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Does My Insurance Cover Detox?

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One of the major obstacles many people face when wanting to take control of their alcohol use disorder (AUD) or substance use disorder (SUD) is the cost of detox and addiction treatment. One common question many people have is, “Does my insurance cover detox?” Fortunately, you have several viable options to cover the cost of care with or without insurance.

What Is Detox?

Detox is the first step to recovery from AUD or SUD. It requires an inpatient stay at a qualified medical detox center. The purpose of detox is to wean the patient off of their addictive substance until they are physically stabilized. Detox can include the use of medication therapies when appropriate. It can also include counseling and other mental health services.

Does Insurance Cover Detox?

With the creation of the Patient Protection and Affordable Care Act, it made detox and treatment for alcohol and substance use disorders part of covered medical conditions. It also prevented denial of coverage for those with pre-existing AUD or SUD conditions. As a result, those with insurance coverage through the Health Insurance Marketplace have coverage for detox up to a certain percentage based on the level of plan and type of plan selected. For example, most Silver-level plans cover up to 70% of detox and addiction treatment costs.

For those with employer-sponsored coverage, most health insurance plans obtained through an employer also include a certain percentage of coverage for detox and addiction treatment. However, one would need to refer to their plan specifics to determine the exact amount of coverage.

What Is the Difference Between “In-Network” and “Out-of-Network?”

Some insurance plans will require you to obtain detox treatment from an “in-network” provider. This means the insurance company has negotiated special rates and allowable charges for detox treatment with specific treatment facilities.

If your insurance requires you to obtain treatment from an in-network provider, and you want your insurance to pay their part of the treatment, then you have chosen one of the facilities that are considered in network.

An “out-of-network” provider is one that does not have an existing agreement with the insurance company. However, some insurance plans also provide coverage for out-of-network detox treatment facilities.

To find out if your insurance covers a facility you are considering, the easiest way is to contact the treatment center directly. There should also be a toll-free phone number on the back of your insurance card. You can call and speak with a benefits coordinator from your insurance company.

How Long Does Insurance Cover Detox Treatment?

The length of stay for insurance-covered detox treatment will vary. Most of the time, the insurance company and treatment facility will work together to determine the time needed for detox. This results in a personalized treatment plan that usually lasts two to four weeks and is generally covered by insurance for the entire stay.

The insurance company will also often cover their percentage of the costs for any medication therapies, counseling, and other services that are part of the treatment plan.

Does Insurance Cover Co-Occurring Disorder Detox Treatment?

Just about every insurance plan has some form of coverage for behavioral and mental health services. So, insurance would provide coverage based on the plan specifics if an individual is diagnosed with a co-occurring disorder, where they have an AUD or SUD and a mental health disorder.

Does Insurance Cover Addiction Treatment After Detox?

Alcohol and drug addiction treatment are covered by insurance as well. However, you may need a referral from a doctor at the medical detox center, depending on the specifics of your insurance policy requirements. You may also have to obtain treatment from an ‘in-network” provider.

In most cases, plans obtained through the Health Insurance Marketplace, employer-sponsored plans, Medicaid, and Medicare all provide coverage for addiction treatment services after detox treatment is completed.

What If I Do Not Have Insurance Coverage?

AUD and SUD can leave a person financially strained, without a job, and without insurance coverage. Fortunately, there are options for starting detox treatment without insurance. Many states have state or federal-sponsored programs, like Medicaid. Various healthcare networks and detox centers also offer grants and scholarships. In addition, some detox centers provide financing and payment plans to make it affordable to obtain treatment.

To learn more about these options, you should contact the medical detox center directly and speak to an admissions coordinator. They will review your options and provide you with the details about which ones you qualify for. They will also show you how to apply for specific programs, financing, and scholarships.

Start Detox With or Without Insurance at Our Pompano Beach, FL Detox Center

At Retreat of Broward we are dedicated to making detox treatment accessible to those with or without insurance coverage. Our admissions coordinator will work with you to determine what options are available to you. For more information or to start your detox treatment, contact us today.

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