Does Insurance Really Cover Rehab? Understanding Your Benefits and Getting Treatment Approved

One of the biggest barriers to seeking addiction treatment isn't willingness—it's the fear that insurance won't cover it.

The good news? Most insurance plans DO cover rehab—often much more than you think.

Thanks to the Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act, insurance companies are required to cover mental health and substance abuse treatment at the same level as physical health conditions.

At Wellness Haven, we work with all major insurance providers to help clients access the care they need. Here's everything you need to know about insurance coverage for rehab.

💡 Yes, Insurance Covers Rehab—Here's How

Under federal law, most insurance plans must cover:

✓ Detoxification services (medically supervised withdrawal)
✓ Inpatient/residential treatment (24/7 care in a facility)
✓ Outpatient programs (therapy and support while living at home)
✓ Medication-assisted treatment (MAT) (medications like Suboxone, Vivitrol)
✓ Therapy and counseling (individual, group, family therapy)
✓ Mental health treatment (for co-occurring disorders like depression, anxiety, PTSD)

Coverage levels vary based on your specific plan, but addiction treatment is considered an essential health benefit under the ACA.

🏥 What Types of Insurance Cover Rehab?

Almost all major insurance plans provide some level of addiction treatment coverage:

1. Private Insurance (PPO, HMO, EPO)

PPO (Preferred Provider Organization)

• Most flexible coverage
• Out-of-network benefits (you can attend rehab anywhere)
• Pre-authorization required for residential treatment
• Higher out-of-pocket costs for out-of-network care

HMO (Health Maintenance Organization)

• In-network only (limited to approved providers)
• Lower out-of-pocket costs
• Requires referrals from primary care doctor

EPO (Exclusive Provider Organization)

• In-network coverage only (except emergencies)
• No referrals needed
• Lower premiums, but less flexibility

2. Employer-Sponsored Plans

If you have health insurance through your employer, it likely includes substance abuse coverage. Check your Summary of Benefits or call HR to confirm.

3. Medicare

Medicare Part A covers:

• Inpatient detox and residential treatment (with copay)
• Up to 190 days of inpatient psychiatric care (lifetime limit)

Medicare Part B covers:

• Outpatient therapy
• Medication-assisted treatment (MAT)

4. Medicaid

Medicaid covers:

• Detox and residential treatment (varies by state)
• Outpatient therapy and counseling
• Medication-assisted treatment

Coverage depends on your state's Medicaid program.

5. Marketplace/ACA Plans

Plans purchased through the Health Insurance Marketplace must cover:

• Behavioral health services (therapy, counseling)
• Substance abuse treatment (detox, inpatient, outpatient)
• Mental health care (for co-occurring disorders)

💼 Which Insurance Providers Does Wellness Haven Accept?

We work with all major insurance companies, including:

• Cigna
• Aetna
• Blue Cross Blue Shield
• UnitedHealthcare
• Anthem
• UMR
• GEHA
• And many others

We offer FREE insurance verification—call us at (818) 475-4555 and we'll:

• Check your coverage
• Explain your benefits and out-of-pocket costs
• Help you get pre-authorization
• Answer all your questions

🔍 How to Find Out What Your Insurance Covers

Here's how to check your rehab coverage:

Step 1: Review Your Insurance Card

Look for:

• Member Services Phone Number (usually on the back)
• Policy Number and Group Number
• Behavioral Health or EAP Number (if separate)

Step 2: Call Your Insurance Provider

When you call, ask these specific questions:

1. "Does my plan cover substance abuse treatment?"
2. "What are my benefits for inpatient/residential rehab?"
3. "Do I have out-of-network benefits?"
4. "What is my deductible, copay, and coinsurance?"
5. "Do I need pre-authorization for residential treatment?"
6. "How many days of inpatient treatment are covered per year?"
7. "Does my plan cover dual diagnosis treatment?"

Step 3: Contact Wellness Haven for Free Verification

Let us do the work for you! Our admissions team will:

• Call your insurance company
• Verify your benefits
• Explain your coverage in plain English
• Help you understand out-of-pocket costs
• Guide you through pre-authorization

Call now for free insurance verification: (818) 475-4555

💰 What Will I Have to Pay Out of Pocket?

Even with insurance, you may have some costs:

Deductible

The amount you pay before insurance kicks in. For example, if your deductible is $2,000, you'll pay that amount first, then insurance covers the rest.

Copayment (Copay)

A fixed amount you pay per visit or service. Example: $50 copay per therapy session.

Coinsurance

A percentage of the treatment cost you pay after meeting your deductible. Example: 80/20 coinsurance means insurance pays 80%, you pay 20%.

Out-of-Network Costs

If you attend an out-of-network facility (like Wellness Haven for some plans), you may pay higher coinsurance or deductibles—but many clients find the quality of care worth it.

Good news: Many clients pay little to nothing out of pocket after insurance, especially with PPO plans.

📋 How to Get Your Rehab Pre-Authorized by Insurance

Most insurance companies require pre-authorization (also called prior authorization or precertification) before covering residential treatment.

How Pre-Authorization Works:

1. Your treatment facility (Wellness Haven) submits a request to your insurance company with:

   • Your diagnosis
   • Medical necessity for treatment
   • Proposed treatment plan and length of stay

2. Insurance reviews the request and determines if treatment is "medically necessary."

3. Approval is granted (usually within 24–72 hours), and you can begin treatment.

We handle this entire process for you—just provide your insurance information and we'll take care of the rest.

🚫 What If My Insurance Denies Coverage?

If your insurance denies coverage, don't give up. You have options:

1. Appeal the Decision

You have the legal right to appeal an insurance denial. We can help you:

• Gather supporting documentation
• Submit a formal appeal
• Advocate for your coverage

2. Request a Peer-to-Peer Review

Your doctor can speak directly with the insurance company's medical reviewer to explain why treatment is necessary.

3. Explore Payment Options

Wellness Haven offers:

• Payment plans
• Financing options
• Flexible scheduling for outpatient care

Don't let a denial stop you from getting help. Call us and we'll work with you to find a solution.

🧾 Frequently Asked Questions

📞 Ready to Use Your Insurance for Rehab?

If you're ready to use your insurance benefits to get the treatment you need, Wellness Haven is here to help.

At Wellness Haven, we believe in treating the whole person—not just the addiction. Our compassionate team is ready to guide you toward lasting transformation.

Contact us today:

• Phone: (818) 475-4555
• Website: WellnessHaven.com
• Email: info@lawellnesshaven.com

Your journey to healing starts with a single step—and your insurance can help make it happen.

📚 Additional Resources

Explore More About Our Programs:

• Residential Treatment Programs
• Detox Programs
• Insurance Coverage Guide
• About Wellness Haven

Educational Resources:

• Out-of-State Patient Information
• What to Bring to Rehab
• Admissions Process

Tags: Does Insurance Cover Rehab | Insurance for Addiction Treatment | Rehab Coverage | PPO Insurance | Health Insurance Benefits | Pre-Authorization | Rehab Costs | Mental Health Parity | Affordable Rehab