Using Health Benefits for a Treatment Program Following Relapse
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Sometimes, the road to recovery has detours that come in the form of relapse. The rate of relapse after rehab is surprisingly high, with one study estimating 65-70% of individuals relapse within the first 90 days of leaving a rehab program.
While nobody should put off seeking addiction treatment because they are worried about payment, it can leave you wondering, “How many times will insurance pay for rehab?”
If this sounds familiar, support (and answers) have arrived with our full resources on this very topic!
Several factors determine if insurance providers will pay for a second (or third or fourth) stint in rehab. This includes whether rehab seems to be an effective course of treatment for you, how many times you have attended a rehab facility this year, and the specifics of your insurance benefits.
Most insurance providers will cover rehab if it seems to be effective, and we will work with you or your loved one every step of the way to make the process as smooth as possible.
At Changes Healing Center in Phoenix, we can quickly find out if you are covered by insurance and discuss options for treatment. Place a confidential call to our facility and start your path to continued recovery today!
Does Insurance Cover Rehab and Substance Abuse Treatment?
The Affordable Care Act established guidelines regarding American healthcare and made it necessary for healthcare providers to include drug or alcohol treatment as part of their policy. Treatments for substance abuse and mental health conditions are considered essential benefits.
This insurance coverage can vary depending on the specifics of rehab insurance under your healthcare provider. At Changes, our evidence-based programs and Joint Commission accreditation as a treatment provider committed to excellence help us gain insurance coverage approvals, even if rehab has been denied in the past.
What Types of Insurance Plans Are There?
Individuals with insurance coverage have either public health insurance policies like Medicaid, Medicare, or AHCCCS in Arizona, or private insurance through their employer or another source. These are most commonly classified as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans.
With an HMO plan, insurance companies work with a group of chosen treatment facilities and healthcare providers. Members selecting a facility outside of the network typically pay out-of-pocket for services.
By contrast, PPO plans have a wider selection of providers. While insured individuals can use out-of-network providers, they will have higher copays than when choosing in-network providers. There are also health insurance plans that combine parts of each of these plans which may or may not have out-of-pocket expenses.
How to Find Out What Rehab Treatment is Covered by My Insurance Plan
The specifics of any insurance plan can be tricky to understand. Even if you know what type of insurance you have, it can be hard to know what to expect as far as paying for rehab services and whether treatment will be covered. This can also change depending on if you have public or private insurance.
While you could contact your insurance provider directly or look at the health insurance marketplace, this often involves sitting on hold. If you are unfamiliar with how insurance works, it can also be hard to know which questions to ask regarding treatment and verifying insurance coverage.
The better option is to speak with someone from our rehab facility. We can easily verify many insurance plans over the phone and from there, we can help you decide on the next step to take in recovery!
Will Insurance Cover Rehab if I Relapse?
Whether or not insurance covers rehab treatment following relapse depends on a few factors. First, insurance providers may look at your treatment history in drug and alcohol rehab. They may consider your medical history, whether you finished the program, how long the program was the first time, and how recently you attended the program.
Second, there might be limitations on insurance coverage for rehab depending on the specifics of your insurance plan. While insurance companies must include addiction treatment because of the Affordable Care Act, providers can still set policy limits. Some individuals may also have to pay a copay or deductible for treatment.
Finally, insurance companies may consider your willingness to attend rehab and follow through with aftercare. Providers may be wary of paying for rehab after a relapse if there hasn’t been much success in the past. The answer to how many times will insurance pay for rehab can also be affected by the time in between program attendance, and whether or not treatment was left against medical advice (AMA) in the past.
Will My Insurance Pay for Detox?
Many insurance companies, from Blue Cross Blue Shield to United Healthcare, pay for detox as part of addiction treatment. The detox process is different depending on factors like the substance(s) used, frequency of use, and dosage.
When detoxing from opiates, alcohol, and other substances, withdrawal can even be dangerous. Many treatment centers prescribe addiction medicine during the withdrawal process. This may or may not be covered by insurance.
With all the uncertainty over what specific insurance plans cover, the easiest way to find out if your rehab or detox treatment is covered is to call our facility directly. We can connect with your insurance company faster. Even if you don’t have health coverage, we can work together to fight alcohol or drug addiction. Learn more about our inpatient and outpatient services at our treatment center and ask about possible payment plans.
What if My Insurance Provider Won’t Pay for Rehab Again?
While insurance must provide some coverage for substance abuse treatment, a client’s particular health insurance plan will not always cover a second visit to inpatient rehab. We want you to know that you still have options when your plan won’t cover substance abuse treatment.
