Insurance and Outpatient Addiction Treatment

Will Insurance Cover Outpatient Addiction Treatment?

Outpatient treatment is a form drug rehab offered at close to 10,000 facilities across the United States. Most accept insurance payments, but not all policies offer comprehensive coverage. It is wise to work with an insurance specialist at the treatment center, so you will be confident that insurance for outpatient treatment is covered by your insurance policy.

As noted in a Substance Abuse and Mental Health Services Administration (SAMHSA) report from 2014, over 22 million people needed help for alcohol and drug abuse, and less than 3 million got help. Many failed to seek help or were left without access to it due to a lack of funds or health insurance coverage.
The good news is, this is changing as more companies are providing insurance for outpatient treatment. Still, even those policies that offer coverage may not offer the type of coverage an individual requires. It is critical to verify insurance coverage before committing to a specific treatment center because insurance coverage does tend to come with strict limitations.

What Is Outpatient Addiction Treatment?

Outpatient treatment for addiction is a model where the person travels to an outpatient rehab facility on treatment and then returns to their residence whether it be home or a local sober living home. Patients do not stay overnight or live at a residential facility.

Outpatient care is most typically recommended for people who have family or work responsibilities outside of the treatment environment, and it is usually only indicated for those individuals who are low-risk clients. The risk for relapse for people in outpatient care is generally higher since they can return to their residence each night and do not receive the 24-hour supervision included with inpatient care. Therefore, outpatient treatment isn’t recommended for individuals with severe or long-term addictions.

Outpatient treatment is offered at close to 10,000 rehab centers across the United States, per SAMHSA. The usual treatment experience includes:

  • Medical detoxification
  • Individual therapy
  • Process groups
  • Family therapy
  • Routine drug and alcohol
  • esting
  • Evaluation for co-occurring disorders
  • Employment support
  • Nutrition & physical fitness
  • Skills groups
According to SAMHSA, 31.4% of individuals who needed addiction treatment but did not receive it cited lack of health insurance as the primary reason.

Paying for Outpatient Rehab

Many who participate in outpatient drug and alcohol addiction rehab pay for treatment costs with health insurance. This is ideal since treatment costs can run into the thousands of dollars.

Still, many in need of addiction treatment do not have health care insurance. Data from 2010 to 2013 indicated that 31.4% of individuals who needed addiction treatment but did not receive it cited lack of health insurance as the primary reason, according to SAMHSA.

There were over 10 million people insured through insurance plans under the Affordable Care Act (ACA) as of the end of the 1st quarter of 2015, per the U.S. Department of Health and Human Services. All plans available through the ACA must cover substance abuse treatment, but the total amount covered varies from plan to plan.

Some insurance plans may have higher monthly premiums, but cover treatment at or close to 100%. Others plans may only cover 70-80% of the costs, but monthly premiums are reduced. Deductibles follow the same pattern.

Insurance for outpatient care is far more common than coverage for inpatient treatment, and it comes down to cost. It is more expensive to live on-site and seek treatment 24/7 than it is to show up 3 to 5 days per week for a few hours of treatment. As a result, far more treatment centers make outpatient care available than inpatient care.

Verifying Coverage for Outpatient Drug Rehab

Insurance coverage options can vary a great deal from one health insurance plan to another. It is a good idea to work with an insurance specialist at the treatment center you are interested in to confirm the extent of treatment covered by your policy.

Outpatient treatment is a broad term, and some policies may not cover certain programs, such as holistic treatment options, exercise programs, and alternative therapies. It is advisable for individuals to reach out to their insurance companies before enrolling in treatment and ask a few questions, such as:

  • Are there any specific drug treatment services or medications that are not covered?
  • What length of treatment will be covered?
  • Which facilities are in-network with my plan?
  • How much of the balance is the insured party responsible for?
  • Is anything still owed on my deductible?

If a person’s policy does not offer enough coverage for addiction, there are options. Many treatment centers offer payment plans to clients who need financial assistance.

At Clearpoint, the insurance verification process can take from a few minutes to several hours. Other addiction providers may require more or less time to verify benefits, and results can vary.

Call us at: 1-203-293-1723