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Using Health Insurance to Cover Rehab Costs: What Employees Need to Know

Health Insurance to Cover Rehab Costs

If you’re ready to seek help for substance abuse or addiction treatment, one of the biggest questions on your mind is likely: Will my health insurance cover this? The good news is that, in most cases, yes—it will. Thanks to the Affordable Care Act, health insurance companies are required to provide coverage for addiction treatment, just like they would for any other medical care or mental health condition.

At Ocean Ridge Recovery, we work closely with clients and their insurance providers every day to ensure they can access substance abuse treatment with as little stress as possible. Here’s what you need to know about using insurance for rehab, understanding your benefits, and reducing out of pocket expenses along the way.

Health Insurance

Understanding Your Health Insurance Coverage

Not all health insurance plans are the same. Your specific insurance coverage depends on your insurance company, your insurance plan type, and whether your chosen treatment provider is in network or out of network.

Here are some common plan types:

  • Preferred Provider Organization (PPO): More flexibility with in network and out of network providers, but costs vary.
  • Health Maintenance Organization (HMO): Requires you to stay in network and often need a primary care physician referral.
  • Private health insurance: Varies widely in coverage and benefits depending on your insurance provider.
  • Health insurance marketplace plans: Must include essential health benefits, which means addiction treatment coverage is required.

What Addiction Treatment Services Are Typically Covered?

Under most health insurance policies, plans are required to cover both mental health and substance abuse treatment, including:

  • Inpatient rehab and residential treatment facilities
  • Outpatient treatment and therapy
  • Medication assisted treatment (MAT)
  • Dual diagnosis care for mental health concerns
  • Detox programs
  • Alcohol rehab and drug and alcohol recovery services
  • Support for mental illness or mental health issues

These treatment services are often considered covered services, especially when provided by in network providers or addiction treatment centers that have contracts with health insurance providers.

What Will I Have to Pay Out of Pocket?

Even with insurance coverage, there may still be out of pocket costs—such as deductibles, co-pays, or non-covered services. That’s why it’s important to contact your insurance provider directly or work with a treatment facility like Ocean Ridge that can verify your insurance benefits for you.

We’ll help you understand:

  • Your in network vs. out of network options
  • Expected out of pocket expenses
  • Pre-authorization requirements
  • Covered addiction treatment facilities or treatment programs
  • What your insurance cover rehab benefits actually include

What If I’m Covered by a Workplace Plan?

Many employees are covered through employer-sponsored health insurance companies. These plans are often robust and include mental health services, substance abuse treatment, and access to employee assistance programs (EAPs) that can connect you with addiction treatment facilities like Ocean Ridge.

We’re also familiar with working alongside major insurance providers and HR departments to make the process simple and confidential—so you can focus on healing without the added stress.

Paperwork for insurance

Navigating the Cost of Treatment with Ocean Ridge

At Ocean Ridge Recovery, we believe the cost of treatment should never stop you from getting help. We’re in-network with many healthcare insurance providers and work directly with them to maximize your health insurance coverage while minimizing your out of pocket expenses.

Whether you’re looking for alcohol addiction treatment, inpatient rehab, or a flexible outpatient treatment program, our admissions team is here to walk you through every step—from verifying your insurance for rehab to creating a treatment plan that aligns with your goals and budget.

Take the First Step—We’ll Help With the Rest

If you’re feeling overwhelmed by figuring out insurance policies, treatment programs, or what your insurance company will cover—don’t worry. You don’t have to figure it out alone.

Contact Ocean Ridge Recovery today for a free, confidential insurance verification. Let us help you understand your health insurance options, so you can get the addiction treatment you need without added financial stress.

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Frequently Asked Questions

Are addiction treatment programs covered by insurance?

Yes, many addiction treatment programs are covered by insurance, especially those that are deemed medically necessary. Coverage may include inpatient rehab, outpatient treatment, detox services, and therapy. It’s important to check with your insurance provider or have a treatment center like Ocean Ridge verify your benefits to understand exactly what’s included in your plan.

What is the role of the Mental Health Services Administration in addiction treatment?

The Mental Health Services Administration—more formally known as the Substance Abuse and Mental Health Services Administration (SAMHSA)—helps set standards for quality care and provides funding and guidance for addiction and mental health services. While SAMHSA doesn’t provide direct treatment, they are a valuable resource for finding reputable treatment programs and understanding your options.

Does health insurance cover mental health care in addition to addiction treatment?

Yes. Under the Affordable Care Act, mental health care is considered an essential health benefit. That means most health insurance plans are required to provide health coverage for both mental health care and addiction treatment, including therapy, medication, and dual diagnosis services when appropriate.

How do I know if I have the right health coverage for rehab?

The best way to confirm your health coverage is to call your insurance provider or have a trusted treatment center like Ocean Ridge Recovery do a free insurance verification. We’ll review your policy, explain your benefits, and help you understand what addiction treatment programs are covered—and what out-of-pocket costs you may be responsible for.

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