
- Whether the deductible was met
- The portion of cost covered by your insurer
- The remaining cost that you are responsible for covering
These documents are generally very detailed, so they should include all the information you need to assess your detox costs.
If you have any questions, the document will include a phone number to call; or you can call the phone number on your insurance card.
There’s no such thing as a silly question about detox coverage—you should go into substance abuse treatment knowing exactly what’s covered with no questions to worry about. Don’t hesitate to call your insurance company to ask about your detox coverage.
What Are the Factors Influencing Detox Program Costs and Insurance Coverage?
There can be a lot of variation in your out-of-pocket cost of detox; that’s why it’s so hard to predict without calling your insurer.
The factors that affect your out-of-pocket detox cost include:
The Detox Program’s Listed Price
The price of detox before insurance can vary significantly! In general, the range is about $500 to $1,000 per day.
The price might trend closer to $1,000 for detox in an urban area with amenities. For a detox that’s down-to-earth and located rurally, it’s common to find prices closer to $500 per day. There’s so much variation that it’s hard to predict.
The Treatment Provider’s Status as In- or Out-of-Network
Your insurance company approves certain treatment providers as in-network. If you attend a detox program that’s not on that list, then it’s considered out-of-network.
If your provider is in-network, you’ll receive the maximum coverage. Out-of-network providers are only partially covered with a high coinsurance fee, if your insurer covers them at all.
Whether Your Plan is an HMO or PPO
The two most common types of healthcare plan are Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).
Many HMO plans have low-cost copays and coinsurance for detox treatment, or even cover all of it. The catch is that you must use an in-network provider to receive any coverage. But if you do, your out-of-pocket cost could be a little lighter.
PPO plans often have higher copay and coinsurance costs, so you will probably pay more out-of-pocket even with an in-network provider. The trade-off is that you can use out-of-network detox options (at a higher cost).
The Insurance Policy’s Stated Coverage
Your insurance company sends you a document each time you renew coverage that details what’s covered and to what extent.
That means specific dollar amounts or percentages so you can plan out your financial responsibility. You can also access this document on your insurer’s website.
How Much Does Insurance Pay for Detox Rehab?
You can’t predict how much insurance will pay for detox rehab without knowing:
- The insurance company
- The specific policy and plan
- The “retail cost” of the treatment center
- The coverage guidelines for medical detox, including copay and coinsurance amounts
However, you can find how much insurance will pay for detox by speaking to an insurance agent.
Call your insurance company at the Member Services phone number on your membership card to discuss your policy in detail.
You can also call your preferred treatment provider and ask about insurance verification. Many treatment centers can contact insurance on your behalf and get the details for you.
How Long Does Insurance Cover Detox Rehab?
Most insurance policies cover the entire length of the detox stay either fully or partially. The average detox stay takes 3 to 5 days, depending on your condition and history.
How to Cover Detox When Insurance Won’t
Even the best insurance policy may leave you with some out-of-pocket costs after they cover detox. It’s important to figure out a plan before you enter detox so you can focus on getting through it!
The available resources are different in each area, but you can look into:
- State resources such as scaling income-based or cost-free detox (although state resources usually come with a long wait, and detox usually can’t wait)
- Recovery communities, e.g. local branches of Alcoholics Anonymous, 12 Steps, or other similar groups
- Religious communities such as churches, mosques, and temples
These resources are often welcoming to people who need help covering basic medical expenses, including detox. If they don’t have a fund to cover your costs directly, they can network you with the right resources in your area.
Verifying Coverage and Finding the Best Detox Services
Before you start treatment, you should verify coverage for detox services by:
- Logging into your insurance company’s online portal: Almost all insurance companies have an online self-service portal that members can use to check their policy and coverage. You can find this on your insurer’s website.
- Calling your insurance company: You can call your insurance company and talk to a trained representative about your insurance coverage. The phone number is usually located on the back of your insurance card.
- Talking to your healthcare provider or treatment provider: Your family doctor can check your insurance coverage when you’re getting your treatment referral. Otherwise, your treatment center will check for you.
Your insurance company can provide a list of in-network treatment centers or let you know the cost of an out-of-network detox. If you have trouble finding a great detox program, call the phone number on your insurance card.
What Substances Does My Health Insurance Cover for Detox Rehab?
Most health insurance policies cover any kind of substance detox as long as the substance can cause a physical discontinuation syndrome.
Discontinuation syndrome simply means that your body experiences withdrawal when you stop taking the substance. The substances that cause withdrawal include:
Insurance companies are likely to cover detox programs as long as they involve one of the above substances.
This isn’t a complete list of every drug that can cause withdrawal, so check for yourself with your insurance company to see if your detox is covered.
Is Alcohol Detox Rehab Covered by Health Insurance?
Health insurance policies usually cover alcohol detox. The services covered for alcohol detox include:
- Inpatient stay
- Medications to control symptoms
- Nursing care and support
- Treatment for any withdrawal complications
Is Cocaine Detox Rehab Covered by Health Insurance?
Cocaine detox is usually covered by health insurance. Programs for cocaine detox can be long compared to others, so double-check your coverage.
Is Meth Detox Rehab Covered by Health Insurance?
Meth detox is almost always included in detox coverage. Stimulant withdrawal can take longer, so check with insurance about your stay’s length.
Is Prescription Drug Detox Rehab Covered by Health Insurance?
Your insurance company will likely pay for detox from the following addictive prescription drugs:
- Opioid pain medications
- Stimulant medications for fatigue and ADHD
- Benzodiazepine medications for sleep and anxiety
Why Bedrock Recovery Center?
Start your recovery journey with detox at Bedrock Recovery Center. We offer evidence-based addiction care from a compassionate, experienced team. Call us today to find out how we can help.
