Is Addiction Treatment Covered by Insurance?

Insurance companies cover, by far, the major part of the cost of addiction treatment. Even though it is hard to find one that pays 100% of the cost, no treatment center wants to reject a patient who is in need of treatment, simply because he or she cannot afford the out of pocket. Generally, the treatment centers will do whatever they can to allow the patient to afford the treatment. Here are some general guidelines about insurance coverage.

In-Network or Out?

Policies that provide services based on a network model usually limit reimbursement for out of network services, particularly in the case of drug rehab. This doesn’t mean your HMO won’t pay for your out of network treatment, it may pay for less than the actual cost to you. That is why a person knowledgeable with insurance policies has to get involved and provide specific information regarding the case to the insurance company. The provided information is based on the diagnosis assessment regarding the type, severity, and duration of the addiction. We, at Florida Center for Recovery, have trained dedicated personnel that using the assessment from our doctors and licensed therapists try to figure out your insurance benefits and the percentage of the overall cost you (or your family) have to pay. They will argue on your behalf for the maximum possible coverage you need when talking to your insurance agent.

It is very important that our utilization review department (fancy word for the department that its job is to figure out what part of your insurance policy applies to your current medical needs) to get involved at the earliest possible. Having said that, it is also possible to have your insurance company tell you everything there is to know about your policy and how it applies to your benefits regarding your current condition, but it is crucial to know the right questions to ask and to provide the right information when you contact the company’s agent directly.

Type of Addiction

Insurance companies generally base their reimbursement policies on the assessed diagnosis. Addiction treatment generally falls under mental health care and then under different types of addictions. That means an accepted diagnosis, like depression or alcohol abuse syndrome, is more likely to be covered than, say, shopping addiction. It is important to know whether your particular addiction falls within the Diagnostic Services Manual used by the psychiatric profession. It is also important to have the diagnosis done by a licensed professional recognized by the insurer. Some addictions are treated with an established course of therapy that is approved and is result based. For example, someone receiving methadone for heroin addiction will be enrolled in an addiction treatment program where the physician provides the input and a standardized treatment plan. This treatment for heroin addiction is more widely accepted by insurance companies than a marijuana addiction treatment which may or may not follow a set course of treatment.

Length of Addiction Treatment Covered by Insurance

Although addiction treatment specialists know that, in many cases, 90 days or more of rehab are needed to give the clients a good chance at recovery, insurance companies often set the limits. Usually, policies have a dollar maximum set or a time limit set, or both. This is why a reputable rehab center such as the Florida Center for Recovery works with the clients to accommodate them for their treatment beyond the limit set by the insurance company when needed.


For the most part, an insurance policy that covers addiction will pay for the drug and alcohol detox, especially for inpatient treatment. Also, it often pays for the care that requires drugs to fight the cravings or treat other related mental health issues such as anxiety and depression. But once the detoxification process is completed, most insurance companies have a set dollar amount assigned for the rest of the treatment. In our treatment center, through different types of financial arrangements such as partial payment plans or even scholarships, we offer long term rehab to those who qualify and their insurance plan does not cover the full term of their rehab.

How to Find Out About Your Policy

We recommend you start with getting help from professionals that are doing this on a daily basis. Our drug and alcohol rehab center, Florida Center for Recovery, have professionals on staff who are trained to get you the treatment benefits you are entitled to, according to your plan coverage, and your particular medical needs.

Our facility, like many qualified drug and alcohol rehab centers, is able to provide you reliable information about your insurance benefit when you call, and like many other facilities will take care of the insurance paperwork for you.

Let’s mention that it doesn’t mean that you cannot call your insurer’s agent directly and ask him or her for the exact section in your policy which talks about addiction treatment and the coverage that it provides. If you feel that the agent helping you is not exactly answering your questions or is not knowledgeable enough, ask for a manager. Just keep in mind that the rehab centers often have an upper hand in helping you get the most out of your insurance benefits.

Need more information regarding insurance coverage for addiction treatment?

You may contact us at (800) 851-3291

For an informational brochure about our addiction treatment center and the programs click here:  online brochure

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