Navigating Health Insurance for Substance Addiction Treatment

There are many considerations when preparing for residential substance addiction treatment, including how health insurance coverage may affect treatment access and payment. It’s also important to note that you can access residential care if you don’t have health insurance. This article shares information about health insurance in connection with addiction treatment and includes tips on what to ask and actions to take.

Health Insurance and Substance Addiction Treatment

If you have a health insurance policy and you’re looking to access substance addiction treatment, check the details of your policy to verify what coverage is in place. Insurance policies may cover the following:

• Inpatient rehab: Rehab programs run in facilities where participants stay overnight
• Medical detoxification: Drug detox carried out under medical supervision. 
• Medication-assisted treatment: Substance abuse treatment that involves taking medication
• Outpatient therapy: Therapy delivered in facilities where participants do not stay overnight
• Partial hospitalization programs: Intensive treatment programs that provide treatment to individuals who do not stay at a facility overnight
• Residential rehab services: Rehab services delivered in specialist centers where individuals stay for the duration of a treatment program

It may also be helpful to check the insurance provisions for substance addiction and drug use disorder treatment included in the Affordable Care Act and Mental Health Parity and Addiction Equity Act. 

Insurance Terms and Definitions

It’s important to be aware of insurance terms and definitions when reviewing and comparing policies and checking if substance addiction treatment is covered by your plan. Here are some common terms you may come across:

• Preauthorization: With a preauthorization contingency, you must check with the insurance provider and get approval before starting treatment
• In-network: Healthcare providers or facilities that are part of your health insurance company’s network of providers or partners
• Out-of-network: Healthcare providers or facilities that are not part of your health insurer’s network of providers
• Deductibles: The sum you pay before your insurance company starts covering your costs 
• Copays: A set fee for a specific service or treatment, which is decided by your insurance provider; for example, a consultation or prescription charge

Tips Regarding Insurance

Figuring out health insurance and whether you’re covered for substance addiction treatment can give you clarity and reassurance before you start your program. Here are some helpful tips to help you navigate the process:

Check coverage availability and extent

Before beginning substance abuse treatment, check:

• If coverage is available for addiction treatment under your health insurance plan
• What specific types of services are covered
• If you need a referral from a medical professional to start treatment
• If there any limitations related to the length of your stay in a specific facility
• If medications are covered by your health policy
• If outpatient services following inpatient treatment are included 
• Check if telehealth services are included in coverage

After receiving treatment, check your Explanation of Benefits (EOB), a document that outlines charges and costs you’ve incurred for treatments and services. Make sure the EOB aligns with the treatment you received. 

Find out how long insurance approval takes

Contact your insurance provider or access information online to find out how long insurance approval takes. This will give you an idea of when you can start treatment. 

Keep records

It’s always beneficial to keep records when using health insurance coverage to access substance addiction treatment. This record keeping should involve everything from communications with your insurance provider to policy summaries, terms, and conditions. EOB statements are also records to be kept with your insurance documentation.

Insurance Support from Jackson House Recovery Centers

Jackson House Recovery Centers provides professional treatment for individuals dealing with substance addiction. We recognize that there can be complexities and challenges in navigating health insurance coverage, and we offer support to help. Our team is experienced in helping families understand how insurance aligns with substance use treatment and minimizing insurance-related stress. Here’s how we can help:

• We work with you to determine coverage and costs: During the initial assessment step of our admissions process, we verify that we can provide the healthcare services you need and review your insurance coverage. In this step of the admissions process, we will discuss with you the out-of-pocket expenses you may be charged. 
• We accept a wide range of health insurance plans from multiple providers: Our admissions page lists our accepted health insurance providers, a group that includes Blue Cross / Blue Shield, HMC HealthWorks, and United Healthcare. Note that we do not accept Medicaid or Medi-Cal.

Providing Substance Addiction Care

At Jackson House Recovery Centers, it's our goal to make substance addiction care as accessible and effective as possible. We strive to ensure treatment is affordable while maintaining the highest standards of quality and care. Also, we accept insurance and non-insurance payments:

We believe that treatment is a worthy investment in your short- and long-term health, wellness, and happiness.

Contact Us

Jackson House Recovery Centers has extensive experience in delivering patient-focused, compassionate care through addiction recovery treatment. We provide addiction treatment rehab services and support for understanding and utilizing insurance coverage.

Our experienced team can help answer questions regarding health insurance, offer considerations and advice if you don’t have insurance coverage, and consult with you if you’re unsure if the treatment services you plan to receive are included in your insurance coverage. 

If you have questions about whether your health insurance plan covers substance addiction treatment, or if you’d like to schedule a treatment consultation, please get in touch with our team.