How Many Times Will Insurance Pay for Rehab?

4.7K

Getting Help Following Past Treatment or a Relapse at Catalina

How many times will insurance pay for rehab? For some people, one residential stay in a treatment facility may not be enough to embrace sobriety for good. Instead, you may need to work with your healthcare provider for a second (or third or more) visit for treatment.

If you have relapsed or otherwise need advice and answers on how many times will insurance pay for rehab, you have arrived at exactly the right resource!

Catalina Behavioral Health wants you to have access to the services you need for substance use disorder and any underlying mental health condition. At any time, we would be honored if you allow us to verify your insurance policy to determine what a second or subsequent round of treatment will cost out of pocket for you or your loved ones.

Keep reading to get more answers on insurance coverage for multiple rehab stays, and remember we are just a call away, and verifying insurance with our admissions team is quick, easy, and completely confidential with no obligation!

How Many Times Will Insurance Pay for Rehab In My Case? 6 Factors to Consider

According to the Substance Abuse and Mental Health Services Administration, 29 million adults have had a substance use issue. Of this number, 72 percent are either in recovery or consider themselves recovered from substance abuse.

All of this begs the question: How many times will insurance pay for rehab if someone needs additional support to achieve lasting sobriety?

Since you are seeking rehab insurance coverage answers, here are a few things you need to know about how many times insurance will pay for treatment.

1) The Affordable Care Act and Essential Health Benefits Now Covered

First and foremost, let’s take a closer look at whether your insurance coverage extends to substance abuse or mental health conditions. The good news is that alcohol or drug addiction treatment is indeed covered by insurance. It may not be covered in full in all instances, but insurance cannot deny coverage when you first seek treatment.

The federal government mandates that this falls into the broad category of essential health benefits.

Keep in mind that an insurance provider may cover rehab the first time, but it is not a guarantee they will cover repeated stays. Under the Affordable Care Act, also known as ACA or Obamacare, insurance providers use evidence to determine what level of help will be most appropriate for you. Bouncing in and out of care might be a red flag and strip some of these benefits away.

2) Treatment for Substance Use Disorders in the Same Year

Will insurance pay if you have to return to rehab within the first year of your treatment? Oftentimes, they will cover residential treatment facilities for your first stint in treatment. With that in mind, some people are discharged from care and end up relapsing when they return to familiar surroundings.

Will insurance pay for rehab a second time in the same calendar year? In some cases, yes, but you may have to advocate for yourself or allow us to do so on your behalf.

If you have to return to our treatment facilities, it might cause your insurance company to question if our treatment process is truly working for you. They may not feel like your recovery is going to succeed with another round of residential. After all, this around-the-clock care is extremely expensive for them.

They may recommend that you seek outpatient care or mental health services first before returning to a rehab facility. At Catalina, our team can help navigate this situation, and provide the evidence that additional support will be the best option for lasting recovery success.

3) The Length of Treatment for Substance Use Disorders in the Past

Insurance plans may be more apt to kick in for rehab a second time if your first foray into treatment was relatively short-lived. For example, maybe you went through a medical detox and then transitioned to a much lower level of care. Your stay may have lasted only a couple of weeks rather than the full 30 to 90 days we typically recommend.

It is more common for your insurance plan to really cover rehab a second time under these circumstances.

On the other hand, will insurance pay if you complete a more rigorous treatment? If you have attended several months of treatment followed by partial hospitalization or intensive outpatient, they may be less likely to cover rehab again in the same calendar year.

Always comply with your treatment plan and get the maximum that your benefits will cover. Our team of admissions specialists can help you determine what is recommended and covered by insurance.

4) Your Unique Policy and Coverage Limits

When it comes to rehab, insurance coverage varies wildly in terms of your out-of-pocket costs. The factor that causes your treatment costs to vary the most is your unique plan and benefits. Some plans will cover the first stint in residential treatment in its entirety while subsequent stays may be covered at a reduced rate.

In many cases, your treatment attendance and relapse history will be heavily evaluated when determining what your insurance policies are likely to cover. If you have co-occurring mental health conditions, they might permit you to receive treatment for this first with a secondary emphasis on substance use.

Our admissions team is well-versed in the many insurance policies that exist. We can help you navigate these waters with ease. Allow us to verify your insurance benefits so that you know what your insurance will cover definitively.

5) Attempting New Treatment Methods

Will health insurance cover a new type of treatment that you have not tried before? There are no quick and easy one-size-fits-all solutions when it comes to substance abuse treatment. Some people prefer the structure of 12-step meetings or SMART Recovery (which also have the benefit of being free). Others might prefer to work on their addiction treatment in a one-on-one setting.

Your health insurance may be more likely to cover repeated addiction treatment if you are trying a new approach to sobriety.

That is not to say that they will cover every novel therapy on the market today. Instead, they want to see that you are giving evidence-based therapies a real shot at helping. This can include treatments like cognitive behavioral therapy for substance abuse, dialectical behavioral therapy, EMDR, and more. You may also choose to attend a program that offers ancillary therapies like yoga and art therapy.

If your addiction treatment is going to be different the second time around, you should emphasize that with your insurance provider. Your health insurance policy might be more apt to cover these services if that is the case.

6) Medical Necessity Treatments and Health Insurance Policies

Of course, there may be times when your treatment becomes a medical necessity. They might have covered a stay in a rehab facility already this year, but suppose that you get out and relapse quickly. Your situation may require another medical detox to help you stay safe as drugs and alcohol leave your system.

