How to Get Insurance to Pay for Inpatient Rehab

Using Health Insurance Coverage for Residential Care at Icarus

Residential inpatient treatment is among the more expensive forms of addiction treatment, but that does not mean that it is inaccessible for you or your loved one. Health insurance coverage can pay for a significant portion, or even all, of your treatment costs. However, it can be challenging to find a treatment provider that takes your insurance plan in some cases.

Icarus Behavioral Health is pleased to accept many forms of insurance to ensure care is accessible in New Mexico, and to provide this resource to help you get care covered.

So, what should you know about how to get insurance to pay for inpatient rehab? This article will detail how to find addiction treatment that works with your insurance provider, how to get an insurance policy if you don’t have one already, and frequently asked questions about rehab and insurance.

Find a Substance Abuse Treatment Center That Accepts Your Insurance

No matter where you get treatment for drug or alcohol addiction, one of the first steps in the admissions process will almost always be to verify your health insurance coverage or another payment option. That way, you and your family can be confident that the cost of your care is covered.

Most treatment centers, like Icarus Behavioral Health, are able to provide referrals if we do not work with your insurance plan.

Icarus Behavioral Health accepts most forms of health insurance. This includes private insurance, employer-provided insurance plans, VA health benefits, and Medicaid.

Plans we take include but aren’t limited to the following:

• Aetna
• Anthem
• Blue Cross Blue Shield (BCBS)
• Cigna
• Evernorth
• GEHA    (Federal Employees)
• Magellan
• Medicaid
• Molina
• Optum
• TRICARE  (Armed Forces and Immediate Family)
• VA plans
• Western Sky

When you reach out to us about treatment, our staff will help you verify your insurance coverage for free. You are also welcome to use our online insurance verification form to confirm that your insurance provider is accepted.

Then, we will go over any possible out-of-cost expenses. Never be afraid to express your need for treatment and cost barriers to rehab centers – they may be able to help you talk through ways to cover rehab costs, including out-of-pocket costs or the total cost of a treatment program.

Roughly 26 million people in the United States don’t have a healthcare plan. If you don’t have insurance, you may be able to sign up in time to use it for addiction treatment.

How to Access and Use Coverage Through the Health Insurance Marketplace

The Health Insurance Marketplace was put into place as a component of the Affordable Care Act (also known as Obamacare) and helps you find health coverage based on your area and other factors, like income. There are multiple ways to access coverage. Covered services by most big-name insurance providers include inpatient and outpatient treatment for drug abuse, medical detox, mental health therapy, medication management, and other services.

Sign up online

One of the most popular ways to find an insurance policy is to apply online.

There’s a certain timeframe for individuals can sign up for an insurance policy through the Health Insurance Marketplace each year. Right now, you can sign up for health insurance coverage in 2024 through the Health Insurance Marketplace until December 15th, 2023.

Note that some circumstances, like a recent move, may allow you to access insurance policies through the marketplace outside of this window.

Get assistance with your application

If you are unable to complete the form yourself or need help applying for any reason, you can use this search tool to find a local assistant or agent/broker who can help.

How to Access and Use Coverage Through the Affordable Care Act (ACA)

The Affordable Care Act (ACA) ensures that low-income and uninsured United States citizens have access to healthcare. If you are low-income or part of a certain population, you may qualify for your state’s Medicaid plan through the ACA. For example, disability may qualify you for Medicaid even if you wouldn’t be an eligible recipient otherwise.

The Affordable Care Act was enacted in 2010. Since that time, the Affordable Care Act has helped millions of individuals in the US get access to necessary healthcare services, including addiction treatment.

Substance abuse coverage is one of many services Medicaid can cover. Substance Use Disorder services covered by Medicaid include but aren’t limited to:

• Medication-assisted treatment (MAT)
• Medical detoxification
• Inpatient or residential drug rehab
• Partial hospitalization programs
• Intensive outpatient programs
• Standard outpatient care
• Mental health therapy

Go to Medicaid.gov to learn more about Medicaid and how to apply. You can also find a local office, center, or organization that can help you through the application process in person when you search the web for one in your local area.

What if my Coverage for Drug or Alcohol Rehab is Denied?

First, remember that an initial denial of insurance coverage is not the end. In some cases, it takes multiple attempts to get insurance to cover treatment.

What you may be able to do is get a referral or recommendation from a medical provider, such as a primary care doctor or therapist, to a treatment center that accepts your insurance. Often, they will know what codes to use to get services covered as long as a treatment center is in-network.

