How Many Times Will Insurance Pay for Rehab?

Getting Treatment Help Covered by Insurance Following Relapse

If you or a loved one has stumbled in recovery, know, first, that you are not alone. It’s not unusual for someone with a drug or alcohol problem to have a relapse. Substance abuse is a very “sticky” disorder, and some will need drug or alcohol treatment more than once.

But that situation still leaves a critical question: How many times will insurance pay for rehab services?

Ingrained Recovery, a 50-acre, upscale recovery ranch in Eastman, Georgia, can attest to the validity of this dilemma. While the health insurance provider is mandated to cover mental health services, they are often stingy about approving drug and alcohol rehab treatment.

Please continue reading to discover how health insurance companies authorize additional addiction treatment and determine what rehab costs they’ll cover. And remember, the caring team at Ingrained can help answer any questions and confidentially verify benefits at any time with a quick call.

Does Insurance Cover Rehab When Repeating Substance Abuse Treatment?

Before we start discussing how health insurance policies decide on allowable coverage, let’s mention that Ingrained Recovery has a highly competent admissions team. Our professional staff is well-versed in reviewing group and private insurance plans to help you gain the most insurance benefits.

We’ll explain more about this service later on this page. But if you’re ready for this assistance right now, please contact us immediately. Once you call us, we’ll take it from there!

A discussion of limitations on insurance coverage for addiction medicine can be a bit complicated. There is no national standard regarding how many times will insurance pay for rehab. Instead, the determination of coverage comes down to the following factors:

• The specific language of the individual insurance policy
• Plan type, i.e., public or private insurance
• Whether the insurance company deems addiction treatment a medical necessity

Most health insurance providers recognize that relapse is a frequent part of the healing process. Therefore, they may not expressly limit the number of times insurance will pay for rehab.

The Availability of Choices for Addiction Treatment and Mental Health Treatment

However, your health insurance plan may subject plan members to nearly impossible to meet criteria to receive the insurance benefits. For instance, they require a pre-authorization or try to force you into using only in-network providers. They may also only allow insurance coverage for lower levels of care after an inpatient rehab program.

It’s also worth mentioning that the insurance provider directly pays the treatment center for rehab costs covered. It’s a question we sometimes hear in substance abuse treatment centers

Rest assured that you do not need to deal with those roadblocks the insurance providers have put in place alone. Our fast and free insurance verification service will clear those pitfalls out of your way!

Insurance Provider Approval Factors for Additional Rehabilitation Services

Here are some of the things to remember when you need additional substance abuse or mental health treatment after a relapse or have otherwise decided to return to get further rehab support:

Insurance Plans Vary Greatly

Answering your question of how many times will insurance pay for rehab starts with an acknowledgment that health insurance plans have great variations in coverage.

Regardless of whether you have private insurance, TRICARE, Blue Cross Blue Shield, Aetna, or UnitedHealthcare, health insurance coverage limits are written into your policy.

Your Health Insurance Policy Must Comply with the Affordable Care Act (ACA)

Many insurance companies list their services to American consumers on the expansive health insurance marketplace, created under the ACA (Obamacare). This law required insurance providers to cover substance abuse treatment and mental health services the same way they treat physical health concerns.

For the first time, mental health disorders, including substance use disorders, were recognized as an essential health benefit. The conditions have at least begun to receive the attention they always deserved.

However, things are not always what they seem. Some loopholes still exist for insurers who want to limit how much they’ll pay for rehab. For instance, insurance companies sent lobbyists to fight to have certain group health plans “grandfathered in” under the old rules. They succeeded and effectively shut out some plan participants seeking treatment for substance abuse issues.

These are luckily becoming less common, as plan participants from the earliest days of the Affordable Care Act retire or switch jobs.

Lifetime and Annual Limits Can Impact a Treatment Plan

Depending on the particular health insurance plan, lifetime or annual coverage limits can present a barrier to receiving care during the same policy year.

Annual limits are usually the pain point. Lifetime limits are prohibited by the ACA, with one glaring exception – those grandfathered insurance coverage instances mentioned previously.

Managed Care and Treatment Authorization Policies

Insurance providers use managed care principles to determine if payouts for treatment centers are medically necessary. They make their plan member apply for pre-authorization for rehab services and review the case to see if they “need care” before allowing treatment.

The insurance provider may also require progress reviews or proof of the person’s ongoing need for rehab facility services after a relapse. The process is deliberately cumbersome and triggering.

SAMHSA Proves the Need for Effective Drug and Alcohol Rehab Programs Persists

The need to answer the question at hand – does insurance pay for rehab – has never been greater. That’s not an opinion – it’s a fact explained in the Substance Abuse and Mental Health Services Administration (SAMHSA) report in 2023.

SAMHSA’s Key Findings About Seeking Addiction Treatment

SAMHSA surveyed Americans about their lived experiences with alcohol and drug rehab. These were everyday people who opened up and self-reported their past interactions with the mental health industry.

Here are the key findings:

Addiction Treatment Needs Are Still Unmet

29 million Americans reported a past substance use problem; 20.9 million considered themselves as being in recovery. That leaves a gap of almost 8 million Americans who still appear to need substance abuse treatment services.

