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How Much Does Rehab Cost?: Insurance, Financing, Private Pay Options

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Once it becomes apparent that a person has a substance use disorder (SUD) and they decide to get professional addiction treatment for it, the next questions they likely have are:

  • Where are they going to go for help; and 
  • How are they going to pay for it?

Having the means to pay for rehab is essential to getting the help one needs to work on their SUD and work their way to sobriety. Cost is often a barrier to treatment, and many people pass up the chance to get the recovery help they need because they think they cannot afford it. It is also possible that they do not know how to go about getting the resources they need to pay for it. However, cost is not a reason to pass up addiction treatment. 

Leaving a drug or alcohol problem or a mental health disorder untreated only increases the chance of making the issue worse. The person struggling with an adverse condition puts themselves in harm’s way by not taking care of the problem or themselves.

Many people who misuse alcohol and drugs also have a mental health disorder that also needs treatment. These disorders include anxiety, depression, post-traumatic disorder, and many others. Getting help at a rehab that also addresses co-occurring disorders at the same time is important for people who have both.

There are nearly 15,000 specialized substance use treatment facilities in the U.S., so people looking for help have many, many options to review and choose from. Still, you will have to consider your options carefully because not all health plans cover the same services, and not every facility offers the same treatment types.

Commonly Used Services in a Rehab Program

Treatment programs look different according to the person receiving help for substance addiction or dependence. As you review your rehab costs, you could need any of the following services:

  • Medical detox, maintenance medications
  • Residential (inpatient) care 
  • Long-term residential care 
  • Intensive outpatient (nine or more hours) or outpatient care (fewer than nine hours)
  • Aftercare counseling or therapy

Addiction care professionals can review your situation and determine what you will need, and can help you find facilities that provide the services you need.

What Determines Rehab Costs

As you set out to determine what kind of treatment you need, you will have to consider what your program will look like. Much will depend on how severe your substance dependence is. You will also need to consider:

  • How long your recovery program will last
  • Where the facility is located (rehab in your home state vs. out-of-state treatment)
  • Whether the facility is public or private
  • The facility’s services, amenities 
  • If you can take time away from work for treatment

If you need a program that requires you to stay on-site at a facility for at least 30 days or longer, this will cost more than receiving treatment at a facility and then returning home when sessions are done. If you are unsure what kind of program you will need, addiction care specialists can help you determine the proper placement that works for you.

One key thing to remember is that rehab costs will vary according to the facility and the services offered. Where you receive treatment can make a big difference. States and health insurance plans offer different coverages.

If you are in the moderate-to-severe stages of addiction, you may want to consider residential (inpatient) treatment for at least 90 days or three months. The National Institute on Drug Abuse points to research that says this period is ideal for giving people in recovery the time they need to increase their chances of lasting sobriety. 

Drug treatment is an investment, regardless of where you start on the continuum of care, so devoting the proper time to recovery is important, and that time is also a cost investment.

You will have to consider where you will receive treatment, which can affect costs. Private facilities can cost more than private ones, and your expenses could reach the maximum limits your insurance requires. Before choosing, prospective clients should look at a rehabilitation facility’s credentials, quality of treatment plans, track record of treating patients, and more.

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Paying for Rehab: The Options

There are many ways to pay for rehab. Some people will have insurance, while others may pay out of pocket on their own. We will look at a few options below:

Insurance

If you are using health insurance to pay for your substance use treatment program, you will have to first check to see what your insurance policy covers. In general, health insurers know that addiction is a medical condition that is treatable under the Affordable Care Act (ACA) as of 2014. The ACA requires insurance plans cover the Essential Health Benefits, no matter what kind of insurance a person has. A person can receive coverage for mental health conditions, drug or alcohol use, and therapy and counseling.

Your insurer will cover whatever falls under your plan. Anything that falls outside of that will have to be covered by other financial arrangements. It is important to keep in mind that while most insurance companies cover addiction treatment, they may not provide coverage for certain types of therapy or certain treatment facilities.

Your health insurer may also review the location of the facility where you want to receive treatment, such as if it is your state or out of state. Whether you have public insurance, private insurance, or group insurance is also a factor and can affect coverage requirements.

Some treatment facilities, such as those partially or entirely subsidized by the government, state, and/or federal health insurance plans for payment. Some also accept Medicaid and Medicare, which is for people older than age 65. Public insurance plans usually have income restrictions.

If you are using private insurance, which is paid for by the person or their employer, you likely will have more options. Private insurance plans can cover a large portion of your treatment expenses. You will have to find out what your deductible is, which has to be paid before your insurance coverage starts. After you have paid your share, your insurer can determine what it will cover, and you will give you a better estimate of what you will need to spend on rehab.

HMOs vs. PPOs

Whether you have a health maintenance organization (HMO) or a preferred provider organization (PPO) can affect how much rehab will cost for you. An HMO generally covers care costs from in-network providers, making them more affordable. If you choose a rehab facility that is listed “in-network,” it means you will be offered some services at a lower rate because the facility has an agreement with your insurer. If you receive treatment from an “out-of-network” provider, which does not have an agreement with your provider, your costs likely will be higher.

If you have a PPO plan, it may cover costs from providers who are out-of-network. It is also possible that you will have to cover some costs upfront and then seek reimbursement from your provider.

Before you choose a program, call your insurer to find out what your policy covers and make sure you understand all costs, including the ones your insurer covers. You may also want to ask about the deductible you will have to pay and if you will need a primary care physician to refer you for rehabilitation services.

Financing

If you wish to pay for rehab with various methods of payment, there are facilities that accept credit cards that have enough money on them to cover costs. Some people take out different kinds of loans to pay for treatment. You may have to do some homework to determine which loan has an attractive interest rate that is affordable to you. You can also sell some items to get the money you need or join a crowdfunding site to raise money for treatment.

Private Pay Options

Everyone does not have health insurance to cover rehab, but they can still pay directly with cash or check. Some family members and friends are also in a position to pay rehabilitation facilities that accept cash payment for treatment services. Private pay options allow people to have more control over their plans and the services they receive.

No One Can Afford to Pass Up Getting Help for Addiction

While having money to pay for treatment is essential, everyone is encouraged to get help if they need it. Whether you have insurance that can cover the costs of substance use treatment services or not, options are available to help you get the care you need. You could be eligible for facility scholarships or grants that can help you cover your rehab costs. Social programs may also know of resources that can help you.

The cost of not getting help for a SUD is far steeper than the cost of treatment. Battling the chronic disease of addiction can affect all areas of a person’s life, including their job,  relationships, and money. 

Substance use battles can also lead to hardship, overdose, and possibly death. Rehab teaches people in recovery what they can do to manage their recovery and how to avoid their triggers and stressors so that they can avoid relapse.

Seek out all options for help as it could save your life or the life of a loved one. The staff at Vista Pines Health can guide you in finding the help you need. Call us today so we can get started on helping you find your way to sobriety.

Sources

NIDA. (January, 2018). “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states

National Institute on Drug Abuse. (January 2018). “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment

American Society of Addiction Medicine. (2015, May 13) ASAM Continuum. Knowledge Base. What are the ASAM Levels of Care? from https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/

Unknown author (January, 2018). What Marketplace health insurance plans cover. HealthCare. from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

Medicare. Inpatient rehabilitation care. from https://www.medicare.gov/coverage/inpatient-rehabilitation-care

Drug addiction (substance use disorder). (2017, October 26). from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112

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