Do Insurance Companies Provide Rehab and Cocaine Treatment Coverage?

Addiction treatment is expensive. If an addiction treatment client has to come out of pocket to cover the costs, it might be enough to stop them from seeking help. That presents a couple of precarious situations. Either the individual keeps suffering within their cycle of addiction, or they attempt to stop “cold turkey” on their own. Frankly, that’s a very dangerous thing for someone to attempt, especially if their addiction is a substantial addiction to heroin or cocaine.

If someone doesn’t have healthcare insurance, they will have to search for the financial resources necessary to pay for treatment. By way of making several suggestions, here some of the ways someone might pay for treatment:

  • Pull from personal savings
  • Borrow from family or friends
  • Take out a personal loan or use credit cards
  • Negotiate with the rehab of choice for pay later alternative or rehab financing
  • Apply for any available addiction treatment grants or scholarships

If a rehab client has healthcare insurance, they can rest a little easier. Thanks in large part to the law, they can consider addiction treatment, knowing their insurance company will have to cover at least a portion of the related costs.

Do Insurance Companies Provide Rehab and Cocaine Treatment Coverage?

According to the Affordable Care Act, which was sign into law in 2009, all US citizens are required to carry some form of healthcare insurance. Their insurance can come by way of an individual policy, family policy or through their employer. Of course, having insurance doesn’t address the most important issue. Do insurance companies provide rehab and cocaine treatment coverage?

The answer is a qualified yes. In addition to requiring individuals to carry healthcare insurance, the Affordable Care Act also sets certain coverage standards to which healthcare insurance providers must adhere. The coverage standards that most address addiction treatment includes:

  • The insurance company must cover certain aspects of addiction treatment
  • The extent of coverage pertaining to each aspect is flexible within certain guidelines
  • Insurance companies cannot discriminate against customers who have a preexisting cocaine addiction

These are the rules everyone in the addiction treatment industry has to abide by.

Statutory Addiction Treatment Categories

As indicated in the above listing, there are certain aspects of treatment that insurance providers must cover. Remember, the extent or percentage of coverage falls under the insurance company’s discretion. The checks and balances against them low-balling a percentage is a risk a customer will have chronic relapses if they cannot get the level of treatment they need. The insurance company stands to pay more in relapse treatment than they ever would if the customer gets what they need the first time.

As for the statutory addiction treatment categories, there are five. They include:

  • Inpatient Care
  • Outpatient and intensive outpatient care
  • Detox programs
  • Addiction treatment medications
  • Aftercare programs

Inpatient Care

Inpatient care is the most expensive and restrictive form of treatment. The client is required to undergo up to 90 days of intensive treatment while confined as a voluntary resident of the rehab facility. Since the costs are substantial, insurance companies often set some limitations.

Outpatient and Intensive Outpatient Care

If a client has circumstances under which they can benefit from treatment under less restrictive circumstances, that’s a good thing. Insurance companies often cover most if not all outpatient treatment costs because they are far less expensive than inpatient treatment costs.

Detox Programs

Recognizing the importance of detox programs, insurance companies will typically cover 100% of the costs. Detox programs give the client an opportunity to prepare for therapy by getting past their withdrawal symptoms and residual substance cravings while under the care of medical professionals.

Addiction Treatment Medications

As hypocritical as it may seem, there are some aspects, namely detox, of treatment that require the client to receive relief medications. Insurance companies will cover these costs if a doctor prescribes said medications.

Aftercare Programs

Even after a successful stint in rehab, the client still has the potential for relapse. In order to help prevent that from happening, insurance companies will offer access to some forms of aftercare treatment.