Utilizing
Private Insurance

As previously noted, there are sometimes steps one has to take before insurance will cover addiction treatment. In some cases, these steps include a referral from a primary care provider or certain types of diagnostic testing. Some insurance plans cover 100% of detox and treatment expenses once the covered member meets their deductibles. On the other hand, other insurance providers require covered members to pay copayments for each service the facility charges the company for. For example, if someone participates in detox, therapy, medication administration, and aftercare programs, a copayment might be necessary for each one of these services. If you are unsure what your insurance provider will or will not cover, the team at My Recovery can help put you in contact with the right people to better understand your insurance benefits before committing to an addiction treatment facility. Also, insurance companies may require selecting an in-network treatment facility to ensure the highest-paid benefit. Out of network treatment facilities may be utilized; however, this often comes at a higher out of pocket cost. 

Another caveat to private insurance coverage for addiction treatment is the type and extent of treatment the insurance company will agree to cover. Because the detox process varies significantly depending on the individual and the substance they were addicted to, the cost covered by insurance will vary according to the detox process the covered member requires and their individual insurance plan. For example, non-medical detox may be less costly than a hospital-based or a medically supervised detox program. Also, while insurance companies are obligated to offer benefits for substance abuse treatment, they do not have to cover the highest level of care. If someone struggling with addiction can be best served in an outpatient care setting, that is likely with the insurance company will agree to cover. However, if outpatient care is not successful, inpatient care might be deemed medically necessary and therefore covered by the insurance policy. 

Insurance companies will cover addiction treatment services for a specific period. When determining the coverage they provide to a patient they utilize several criteria. The insurance company will likely work with one’s primary care provider or addiction treatment provider to determine the necessary course of treatment before deciding what they will cover and for how long. Because there are multiple levels of care one could seek in addiction treatment, insurance companies may choose to cover one or more possible programs. Some plans may only cover a detox stay. In contrast, others may provide coverage for multiple services as the patient moves through the continuum of care. For example, the insurance company may cover everything from detox through inpatient rehab and outpatient aftercare services. 

Another concern many have when it comes to addiction treatment is whether or not insurance companies will help pay for aftercare services. Although detox and addiction therapies are essential steps towards sobriety and long-term recovery, aftercare remains an integral component of maintaining sobriety. Fortunately, widespread insurance coverage is often available for outpatient treatments and aftercare services. However, there are time limits placed upon these services by many insurance policies, and while some insurance companies may offer policies that cover treatments for up to a year, others may stop coverage after days or a few weeks. It is essential to verify one’s specific insurance coverage with the chosen treatment facility (or look to the team at My Recovery for assistance) before committing to a particular plan of treatment or aftercare program. 

Insurance programs will typically cover evidence-based addiction therapy models. Popular therapy methods used to treat addiction (and many co-occurring mental health disorders) include cognitive-behavioral therapies, family counseling, group therapy, addiction education, and vocational rehabilitation. Because the American Psychological Association approves these treatment models, they are typically covered by most insurance providers. Many addiction treatment centers have begun to offer holistic or alternative treatments as part of their care model. These alternative treatments are offered in conjunction with traditional, evidence-based practices. Unfortunately, not all of these treatments are supported by the American Psychological Association (at this time) and, therefore, may not be covered by most insurance providers.