Per the ACA, all new insurance plans, whether individual or group plans, were required by 2014 to cover ten key categories of health benefits. According to this roundup of essential health benefits, both mental health disorder services and substance use disorder services must be offered by health insurance carriers.
The ACA also mandates providers to offer coverage for surgical care and general medical care.
Thanks to the Affordable Care Act, your health insurance policy must cover the costs of inpatient rehab or outpatient rehab as required, as well as any other required services for the treatment of alcohol use disorder, substance use disorder, or co-occurring disorder (addiction with co-occurring mental health condition).
“Does health insurance cover therapy” is an issue that will vary from plan to plan and from provider to provider.
All of this means it can be tough to establish the extent of coverage for addiction treatment. It can also be challenging to isolate any exclusions in place on your policy.
Once you determine that you are eligible for addiction treatment through your health insurance, you then check that any rehabs on your shortlist accept payment by health insurance. This will not normally be problematic. Indeed, many of the best drug and alcohol rehabs employ insurance specialists to help anyone considering recovery to fully understand the specifics of their policies.
Contact your health insurance provider directly if you have any doubts about the specifics of coverage in place. Ask the insurer what provisions are in place for various types of addiction treatment. Equipped with this knowledge, you can more confidently approach treatment centers to engage with the right level of therapy for your needs.
Most private health insurance plans that offer the most comprehensive coverage for drug and alcohol addiction treatment cost more.
These health insurance providers provide at least partial coverage for the cost of addiction treatment:
Blue Cross Blue Shield
For service veterans requiring rehab, TRICARE may cover part of the cost of treatment. This will vary according to the specifics of the plan.
Many employers offer group health insurance plans. These tend to be costly relative to the coverage provided. You may also encounter prohibitive restrictions when it comes to addiction treatment. For example, the plan may provide coverage for an initial course of addiction treatment but exclude additional coverage if you relapse. Addiction, like most chronic diseases, has relapse rates of between 40% and 60%.
Does insurance cover couples therapy, then? Also, what other types of therapy are covered by health insurance?
What Types of Therapy are Covered by Insurance?
Although health insurance providers are obliged to cover treatment for alcoholism and drug addiction, benefits will vary depending on the state and the provider. You should always closely review your benefits before engaging with treatment you intend to pay for with insurance.
The majority of plans provide coverage for these services:
Medical detoxification services
Medically-managed residential treatment
Dual diagnosis treatment for co-occurring disorders
Additionally, some health insurance plans might offer coverage for the following:
Risk reduction interventions
IOPs (intensive outpatient programs)
PHPs (partial hospitalization programs)
MAT (medication-assisted treatment)
Short-term inpatient hospitalization
Peer support services
Having said that, health insurance may still not provide sufficient coverage to meet the costs of the addiction treatment you need. In the event of requiring rehab services not covered by your insurance plan, you could opt for a personal loan or for private pay to plug the gap.
While studies suggest that intensive outpatient treatment produces favorable outcomes for most mild addictions, moderate and more severe substance use disorders often respond more positively to inpatient treatment. Regrettably, not all health insurance plans will meet the costs of residential rehab.
The following services are not typically covered by health insurance plans as they are not considered medically necessary:
The first step to take is to verify that your insurance plan offers coverage for the treatment of addictions. If so, determine what level of coverage is provided.
You should then work out your treatment needs by liaising with your healthcare provider. Request an assessment to evaluate the extent of your substance use disorder as well as the proposed treatment plan to mitigate a sustained recovery without relapse.
Next, check that the rehab centers or therapists on your shortlist will accept insurance payments.
Finally, check that your insurer will cover the costs of the proposed treatment.
With all this in place, you can work with the treatment center or therapist directly to verify that the coverage will meet the costs of the treatment you need.
Now, all you need to do is focus on your recovery.
Find a Therapist at Los Angeles Therapy Network
You could shortcut the process of finding a therapist by reaching out to LATN today.
Even if you engage with MAT (medication-assisted treatment) for alcohol use disorder or opioid use disorder, this is always most effective if delivered together with psychotherapy.
Reach out to Los Angeles Therapy Network today and find a therapist who can help you to shift from active addiction into sustained sobriety. Many will welcome insurance as payment for therapy. Call the friendly team today at 833.604.1287.