If your coverage is denied at Icarus, we can contact your insurance company and appeal the denial. In that instance, what we will do is challenge their denial and let your health plan know why treatment is a necessity.

Some insurance providers will provide reimbursements for services, even at a mental health or addiction treatment center that is not in-network.

Reimbursements and Other Payment Options

Reimbursements for healthcare services are not often considered by those seeking rehab services, but they can help you go to treatment without long-term medical debt. If you have already been to rehab, your treatment center may be able to submit a claim to your insurance company for reimbursement.

Payment plans can also make addiction treatment possible for those able to cover some costs out-of-pocket. You are welcome to discuss a payment plan with Icarus Behavioral Health.

Financial assistance and scholarships

Many treatment facilities offer financial assistance or scholarships on a limited basis. Contact treatment centers directly to find out whether there is a financial assistance or scholarship opportunity available for the rehab program you’re interested in.

There are other ways to find financial assistance, too. For example, The Substance Abuse and Mental Health Services Administration (SAMHSA) has a block grants program, which is a program that gives money to treatment centers to help individuals who cannot afford it cover the cost of treatment.

Block grants may be geared toward certain populations, such as people who are pregnant. However, it is worth checking to see what is available to you.

Why is Inpatient Rehab More Expensive Than Outpatient Care?

Inpatient substance abuse treatment is more expensive than outpatient care for a couple of reasons. Most notably, residential or inpatient rehab costs for substance abuse, mental health, or dual diagnosis conditions tend to include the following services:

• Meals and snacks
• Room and board
• Full daily treatment schedules
• Access to on-site amenities

On the other hand, outpatient programs do not include room and board (though some may need to pay for sober living) or all meals and generally have less intensive treatment schedules. All of these factors can impact the cost of treatment.

Inpatient substance abuse treatment removes you from daily life triggers temporarily, lets you build new patterns in a substance-free environment, and provides an immersive treatment experience. It is important that those who benefit from inpatient care can access it, whether through substance abuse coverage or other means.

What is the Cost of Inpatient Treatment Out of Pocket?

Inpatient treatment can address substance abuse, mental illness, and dual-diagnosis conditions. The exact cost of inpatient treatment without insurance will differ depending on various factors, such as the length of your treatment stay and where you go for treatment. Even with insurance, coverage limits may differ.

To get the best idea of what your out-of-pocket expenses will be, contact treatment centers directly. Treatment centers like Icarus may also be able to give you guidance on how to get insurance to pay for inpatient rehab if you have additional questions.

Get Inpatient Treatment Covered at Icarus Today!

We’re here to help. When you contact Icarus Behavioral Health, you can ask our staff to verify your health insurance plan, get an estimate of out-of-pocket expenses, or ask any other questions you might have about inpatient rehab.

To get in touch and for free and confidential insurance verification, call our confidential admissions line today!

FAQs on How to Get Insurance to Pay for Inpatient Rehab

Why do insurance companies deny residential rehab programs?

It is very frustrating when insurance companies deny much-needed rehab. Please understand that denial of coverage does not mean you don’t need help.

Insurance companies often do not have a full picture of what’s going on for the person who needs mental health or addiction treatment, regardless of whether it’s an inpatient or outpatient program. Mistakes made by referring providers (e.g., the wrong ICD code) or employees who work for your insurance plan are also very common.

In some cases, your insurance company might need additional information from you or a provider you work with to understand the necessity of your treatment. In other cases, an insurance company may deny coverage due to an error or an incomplete step in the process.

What can I expect in inpatient rehab for addiction?

Inpatient rehab for addiction recovery, mental health, and dual diagnosis concerns consists of living on-site for the duration of your treatment program. Most often, short-term inpatient treatment at a rehab facility will last for around 30-90 days.

Long-term inpatient rehab, on the other hand, may last for 120 days or more.

During the day, you’ll engage in a range of activities. For example:

• Individual therapy
• Family therapy sessions
• Holistic treatments
• Recreation
• Skill-building
• Groups

Meals are provided by the rehab facility. Before you enter treatment, you’ll get a list of what to bring to treatment, get an assessment, and discuss your general treatment plan. You may also book a tour of the facility you intend to go to.

Does insurance cover rehab at Icarus?

Yes. Insurance does cover drug and alcohol rehab at Icarus. If you want to find out whether we accept your or your family member’s specific health insurance plan, please contact our admissions line directly.