How Many Times Will Insurance Pay for Rehab: Appealing the Decision
Any time an insurance company denies treatment, the insured has a right to ask for an appeal. An appeal means that you disagree with their decision and would like it reviewed.
The first step is to appeal to the health insurance company directly. During the appeal, the company must tell you why the claim was denied and review it again. For urgent medical matters, this process is typically expedited.
The second option is external review. During an external review, an independent party reviews the claim and decides whether the insurance company must provide coverage. This third party is responsible for deciding if insurance pays.
Finding Alternative Ways to Afford Neccesary Treatment
Even if your health insurance policy won’t cover rehab and you are waiting for an appeal, our team at Changes can help you find treatment in your budget. We understand that substance abuse issues are not something that can wait.
We can work together to find a treatment that will work, whether that is setting up payment plans for inpatient programs or tailoring an outpatient program to your budget. Either way, you’ll find the support that you need for recovery at Changes.
What is the Point of Rehab if I’m Going to Relapse?
Learning about the risk of relapse after detox can be discouraging. However, it’s important to remember that relapsing isn’t something that is guaranteed to happen. And, even if you do relapse, it doesn’t mean that you have failed in recovery. Many people relapse, return to a treatment program, and find the support that they need to get clean again. It can be a learning experience.
Furthermore, the drug and alcohol rehab center that you attend makes a difference. Not all treatment centers are created equally. At Changes Healing Center, we recognize each of our clients as individuals and build a treatment plan to suit their unique needs.
Working in individual therapy to build skills to promote sobriety, building support and relationships in group therapy, and finding the right aftercare services all contribute to a successful recovery process.
The Substance Abuse and Mental Health Services Administration and Evidence-Based Practices
Substance misuse is a widespread problem, particularly in the United States where substance abuse disorder is more prevalent than in many other developed countries. One resource regarding treatment is the Substance Abuse and Mental Health Services Administration, which provides guidelines on mental health, substance abuse treatment, and more.
At Changes, we use evidence-based treatments and stay up-to-date on the latest information from the Substance Abuse and Mental Health Services Administration (SAMHSA). Our understanding of addiction and its effects on the body and brain is constantly adapting and we understand the importance of using proven methods that work.
Some of the treatments provided at our facility include individual, group, family, and art therapy, physical activity, cognitive behavioral therapy, mindfulness and meditation practices, and more. These treatments are offered as part of our inpatient programs and our outpatient programs incorporate many of these strategies as well.
Is Rehab Expensive?
The total cost of rehab varies depending on where the facility is located, funding, and services offered. However, the average total cost for inpatient rehab treatment in Arizona is $56,789. The cost of outpatient rehabilitation treatments is significantly lower, typically costing around $1,706.
For clients without insurance, the cost of rehab may seem intimidating. Even if you are unsure about insurance coverage options for treatment, give us a call at Changes today. We can work together to tailor a treatment program for substance use disorders that fits your unique needs for the best chance at long-term recovery.
Rehab Costs vs The Costs of Addiction and Alcoholism
While the high cost of rehabilitation services can be daunting, addiction costs much more. The cost of keeping up with drug and alcohol habits can put people in a financial hole.
An alcohol and/or substance use disorder also takes a physical toll on the body, strains relationships, and may cause legal or employment troubles. The high cost of a drug or alcohol problem makes the costs of rehab well worth it.
Should I Choose Inpatient or Outpatient Treatment for Addiction?
Whether inpatient or outpatient programs are best depends on the individuals. Clients with severe substance use disorder or mental health disorders often find the most help at our inpatient facility.
Other patients find that partial hospitalization programs or intensive outpatient programs work for their situation. Both of these options last several hours each day while allowing clients to go to work, handle responsibilities, and sleep at home. These are also more affordable options than inpatient therapy for clients struggling with rehab insurance.
Finally, some patients choose outpatient therapy, support groups like Alcoholics Anonymous and Narcotics Anonymous, and other resources as part of their treatment. With so many effective options, it’s easier than ever to find a course of treatment that will work for your specific situation.
Find the Help You Need After Relapse at Changes
Relapsing does not have to be the end of your recovery. Many of our clients who have sought addiction treatment after a relapse find that they learn from the experience, giving them new insight into their recovery. This is especially true for clients who work the program, take necessary steps to identify negative habits in their lives, and get the mental health treatment they need to continue on the road to recovery.
If you’re seeking treatment for drug or alcohol addiction, call our team at Changes Healing Center and find the support you need after a relapse today. Whether you’re seeking inpatient treatment or want to learn more about outpatient programs, we are ready to help get your recovery journey back on track!