How to Get Insurance to Pay for Drug Detox

If you or a loved one decides to enroll in a drug detox program, there are many ways to pay for treatment. While scholarships, sliding scale reduced pricing, private loans, and payment plans are all examples of payment options, using insurance benefits to pay for detox is also common.

If you want to use your insurance to pay for detox, you likely have a lot of questions. Insurance can be confusing, and you probably want to know that things are squared away before you show up for your first day of treatment. To help you better understand your treatment options, here is a quick guide on how to get insurance to pay for drug detox.

How to Get Insurance to Pay for Drug Detox

Most health insurance plans today cover behavioral health treatment like drug detox. However, depending on your policy, your insurance may or may not cover various levels of addiction treatment.

Before an insurance company will approve a claim for detox, most will want to assess some information about the situation. They may require you to prove something called “medical necessity.” This simply means that they want proof that treatment is medically necessary before they authorize or deny payment for it.¹

The general definition of medical necessity includes three main points:

1. The treatment services being requested are necessary to identify or treat an illness that is suspected or has already been diagnosed by a medical professional.
2. The treatment services are consistent with the diagnosis and treatment of that condition and they adhere to good medical standards.
3. The treatment services are required for more than just convenience.

Your insurance company may also want to know that the requested treatment is not more expensive than another treatment option that is just as likely to produce the same results.

If your insurance does cover detox, you may also be required to meet certain admission criteria before your insurance will pay for inpatient treatment.² These criteria will vary depending on your insurance policy but may include things like:

• Whether your withdrawal symptoms can be managed at the level of treatment requested
• Your cognitive ability to participate in a treatment program
• Your level of motivation to work toward recovery
• Previous failed attempts to get sober at a lower level of care
• Your risk for self-harm or causing harm to others
• A current living situation that is not conducive to recovery
• Any acute medical problems you have²

Getting Started: Talk to Your Insurance Company Directly

Talking to your insurance company directly is the first step to understanding your insurance benefits. Most often, you can find your insurance provider’s contact information on the back of your insurance card. If you receive health insurance through your employer, you may also speak to someone from your company’s HR Department about using your insurance benefits for addiction treatment purposes.

If you’re interested in Briarwood Detox Center’s detox programs but you’re unsure if your health insurance will cover them, call (512) 277-3103 to speak with an admissions representative. We can contact your insurance company on your behalf to verify your coverage, free of charge.

Important Questions to Ask Your Insurance Company

When you call your insurance company, there are a few important questions you should ask to verify the extent of your coverage.

Does my insurance pay for drug detox, inpatient rehab, outpatient rehab, and aftercare services?

Most often, detox and outpatient programs are mostly covered by health insurance. However, while some insurance providers cover the total cost for residential treatment, others may only cover a portion of it.³ This is because inpatient programs are generally longer, provide more intensive care, and are more expensive than outpatient programs. It’s important to verify with your insurance company exactly how much of the total cost will be covered as well as the amount that will be leftover for you to pay.

After your primary care in detox and rehab, you may also want to enroll in aftercare services like outpatient rehab or a peer recovery support program. You may want to ask your insurance company about coverage for those types of programs too.

How many days of detox will my insurance cover?

The duration of detox programs can vary greatly, so you may want to verify the extent of your coverage with your insurance provider. Depending on your policy, your insurance may only cover a portion of the time in treatment.

What prescription benefits does my insurance offer during detox?

In some instances, prescription medications may be necessary during detox. Knowing whether these prescription medications are covered by your insurance provider can be confusing, so it’s ideal to ask them directly. The fewer surprises, the better.

Do I need to enroll at an in-network detox center or am I free to choose any detox center?

In most cases, you will need a referral from your doctor if you want your insurance to cover a visit to a treatment specialist. However, if you choose to see a specialist from a list of in-network providers, you won’t need the referral. Although in-network care is often cheapest, you may choose to use any treatment provider you desire. In some cases, your insurance may reimburse you for the cost of treatment from an out-of-network provider after you pay for it yourself. It depends on your insurance company and your policy.

Is there a copayment?

Although your insurance may provide benefits for addiction treatment services, you may have a copayment (also commonly referred to as a copay), which is a balance that you are required to cover on your own.⁴

What is my deductible?

Depending on your insurance policy, you may have a deductible to pay before your insurance company will pick up the rest of the bill. For example, you may be required to pay a maximum of $3,000 before your insurance company will cover the rest.⁵ If you’re unsure if you have a deductible or how much it is, all you have to do is ask your insurance provider.

What to Do If Your Insurance Doesn’t Cover Drug Detox

There are many ways to pay for drug detox with or without insurance, so if your insurance provider doesn’t cover detox, don’t give up just yet! A few alternative payment options may include:

• Employee Assistance Program (EAP) benefits
• Private healthcare loans
• Credit cards
• Crowdfunding websites like GoFundMe
• Addiction treatment scholarships
• Sliding fee scale options (if available)

Payment options will vary by detox center, so you may want to ask about all your options before making a final decision.

Accepted Insurance Providers

Briarwood Detox Center works with several different insurance providers to ensure affordable addiction treatment:

• Aetna
• Ambetter
• AmeriHealth
• Beacon/ValueOptions
• Blue Cross Blue Shield
• Cigna
• First Health
• Humana
• Magellan
• Magnacare
• Medical Mutual
• UMR
• UnitedHealthcare
• Scott and White
• WebTPA

References:

1. https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/managed-care-addiction-medicine-and-parity-supplement-for-physicians-and-others
2. https://www.bcbsm.com/content/dam/public/Common/Documents/nd-bh-medical-necessity-criteria.pdf
3. http://www.insurancequotes.org/health-insurance/health-resources/addiction-treatment-coverage/
4. https://www.ehealthinsurance.com/resources/small-business/understanding-health-insurance-copayment
5. https://www.quitalcohol.com/health-insurance-and-addiction.html