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Addiction is a chronic and progressive disease that often causes people to relapse – even if they’ve completed an addiction treatment program. According to the National Institute on Drug Abuse (NIDA), the addiction relapse rate is between 40 to 60%.[1]
If you attended an inpatient rehab or outpatient treatment center and relapsed shortly after, you might have to return to a treatment facility to get back on track. Because rehab programs can be expensive, you probably hope to use your insurance to cover the cost.
Health insurance companies are legally required to cover drug and alcohol treatment services, but do they have to cover the cost more than once? While insurance is not required to cover addiction treatment multiple times, they will if rehab is deemed medically necessary. In other words, your insurance company can decide whether or not to cover another trip to rehab.
If your insurance company refuses to cover substance abuse treatment, there are a few steps you can take. First, you can appeal the decision. If that doesn’t work, you might have to consider other methods of paying for treatment, like crowdsourcing, personal loans, or payment plans like sliding scale fees.
In this article, you will learn:
- If insurance pays for rehab multiple times
- How to find out if your health insurance will cover rehab again
- What you should do if insurance is refusing to cover addiction treatment
Will Insurance Pay for Rehab More Than Once?
Health insurance companies must pay for addiction rehabilitation services under the Affordable Care Act (ACA).[2] This includes medical detox, inpatient rehab, outpatient programs, and therapy for substance abuse. These services are considered essential health benefits and are covered by health insurance, no matter your plan type
However, whether your insurance will pay for rehab more than once is a different story. Your health insurance plan could have policy limits on the number of times your insurance will cover rehab. Additionally, your insurance company can decide based on how many times you’ve been to rehab, how effective treatment has been for you, and what type of treatment would produce a better outcome.
If you attended outpatient rehab before and relapsed, your insurance might only offer to cover inpatient treatment, as this is a higher level of care that can produce better outcomes. Another thing to consider is if you’ve been to treatment 3 or 4 times, your health insurance company might decide that addiction treatment won’t be effective for you.
How to Find Out if Your Insurance Will Cover Rehab After a Relapse
Because there is not a clear answer on whether insurance will cover rehab multiple times, you’ll have to do some research. You can call your insurance company and ask them about their policy for covering rehab after a relapse. They might have certain requirements to get coverage, such as having a doctor deem addiction treatment as medically necessary.
Another way to determine if your insurance will pay for rehab again is to get in contact with the admissions counselors at the Mandala Healing Center. Our admissions counselors can run your insurance in the system to determine if coverage will be offered for treatment. If your insurance provides coverage, we can quickly get you into our program to begin your journey back to recovery.
What Should You Do If Insurance Won’t Cover Treatment?
Recovering from a substance use disorder is never easy. If you’ve recently relapsed and your health insurance is refusing to cover treatment, there are a few steps you can take.
First, you should appeal their decision. This requires the insurance company to review the information and reconsider whether they will pay for treatment. If that doesn’t work, you can ask a third party to complete an external review and decide whether coverage should be offered.
If those methods do not work, find another way to pay for treatment. You could consider crowdsourcing the funds you need to afford rehab or get a personal loan to cover the cost.
Even further, some rehab facilities offer payment plans, like sliding scale fees. If you use a sliding scale payment plan, the treatment center will only charge you what you can afford based on your income.
Lastly, some addiction treatment centers offer free treatment funded by state and local governments. Some programs offer scholarships to clients who cannot afford treatment, ensuring everyone who needs help can get the care they need.
Verify Your Insurance Benefits at the Mandala Healing Center
If you or a loved one is worried about whether your insurance will cover treatment, the admissions counselors at the Mandala Healing Center are here to help. We can run your insurance through our system to verify your benefits. Once we determine whether your insurance is covering our program, we can get you started on your recovery journey.
Contact us today for more information on how to verify your insurance benefits and begin recovering in our highly-rated addiction treatment center.
References:
- The National Institute on Drug Abuse (NIDA): The Science of Addiction Treatment and Recovery
- The Office of National Drug Control Policy: Substance Abuse and the Affordable Care Act
