Does Insurance Cover Detox?

does insurance cover detoxThe process of recovery from substance abuse can be stressful for both the person in recovery as well as the family and support system of the individual in recovery. A common and serious obstacle involves the cost of detox and a common question is if insurance will cover the cost of detox services, including medical detoxification and formal treatment. Quality detox treatment can go a long way to ensure the long-term sobriety and recovery of a person struggling with addiction. However, every insurance policy is different in regards to what actually is covered and detox facilities can differ in regards to what insurance they accept for their treatment services.


What to Look For In Insurance Regarding Detox Services

Understanding the terminology in insurance policies and what is actually covered regarding medical detox services and treatment can be very difficult to understand. When looking at detox services there are some initial questions that need to be answered before further decisions are made. Those initial questions may include:

  1. Does my insurance cover rehab treatment or detox care?—the length of the appropriate treatment plan will be taken into consideration in regards to whether the insurance will cover those treatment options. Another important consideration is whether insurance covers inpatient treatment (where an individual lives at the facility with medical and professional staff on premises at all times) and /or outpatient treatment (where an individual spends certain times of the day at the facility and may attend meetings or other activities). The question if insurance will cover detox services at specialty or luxury rehab services is another point to consider.
  1. Will I need a referral from my doctor in order to begin treatment?—there may be stipulations in insurance policies that may require a referral from a primary physician before insurance will cover detox services. The importance of referral is due to the fact that treatment centers as well as insurance companies are realizing that addictions are often accompanied by other co-occurring physical and/or mental conditions. 
  2. Will I need to pay cash for some of my treatment?—in some instances, there may be services that may not be covered properly under insurance. For those services that may not be covered, there may have to be an upfront payment or co-pays involved.
  3. What is the maximum amount of treatment my insurance will cover?—the cost of treatment can vary. It is estimated that most quality detox and treatment centers cost $20,000 to $40,000 while more luxury facilities may cost more. The quality of care that is provided along with the services that are provided that are tailored to an individual’s special needs are obvious factors in choosing a detox facility. 
  4. How long will my insurance allow me to remain in rehab treatment? –in many instances, the insurance coverage someone has may only cover a certain amount of time that an individual stays in treatment. Some policies may cover extended stays of 28 days or longer while other policies may only cover much shorter stays.

Other Options to Consider if Insurance Doesn’t Cover Detox

In the event that insurance does not cover the detox services that are needed, there may be other options that will allow an individual to attend a detox and treatment facility they need. Those options include private medical insurance, Medicaid, Medicare, loans from family and friends or forms of public funds. Also keep in mind that health insurance is fluid in change and treatment coverage can change due to new healthcare legislation and other changes in mental health policies, administration and services.