January 23, 2025
Medically review by: Alexandra Manosa , Addiction Specialist

Getting health insurance for inpatient care can be hard. But knowing your options to get the care you need is crucial. Let’s find out how to use your insurance to pay for therapy at a luxury inpatient rehabilitation facility like Luxe Recovery in Los Angeles.

Does Health Insurance Cover Rehab?

The Affordable Care Act requires most health insurance companies to cover inpatient rehab for mental health, substance misuse, and medical and surgical care. This rule mostly covers drug and alcohol treatment and applies to inpatient and outpatient programs. 

Costs, copayments, and pre-authorization regulations vary by health insurance plan. Talk to your healthcare insurance carrier to see what your plan covers, how much treatment may cost, and how to ensure coverage for inpatient rehab.

How Do I Check My Rehab Insurance Coverage?

Knowing what your health insurance covers for rehab can be stressful, but it’s essential to plan your therapy. Using these steps, you can check your insurance rehab coverage:

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Understanding Your Insurance Policy

Understanding the various types of health insurance plans is an excellent first step in grasping your insurance coverage. Most health insurance plans provide some level of support for substance abuse and mental health treatment, commonly known as behavioral health benefits.

These benefits can encompass both inpatient rehabilitation and outpatient services. It is important to note that the coverage specifics can differ based on your plan. There are four primary categories of health insurance plans which include:

  • Health Maintenance Organization (HMO): HMO plans necessitate the selection of a primary care physician who manages your healthcare and provides referrals for specialized services, such as addiction treatment. Coverage for inpatient rehabilitation through an HMO may depend on the authorization from your primary care physician.
  • Preferred Provider Organization (PPO): PPO plans provide greater flexibility in selecting healthcare providers. Patients can consult in-network specialists, which may result in reduced expenses. Additionally, coverage for out-of-network services may be accessible but at an increased cost.
  • Exclusive Provider Organization (EPO): EPO plans resemble HMOs, yet they feature a more limited network of healthcare providers. The availability of coverage for inpatient rehabilitation is contingent upon whether your chosen facility is part of the network.
  • Point-of-Service (POS): POS plans represent a combination of Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Typically, these plans necessitate the selection of a primary care physician to access in-network benefits, although they may permit visits to out-of-network providers for an extra fee. The specifics of coverage for inpatient drug rehabilitation vary based on your individual plan and the network status of the treatment facility.

Ask Questions to Understand the Specifics of Your Insurance Benefits

Contact your insurance provider to clarify your coverage details. Prepare a list of questions to ask, such as:

  • What specific inpatient and outpatient rehab services are covered under my plan?
  • Are there preferred or in-network rehab facilities that will cost less out-of-pocket?
  • What are my deductible and copayment obligations, and how much have I already met this year?

Gathering this information directly from your insurer helps you understand your benefits and any potential out-of-pocket costs.

Upgrading Your Plan: Ensuring Adequate Coverage

If your current insurance plan doesn’t cover residential treatment well, consider upgrading it during open enrollment. Look for plans that cover mental health and drug misuse treatment more. This is especially true for plans linked to good rehab centers like Luxe Recovery.

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Establish Medical Necessity

Before paying for inpatient rehab, many insurance plans demand that the treatment be determined to be “medically necessary.” Usually, this entails getting records from medical professionals regarding your illness and the requirement for intensive care.

As these records will support your insurance claims, be sure all consultations and treatments are thoroughly documented.

Choose Rehab Centers That Accept Your Insurance

Choose an inpatient rehab facility covered by your insurance to reduce out-of-pocket costs. Verify if your insurance plan covers the facility, as being in-network might save you a lot of money. This procedure can be streamlined with the aid of facilities such as Luxe Recovery, which takes a variety of PPO insurances.

These steps may help you comprehend your insurance policy, letting you focus on rehab without stressing about money. To successfully transition into and maybe through outpatient care, optimize insurance benefits and avoid unexpected costs.

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Options To Cover Your Out-of-Pocket Expenses During Inpatient Rehab

Managing the costs of inpatient rehab can be hard. But, several options can reduce your burden.

Medicare and Medicaid

Eligible people can use Medicare and Medicaid to help pay for many inpatient rehab costs. Medicare only pays for inpatient rehab for a limited time – it has certain conditions. Medicaid funding varies by state and usually covers all of a person’s drug abuse treatment needs. Check your state’s rules to ensure that services like rehab, therapy, and aftercare are covered in the insurance marketplace.

SAMHSA Grants

The Substance Abuse and Mental Health Services Administration (SAMHSA) gives grants that can be used to pay for rehab. These help a lot when you need to pay for long-term care programs. They also cover therapies that your private insurance doesn’t. SAMHSA grants can help people without enough insurance. They can pay for mental health and drug abuse care.

