How to Get Insurance to Pay for Inpatient Rehab

When dealing with drug or alcohol addiction, one of the most significant obstacles to pursuing treatment is often the financial burden. Inpatient care plays a crucial role in the recovery journey, providing a secure, thorough, and intensive approach for individuals grappling with substance use disorders. Unfortunately, the costs associated with such treatment can be daunting, leaving many to question how to get insurance to pay for inpatient rehab. The good news is that most plans offer insurance coverage for addiction treatment, including inpatient rehab.

For those who need inpatient addiction treatment, it is likely they are already facing a mountain of stress. Add navigating insurance coverage to the mix, which can feel overwhelming. However, with the proper knowledge and preparation, it’s possible to make the process easier and more manageable.

By understanding your insurance options and how to advocate for yourself, you can take the first step toward getting the treatment you need without the tremendous financial stress. Whether you’re looking for help for yourself or a loved one, knowing how to approach the economic aspect of rehab can make all the difference in accessing the care you need and deserve.

What Type of Insurance Cover Inpatient Rehab?

Recovery from drug or alcohol addiction can be a challenging and lengthy journey. For individuals facing severe substance use disorders, residential rehabilitation in California for addiction often provides the best opportunity for a successful recovery. However, the financial aspect can significantly influence the decision between inpatient and outpatient treatment, as inpatient care tends to be more expensive.

Healthline reports that the costs for inpatient programs can start at around $2,000 and soar to $40,000, making it unaffordable for many unless they have insurance to help cover the expenses.

Inpatient rehab coverage varies by insurance plan and treatment needs. The Affordable Care Act (ACA), enacted in 2010, expanded healthcare access for lower-income families and required coverage for mental health and substance use disorders, eliminating the denial of coverage for pre-existing conditions.

All ACA-compliant plans now include drug and alcohol treatment. The main concern is understanding the extent and duration of coverage, which may depend on whether your plan only covers in-network facilities.

Most insurance plans require pre-authorization or a referral from a healthcare professional to start treatment. Coverage is based on medical necessity, evaluating whether specific services are essential. The National Association of Insurance Commissioners states that health insurance plans will define medical necessity in their policies.

During the initial evaluation at a rehab facility, addiction specialists assess the severity of the addiction, its impact on daily life, and any co-occurring disorders. This information helps clinicians determine the appropriate care level and treatment plan, which is submitted to your insurance for approval. Your insurance should cover some or all associated costs if inpatient care is needed.

What Documentation Is Needed to Submit an Insurance Claim for Inpatient Rehab?

When it comes to submitting a claim for insurance coverage for inpatient alcohol rehab, the process can be lengthy and a bit complicated. The initial step involves providing a copy of your insurance card and details about the policyholder. You will also need to gather essential admission documents, including your treatment plan, the official diagnosis (complete with an ICD-10 code), and clinical progress notes from your treatment team.

If your treatment necessitates pre-authorization, make sure to include that as well. For those using out-of-network services, additional documentation may be required to demonstrate that the treatment was covered, along with any specific instructions or limitations regarding out-of-network care.

Some insurance providers might ask for written consent from the patient or the policyholder to release the medical information needed to process the claim. An itemized invoice detailing all services provided during your inpatient stay is also necessary. This should encompass room and board, medical services, therapy sessions, and any other treatments, along with their corresponding billing codes.

Finally, a discharge summary is crucial as it outlines your progress and any follow-up recommendations. To facilitate a smooth claims process, keep copies of all submitted documents, maintain communication with your insurance provider and treatment center, and ensure everything is submitted within the timeframe set by your insurer.

Why Do Some Insurance Companies Deny Rehab?

Coverage denials can happen for various reasons, often stemming from policy limitations, cost-control strategies, and eligibility requirements. Coverage may be denied if a treatment is not classified as “medically necessary” or if the rehabilitation center is outside the insurer’s network.

Policies frequently impose restrictions on the number of treatment days or the types of services covered, which can result in denials if these limits are surpassed. Furthermore, if an individual’s substance use is assessed as not severe enough to warrant inpatient care, treatment may also be rejected.

Administrative errors, such as incorrect billing or missing documentation, can contribute to these denials. In some instances, a history of relapse or non-compliance with prior treatment programs may cause insurers to hesitate in approving additional rehab coverage.

The National Alliance on Mental Illness highlights that certain mental health treatment services, including residential care and intermediate levels of care like partial hospitalization programs (PHPs), face higher denial rates compared to other health conditions. Nevertheless, it’s crucial to understand that many denials can be appealed with the proper documentation or by seeking second opinions.

Are There Payment Plans or Financing Options for Rehab Costs?

For those whose insurance falls short of covering all inpatient care expenses or who lack insurance altogether, numerous drug and alcohol rehabilitation centers provide financing solutions. Some facilities offer payment plans enabling you to distribute the treatment costs over time.

Additionally, many collaborate with financing companies offering medical expense loans, often featuring flexible repayment options. However, it’s important to note that these options may come with interest charges.

Some organizations offer grants or scholarships for individuals needing rehabilitation but cannot cover the full costs. If financing through the rehab center isn’t feasible, some individuals may consider personal loans or credit options, though this route should be approached with caution due to potentially high interest rates.

While rehabilitation can be costly, it’s crucial to consider the financial toll of ongoing addiction as well. Maintaining a drug or alcohol habit can be expensive and may also jeopardize your health, job security, and personal relationships.

How to Get Insurance to Pay for Inpatient Rehab With Help From Resurgence Behavioral Health

Attempting to figure out how to get insurance to pay for inpatient rehab is an added stress many do not need when seeking out help for substance use disorders. At Resurgence Behavioral Health in California, we accept most major insurance plans and many plans from smaller insurance companies to help you access the care you need while maximizing your insurance benefits.

Our experienced team is here to guide you through every step of the process, from verifying your insurance coverage to working directly with providers to ensure you receive the care you deserve without financial stress. Additionally, we offer flexible payment plans and can help you explore scholarship or grant options, ensuring that top-notch addiction treatment costs don’t stand in your way.

If you are ready to start your recovery journey, reach out to Resurgence Behavioral Health today at 855-458-0050 to find out how we can assist you in getting your insurance to pay for inpatient rehab.

External Sources

• Healthline – Understanding the Difference Between Inpatient and Outpatient Rehab
• National Association of Insurance Commissioners – Understanding Health Care Bills: What is Medical Necessity?
• National Alliance on Mental Illness – What to Do If You’re Denied Care By Your Insurance

David Rofofsky
After growing up in New York, David chose to get help with substance abuse in California because of the state's reputation for top-tier treatment. There, he found the treatment he needed to achieve more than nine years of recovery. He's been in the drug and alcohol addiction rehab industry for eight years and now serves as the Director of Admissions for Resurgence Behavioral Health. David remains passionate about the field because he understands how hard it is to pick up the phone and ask for help. However, once the call is made, someone's life can be saved.

Research | Editorial