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What to Do If Your Insurance Refuses to Pay for Rehab

If you have made the decision to go to rehab to seek treatment for your addiction, then you are probably eager to start the life-changing work that will begin once you enter your treatment program – which is why it can be so frustrating when your insurance refuses to pay for rehab. 

If your insurance plan has denied rehab coverage, don’t give up! Even after insurance has denied your claim, there are many steps that you can take to stay on the road to recovery and get the treatment you deserve.

Why Won’t My Insurance Pay for Rehab? 

After a claim denial, the first thing to consider is why your insurance won’t pay for rehab. Due to the holistic and intensive nature of the care provided at many rehab facilities, the price tag for both inpatient and outpatient treatment for your addiction can be hefty. It’s no secret that insurance companies are prone to trying to avoid footing their part of big bills. 

It may be a standard practice of your insurance company to deny the initial claim. Or, your insurance may claim that you need prior authorization (a referral from another doctor stating that you require inpatient treatment), or the rehab program may fail to meet their eligibility criteria qualifying your treatment as a medical necessity. Whatever the case, there is recourse when your insurance refuses to pay for rehab. 

So, what should you do after your insurance denies rehab coverage? 

Check Your Employee Handbook

If your insurance is provided through your work, your first step after insurance denies your claim for rehab should be to consult your company’s employee benefits handbook. Many companies have pre-existing policies that protect their employee’s rights to mental health care, including treatment for addiction. 

This policy can override the decision made by your insurance. Don’t hesitate to reach out to your company’s human resources department to discuss the nature of these benefits further. Per the Americans With Disabilities Act, your privacy and your job are both protected, and you will not be penalized for seeking treatment for your addiction. 

Ask a Government Agency To Help Appeal your Denial 

If your company has no policy in place regarding insurance coverage for substance abuse treatment, or if your insurance is not provided through your work, then you may want to appeal the denial for coverage on your own. 

Since insurance often denies coverage for rehab, there are a number of state and federal laws that guarantee mental health parity. That is to say that mental health should be considered of equal import to insurance companies as physical health. These laws act as a safeguard to ensure that insurance companies respect an individual’s right to quality treatment for substance abuse. 

If your insurance refuses to pay for rehab, and you feel overwhelmed by the process of appealing on your own, then you should reach out to your state insurance department, the office of the attorney general, or your state health department. These government agencies can help enforce these parity laws so that you can get the coverage you deserve to go to rehab.

Ask Your Rehab Center for Help

It’s vital to choose a reputable rehab center for your treatment to ensure the quality of your experience, but also because the rehab’s staff can help negotiate with your insurance on your behalf following a denied claim. 

Your addiction treatment center can stand firm beside you in helping you to get your claim for coverage approved by insurance. The staff knows which questions to ask, and how to prove that your treatment meets the criteria for medical necessity. 

Your treatment center may even allow you to start treatment before you have things settled with your insurance. 

Finally, if the task of getting approval seems too daunting then your treatment center will likely be able to work with you to provide a payment plan that fits your budget or to help you coordinate with a private lender to finance your rehab stay. 

What Next? 

Whatever avenue you choose to pursue after your insurance denies rehab coverage, it is vital that you do not give up in the fight to obtain treatment for your addiction. 

At the Mandala Healing Center in West Palm Beach, we understand how important it is that you receive the treatment you need for your addiction as quickly as possible. That’s why our admissions staff is available to help you begin the process 24/7. 

Find Help for Addiction At Mandala Healing Center

Our admissions coordinators can help alleviate the stress of paying for rehab by working to maximize your benefits and get you the coverage that you deserve. 

We also accept many major insurance policies and are committed to helping you explore all of your options as it comes to financing the cost of your treatment. If you or a loved one are considering rehab but are balking at the cost, don’t wait any longer, reach out today and let us help you get the holistic treatment you deserve.