Varying Levels of Care and Sliding Scale Fees

Many treatment centers know how hard it is to pay for drug addiction recovery, so they offer fees that are based on income or need. This can make inpatient treatment easier to get and cheaper. So you can get the care you need without worrying about the costs.

Facilities may also offer different levels of care that vary in how intense they are and how much they cost. This way, patients can pick the choice that fits their medical needs and budget the best.

State and Federal Assistance Programs

Other state and federal programs can help, too. They cover the cost of inpatient rehab and Medicare and Medicaid. These programs often help low-income people and those without enough health insurance required to cover complete rehab care.

Payment Plans and Financing Options

Many rehab centers understand the cost of treatment. They offer payment plans or financing that allow you to pay for rehab treatment over time. This can ease the immediate financial pressure, allowing you to focus on recovery.

Insurance Negotiation

Sometimes, discussing your situation with your insurance provider can lead to better coverage options or an exception that might cover more treatment services. It’s always worth asking your insurer if they can provide additional help, especially if your provider initially denies coverage for certain aspects of rehab.

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Employer Assistance Programs

Some companies can offer programs that can help pay for inpatient rehab. These programs could be part of an insurance plan offered by the company. Or they could have separate wellness programs to help employees stay healthy.

By looking into these options, you can ease some of the stress of paying for hospital rehab and ensure you get the care you need to help your recovery smoothly.

Insurance Providers and Rehabilitation Coverage

When seeking rehabilitation services, it’s crucial to understand the coverage provided by your insurance. Here’s an overview of what some major insurance providers typically cover:

Can I Have Multiple Insurance Providers?

Yes, you can have multiple insurance providers. When two or more health insurance plans cover one person’s healthcare costs, it’s called coordination of benefits. You might have dual insurance coverage in the following situations:

  • You are married and covered under both your own insurance plan and your spouse’s.
  • You are under 26 years old and covered by your parent’s insurance and your own.
  • You are under 26 years old with divorced parents and are under both parents’ plans as a dependent.
  • You are over 65 years old and have coverage through your employer and Medicare.

Dual coverage has one primary plan that pays first up to its limits. The secondary insurance covers any outstanding treatment costs. Secondary insurance contributions may not cover all out-of-pocket costs.

Managing and using several insurance policies helps maximize benefit coverage for drug or alcohol rehab, inpatient substance addiction treatment, and any necessary transition to outpatient care. 

Given the high expenses of comprehensive addiction treatment programs, this cooperation can help simplify and minimize the financial burden of paying for rehab.

  • Unpaid deductible: The part of your deductible that was not paid this year. You’ve paid $500 toward your $2,500 deductible for other medical procedures, so your unmet deductible is $2,000.
  • Coinsurance: After achieving your deductible, coinsurance is your treatment cost share. Major medical expenses like inpatient substance misuse treatment are covered by insurers 60%–90%. Your 10%–40% coinsurance is due.
  • OOP max: This is the most you will spend in a year for all eligible healthcare services under your plan. Once you exceed this limit, the insurance pays all extra covered expenses for the year.

Calculating Your Cost for Rehab

Let’s consider a practical example:

  • Your treatment costs a total of $60,000.
  • You have an unmet deductible of $2,000.
  • Your coinsurance rate is 40%, bringing your potential coinsurance expense to $24,000.
  • However, your out-of-pocket maximum is $15,000.

In this case, you would pay up to $15,000 if your out-of-pocket maximum includes your deductible. If not, your cost could be as high as $17,000. These calculations are vital for planning financially for treatment.

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Utilizing Resources for Financial Assistance

Don’t be discouraged by the potential costs. Many treatment centers and insurance plans offer resources such as scholarships or financial assistance programs. These can significantly reduce the financial burden and make necessary treatment accessible.

Importance of Professional Guidance

Understanding these insurance elements can be daunting, so contacting a treatment placement specialist can be beneficial. These professionals can help you quickly navigate your insurance policy, confirm your actual costs, and speed up the verification process. This will determine what your insurance will cover.

To know how much you may need to pay for drug or alcohol treatment, you must understand your unpaid deductible. You must also know your coinsurance and out-of-pocket maximum. Always check these details and seek professional help if the process seems overwhelming.

Get Inpatient Addiction Treatment Covered by Insurance at Luxe Recovery

Luxe Recovery in Los Angeles is a great place to get better from addiction using many treatment options in high-end facilities. With us, you can get high-quality care without worrying too much about money if you know what your insurance covers and use the tools available.

We are committed to helping you through this process so that you can fully focus on your healing journey. Contact us today to check your insurance coverage.