Most health insurance plans will at least cover your detoxification. Undergoing detox at home without the supervision of a medical team, access to medication-assisted treatment, and therapeutic care for the early days of sobriety could be dangerous.

Medical needs can directly affect how many times will insurance pay for rehab, and while your insurance carrier might not cover an extended stay in a rehab facility multiple times in the same calendar year, they might provide coverage for detox several times over if it is needed.

Seeking Care Covered by Insurance at Catalina

Catalina Behavioral Health is proud to accept many of the most common insurance coverage plans. If you have health insurance coverage, we want you to maximize your benefits. Be sure to ask us whether we accept your particular health insurance plan when you call for your confidential consultation.

The most pressing question you might ask is: will your insurance cover drug rehab?

Our insurance verification department can help you figure it out. With Catalina, you never have to walk alone through the maze of your insurance company. With a free quick and confidential phone call, we can verify your insurance benefits, get you the needed details, and answer any lingering questions.

Using AHCCCS Health Insurance Coverage to Minimize Costs

Knowing what your health insurance policy is likely to cover is only the first step. You also need to find a facility that will accept your unique insurance plans. Catalina offers residential care covered by a wide variety of both private and public health insurance plans. Using Arizona’s Medicaid system for addiction treatment can be complex to navigate, but we’re here to help.

We accept AHCCCS coverage for rehab that may fully or partially cover our treatment center offerings. Every plan is going to be a little different in what it will cover. You will need to explore your benefits and your unique plan to determine how much you might be on the hook for when treatment ends.

We can help you get the most value out of what health insurance providers will cover.

Self-Pay Solutions for Out-of-Pocket Expenses

What options do you have if insurance will not cover your drug or alcohol treatment? For many people, paying cash upfront for the cost of rehab is not an option. The good news is that we offer flexibility in our self-pay program to help you cover out-of-pocket expenses.

We may be able to offer you a self-pay discount or a sliding scale fee to offset the cost. Our financial assistance team will work with you to create an affordable payment plan to make it easier for you to fully participate in your treatment without worrying about cost.

Don’t let fear of the financial aspect of treatment hold you back from the support of an effective drug and alcohol rehab setting!

3 Reasons Why Your Insurance Coverage May Include Catalina

Will insurance cover rehab? That might be your first and most pressing question, but there is a second that should follow it: what makes insurance coverage more likely to cover substance abuse treatment with Catalina Behavioral Health? Certain standards must be upheld for insurance to cover rehab, and these criteria are significant.

Here are a few reasons why your health insurance might kick in to cover your addiction treatment program at our state-of-the-art facility.

1) Joint Commission Accredited Facilities for Substance Abuse Treatment

Your insurance provider may want to see proof that a particular drug and alcohol rehab is going to give the best standard of care. To this end, Catalina Behavioral Health upholds a rigorous standard that most insurance providers recognize. We are proud to be a Joint Commission-accredited facility.

Joint Commission accreditation proves that we uphold a rigorous standard of care in a supportive and safe environment. The emphasis is on sustainable healthcare practices with an emphasis on the safety of each patient.

Our accreditation represents our commitment to CMS and OSHA standards for patient safety, as well as some of the more rigorous criteria set by the Joint Commission. All of this serves to make it more likely that your insurance company will cover rehab.

2) Getting Mental Health Treatment in Addition to Rehab

One of the aspects of care that sets Catalina apart from other rehabs is our ability to accept mental health primary clients. This means that you can get the mental health treatment you need without labeling it as your typical rehab stay. If you are struggling with the desire to use substances, this might be an option to seek treatment more intensively.

If you are seeking services at Catalina that cover mental health conditions, you will be in good company.

Insurance coverage typically extends to both inpatient and outpatient care for mental health needs. You may prefer residential because it is a rigorous program where you have access to around-the-clock care and a team of professionals who can help you through a difficult time.

Reinforce your sobriety by getting help with your existing health insurance plans.

3) Outpatient Treatment Options Available

When you feel confident about transitioning back to your regular life, you can always segue into our less intensive outpatient programs. Both partial hospitalization and intensive outpatient are available. This type of substance abuse treatment is likely covered by your health insurance as well.

In an outpatient treatment center, you can spend all day (or several hours a day) seeking help. It gives you the structure you need to transition from inpatient treatment back into the rigors of your daily life. Meanwhile, you can still spend time with loved ones and sleep in your bed at night.

Be sure to investigate how long your insurance policies will cover outpatient treatment to get the help you need to sustain sobriety. They may be more likely to cover extended outpatient because it is a lower cost than inpatient rehabilitation.

Let Catalina Verify Your Benefits and Provide Options Today

At Catalina Behavioral Health, we want you to break free from the cycle of substance use disorder, and we believe in the services we offer. Don’t let your insurance policy be the thing that holds you back from seeking rehabilitation services.

Our admissions team can verify your insurance benefits and help you see more clearly what you or your loved ones will pay out of pocket.

Reach out to us now to see how using rehab coverage provides lasting support programs at Catalina!

References

1. Substance Abuse and Mental Health Services Administration. (2023, September 20). Samhsa releases new data on recovery from substance use and mental health problems among adults in the United States.
2. National Archives and Records Administration. (n.d.). Substance abuse and the affordable care act. National Archives and Records Administration.