Other Mental Health Disorders Play a Role

58 million reported struggling with mental health conditions; 38.8 million currently considered themselves “in recovery.” Like those with substance use disorders, these two groups of people have a large gap.

But this time, it’s better described as a chasm. That’s because SAMHSA found that almost 20 million explained that they lived with unresolved mental health conditions.

Age Plays a Part in Recovery

Recovery was more common in groups of adults over 65, with 81% in recovery; younger groups considered themselves in recovery only 67% of the time.

With numbers like these, the answer to how many times will insurance pay for rehab should be as many as necessary. Without all who struggle with addiction gaining equal access to healthcare providers, we cannot magically erase the rate of chronic relapse.

What Will Health Insurance Cover at a Rehab Center?

Out-of-pocket expenses are a worrisome detail for many who need the help of a qualified healthcare provider to overcome an addiction. Keep reading to learn more about the treatment center options considered essential benefits but subject to approval by the insurer.

Evidence-Based Practices Covered by Insurance

Health insurance plans provide coverage for science-backed, proven treatments, like those we provide at Ingrained Recovery.

Counseling for Alcohol or Drug Addiction

Counseling and therapy is a key part of inpatient programs and outpatient services. Regardless of the level of care, therapy helps people get to the heart of why they use drugs or alcohol and change those harmful behaviors.

Inpatient Rehabilitation Services

Those with the most pervasive addictions or co-occurring disorders that complicate things may qualify for inpatient rehab. Patient safety is a prime concern, so almost every insurance plan will pay for inpatient treatment if there’s a chance of self-harm.

However, drug and alcohol rehab cost-coverage is much higher with this level of care, making the insurance company less likely to approve this option.

Outpatient Treatment (Intensive Outpatient Treatment or Partial Hospitalization Programs)

Will insurance pay for rehab in an outpatient setting? You bet! In fact, they prefer outpatient rehab services due to the lower costs associated with this treatment plan. They approve intensive outpatient plans or partial hospitalization based on an assessment of the client’s needs.

Medical Detoxification Services

Rehab services start with medical detox, a time for the alcohol or drugs to metabolize and leave the body. Healthcare providers and insurance companies actually agree that medically supervised detox is the the safest and most effective means of preparing the body for rehab treatment.

Medication-assisted Treatment Services

When the drug of choice is so dangerous that cessation without medication poses a danger, the insurance company will pay for medication-assisted treatment. This insurance coverage is usually approved for rehab from alcohol or opioid use.

Getting Insurance Coverage Help from Ingrained Recovery

We’ve tried to present all the ins and outs of your insurance coverage. However, we also know that it can still be very confusing. In fact, we acknowledge that we can’t give a definite answer to the question: How many times will insurance pay for rehab?

With the variations from one policy to another, there is simply not a cut-and-dry answer. But here’s what we can do to put your mind at ease.

We’ll call your policyholder to discuss your insurance coverage limits. With our help, you will be sure that you don’t have the nasty surprise of unexpected out-of-pocket expenses.

Call us for a confidential, free insurance verification. Out admissions team is glad to contact your insurance company and serve as your advocate.

What We Need to Contact Your Insurance Policyholder

Here’s what you need before you reach out to Ingrained’s admissions help to learn about your coverage limits and get pre-authorized for relapse care:

Your Insurance Policy Card

Please have your insurance card in your hand when you connect with our admissions team. We need to gather both your personal contact information (phone number, date of birth, current address) and some necessary information from that insurance ID card.

We will ask you to locate:

• The insurance company name and phone number (some group plans have dedicated contact numbers)
• The member ID and policy number
• Group number (if it’s group health insurance)
• The policyholder’s name
• Policy effective date (ensuring you are within a coverage window)
• Prescriptions BIN number (so we can also get any prescriptions approved)

You don’t need to remember all these things; we will walk you through it step by step if you need help.

Co-Insurance Information

If you have additional coverages, such as co-insurance with a spouse or a supplemental policy, please tell us when you call. These supplemental plans can offset any costs that may not otherwise be covered by the primary insurance or for closing gaps in the coverage.

Your Past Rehab Facility Treatment History

Remember that insurance companies cover rehab grudgingly and only because the ACA has compelled them to do so. We must prove the need for the highest level of care possible. to make the case that you need inpatient rehab after a relapse.

But before we can leverage those benefits, we must clearly explain your past efforts at drug and alcohol rehab. For example, we will tell them:

• If you have had past outpatient treatment that has not proven effective or long-lasting
• Thoughts of self-harm, suicidal ideation, or suicide attempts
• Any traumatic events that have triggered the relapse

The information you share helps your insurance cover rehab at the proper level of care. For some that means inpatient rehab. For most, it will mean comprehensive outpatient rehab services.

Call Ingrained Recovery for Proven Rehab Program Support

Our initial question was: How many times does insurance cover rehab? While the answer to that is somewhat unclear due to the different types of insurance plans, our commitment to helping you achieve long-lasting recovery is no. We will stand with you and help you get your recovery back on track after a relapse.

The entire Ingrained Recovery team fully commits to helping you put the relapse behind you by learning what went wrong with the goal of fixing it and moving on. We’ll construct customized treatment plans that reignite your motivation for sobriety and give you the coping tools to get there…and stay there for good this time.

Give our admissions staff a call today – your discussions with us are always confidential, so please reach out now for support!