Does Insurance Cover Drug & Alcohol Rehab?
By law, most health plans must provide coverage for mental and behavioral health treatment, which includes care for substance use disorders.1 However, the level of coverage provided by each plan can vary greatly, meaning some forms of treatment may not be covered, and how much you’ll pay out-of-pocket costs will depend on your specific plan.
Using Insurance for Rehab at Greenhouse Treatment Center
Levels of addiction treatment offered at Greenhouse that are covered by many insurance plans include:
- Medical detox.
- Residential or inpatient treatment.
- Day treatment (partial hospitalization).
- Intensive outpatient program.
- Standard outpatient rehab.
Greenhouse Treatment Center is now in-network (INN) with Blue Cross Blue Shield of TX (BCBS TX). This applies to all levels of care offered at Greenhouse: detox, residential treatment, partial hospitalization, and outpatient treatment. Greenhouse is now INN with the following BCBS of TX plans:
- Blue Choice PPOSM Provider Network (Inclusive of Blue Precision/Blue Options)
- Blue EssentialsSM HMO Provider Network
- Blue PremierSM HMO Provider Network
- Blue High Performance Network
- Blue Advantage HMOSM Provider Network
- MyBlue HealthSM HMO Provider Network
Greenhouse is also in-network with:
- Aetna.
- Cigna.
- Ambetter.
- Baylor Scott & White Health Plan.
- Carelon Behavioral Health (formerly Beacon Health Options).
- ComPsych.
- Employers Health Network.
- First Health.
- Humana.
- Magellan Healthcare.
- Molina Healthcare of Texas.
- And more.
Even if your coverage is out-of-network, like certain VA benefit plans, you still may be partially covered at Greenhouse. Check your benefits below to see what your plan covers.
Is Addiction Considered a Medical Necessity?
Due to the Affordable Care Act (ACA) and mental health and substance use treatment parity laws, most plans are mandated to cover mental health and addiction treatment to the same extent that other medical or surgical treatments are covered.2 However, in order to receive coverage, treatment will have to be deemed medically necessary by a licensed healthcare practitioner.
“Medical necessity” is defined by the official website of the Affordable Care Act as a service that is needed to diagnose and treat a condition, a disease or the symptoms thereof, that meets accepted standards of care.3
To learn more about what is covered on your plan, call the number on your insurance card. You can also check your benefits with our free and confidential online verification form.
Do You Need Insurance for Alcohol & Drug Rehab?
No. However, rehabilitation treatment without insurance coverage can be very costly. Even with an increasing percentage of Americans having healthcare, lack of insurance and high costs are still significant barriers to receiving treatment. In fact, 20.9% of Americans that were classified as needing substance use treatment were not able to afford treatment because they lacked insurance, according to the 2019 National Survey of Drug Use and Health (NSDUH).4
How To Pay for Drug & Alcohol Rehab Without Insurance
Some rehab facilities, like Greenhouse Treatment Center, allow certain patients to use flexible payment plans to make paying for treatment more affordable. The client (or family or friends) can pay a set amount every month, over a prearranged period of time, that will cover the cost of treatment when the period of time is over. The set amount to be paid, as well as the period of time over which the amount will be paid, is determined by the nature of treatment (how much it costs), as well as the financial situation of the client (and/or family or whoever is footing the bill).
Sometimes rehabilitation centers will charge for services using a “sliding scale,” where the scale of payment based on the client’s ability to pay the bill. The facility may require the client to fill out paperwork of otherwise show evidence of financial hardship.
Other facilities will sometimes offer scholarships to patients in need of treatment. You can ask treatment centers whether they offer sliding scales or scholarships and, if so, how you qualify.
State-Funded Rehab
There are also government-funded, state-run facilities, and charitable organizations that may provide substance abuse treatment for free or at a reduced cost. However, the requirements for acceptance in these treatment centers is often stringent and the wait time to be admitted may be long due to high demand.5 For help finding a state-run facility, you may call the Substance Abuse and Mental Health Services Administration at 1-800-662-HELP (4357).
Does COBRA Insurance Cover Addiction Treatment?
COBRA is not a type of insurance but instead an Act (the Consolidated Omnibus Budget Rehabilitation Act) that allows you to continue your employer-provided group benefits after you become unemployed. This includes coverage for mental health and substance use treatment.6
Key things to know about COBRA include the following:
- COBRA is not a new insurance; it allows you to keep your insurance at an adjusted cost.
- Your insurance premium will be higher because your employer will no longer be sharing the cost.
- Only companies with 20+ employees are legally required to offer COBRA benefits. However, certain states such as CA offer additional protections for employees of smaller companies.
- There’s a time limit on how long you can keep your insurance through COBRA depending on your state and situation. The time you can extend your insurance benefits after separation from your employer ranges from 18-36 months.
The Mental Health Parity and Addiction Equity Act
The Mental Health Parity Act (originally signed into law by President Bill Clinton in 1996) mandated that insurance providers could not set the dollar limit of coverage for mental health services unequal to that of surgical/medical benefits.7
The Mental Health Parity and Addiction Equity Act—signed in 2008 by President George W. Bush—kept the provisions of the Mental Health Parity Act and extended them to substance abuse treatment as well.
Additionally, non-financial treatment limits are also covered by the parity law, which removes restrictions on how many times a person sees a therapist in a set period of time (but still allows the insurance company to place limitations based on “medical necessity”).8
The Equity Act covers health plans like the Children’s Health Insurance Program, most Medicaid programs (based on individual programs and states), coverage purchased through health insurance exchanges implemented by the Affordable Care Act, and employer-sponsored health coverage for organizations that hire 50 or more employees.9
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