Drug and alcohol addictions are serious conditions that require comprehensive treatment and support. The effects of substance abuse can be devastating, but very few people get the help they need to overcome it.
Worrying about how to pay for rehab may prevent people from seeking treatment. However, insurance typically covers some or all of addiction treatment.
But what should you do if insurance denies your rehab claim? This article will explore the answer to this question. You will learn:
- What services insurance may cover
- How to check the details of your insurance plan
- What steps to take if your insurance company denies your rehab claim
- What to do if insurance won’t pay for rehab
If you or someone you love struggles with substance abuse or addiction, you are not alone. Contact the First Step Behavioral Health specialists to learn about our treatment and recovery support programs. You may also ask questions, get help verifying your insurance, or schedule an intake appointment.
Does Insurance Cover Rehab?
The Affordable Care Act (ACA) requires insurance companies to cover mental health and addiction treatment. This federal law prohibits insurance companies from denying coverage for these essential, medically necessary treatments. Under this law, insurance companies may pay for all levels of care. These include:
- Medical detox programs
- Medication-assisted treatment (MAT) programs
- Residential or inpatient care
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient rehab
- Mental health care
- Medications
- Medical visits
- Counseling and behavioral therapies
However, insurance plans vary significantly. It is essential to understand insurance coverage thoroughly, including details about the services and programs your plan covers.
There are several ways to verify your health insurance coverage before starting treatment. You may:
- Call the number on the back of your insurance card and speak to a representative about in-network treatment facilities and programs
- Learn about the details of your insurance plan on the insurance company’s website
- Ask the First Step Behavioral Health specialists to help you verify your insurance information
First Step Behavioral Health offers inpatient treatment, outpatient treatment, and aftercare programs that support long-term recovery. Contact our intake specialists for assistance verifying insurance or finding the right level of care to meet your needs.
My Insurance Denied My Rehab Claim: What Should I Do?
While insurance companies must cover some or all rehab costs, they may deny a claim for rehab. This can happen for several reasons, including:
- The insurance company does not believe treatment is a medical necessity
- A lack of prior authorization
- Insufficient insurance coverage
If your insurer denies your rehab claim, you may take these steps to find a solution.
1. Read the denial letter carefully.
First, read the denial letter carefully. Make sure you understand the reason the insurance company denied your claim. Understanding the reasons your claim was denied will help you gather the correct information to make an appeal.
2. Understand the details of your policy.
Look carefully at the details of your policy. Compare your policy with the insurance company’s reason for denying your claim.
3. Collect documentation to support your claim.
If you believe your insurance company was wrong to deny your claim, you may begin to gather evidence to support this. Collect medical records and other documentation that support your claim.
4. Follow the appeals process.
Learn about your health insurance company’s appeals process and follow it.
5. Seek outside help.
If your appeal is denied, consider seeking outside legal assistance to file another appeal.
Navigating insurance can be frustrating. Contact the First Step Behavioral Health specialists for help understanding your policy, seeking prior authorization, or for guidance during the appeals process.
What to Do If Insurance Won’t Pay For Rehab
Substance use disorder (SUD) is a serious condition that requires treatment and support. You may still seek treatment if your insurance plan does not cover the services or treatment centers you need.
Here are some of the ways you can get addiction treatment if you do not have insurance.
Payment plans
One of the best ways to get the care you need is to work with your treatment center to create a payment plan. Many treatment facilities offer the option to pay in affordable monthly installments. Contact First Step Behavioral Health to learn more about rehab payment plans.
Grants and scholarships
Some rehab facilities or other organizations offer grants and scholarships to pay for rehab. These can be limited, so it’s a good idea to apply as early as possible.
Sliding scale treatment
Many treatment facilities offer sliding scale fee schedules for people who must pay for treatment out of pocket.
Low-cost rehab programs
Search for local low-cost rehab programs. These programs may fill up quickly, so begin your search as soon as possible.
Crowdfunding
Consider asking friends and family to help you pay for rehab. Many people do not know how to help a loved one struggling with substance abuse. Crowdfunding is one way to gather the financial support you need to pay for rehab.
Contact the First Step Behavioral specialists to learn more about paying for rehab without insurance coverage. Our dedicated intake team will help you explore all of your payment options so that you can get the treatment you need to work toward recovery.
Find Treatment Now
Contact the First Step Behavioral Health team if your insurance company has denied your rehab claim or if you want to explore your treatment options. Reach out with questions, to verify your insurance coverage, or to schedule an intake appointment.