Substance Use Treatment
Recovery is possible with the right support. Our plans cover substance use treatment including detox, rehabilitation, and ongoing recovery services to help you or your loved ones on the path to wellness.
Recovery is possible with the right support. Our plans cover substance use treatment including detox, rehabilitation, and ongoing recovery services to help you or your loved ones on the path to wellness.
Substance use disorders affect over 40 million Americans, yet only about 10% receive the treatment they need. Addiction is a chronic medical condition that affects brain chemistry and behavior, requiring professional treatment for recovery. Without insurance coverage, the cost of treatment can be prohibitive, leaving many people without access to lifesaving care.
Under the Mental Health Parity and Addiction Equity Act, insurance plans must cover substance use treatment at the same level as other medical conditions. This landmark law recognizes addiction as a treatable disease, not a moral failing. Quality treatment works, with evidence showing that people who complete treatment programs have significantly better outcomes than those who try to quit on their own.
Our health insurance plans provide comprehensive coverage for substance use treatment at all levels of care. From medical detoxification to residential rehabilitation to ongoing outpatient support, we cover the full continuum of addiction treatment services. Whether you or a loved one is struggling with alcohol, opioids, or other substances, our coverage helps make recovery accessible.
Residential treatment programs providing 24/7 care in a structured, supportive environment. Programs typically last 28-90 days and include individual therapy, group sessions, and life skills training.
Medically supervised detoxification for safe withdrawal from alcohol, opioids, benzodiazepines, and other substances. 24-hour medical monitoring manages symptoms and prevents dangerous complications.
Flexible treatment options including standard outpatient therapy, intensive outpatient programs (IOP), and partial hospitalization programs (PHP). Continue treatment while maintaining work and family responsibilities.
Peer support groups, group counseling sessions, and 12-step facilitation. Connecting with others in recovery provides motivation, accountability, and the understanding that you're not alone in your journey.
FDA-approved medications like Suboxone, methadone, and Vivitrol combined with counseling. MAT is highly effective for opioid and alcohol use disorders, reducing cravings and preventing relapse.
Ongoing support services including continued therapy, support groups, sober living arrangements, and relapse prevention programs. Long-term support is crucial for maintaining recovery.
The first step for many people, medical detox provides safe, supervised withdrawal from substances. Depending on the substance and severity of dependence, detox typically lasts 3-10 days. Medical staff monitor vital signs and provide medications to manage withdrawal symptoms safely.
24-hour care in a treatment facility away from triggers and temptations. Residential programs provide intensive therapy, education about addiction, coping skills development, and peer support in a structured environment. Ideal for moderate to severe substance use disorders.
Hospital-level treatment intensity while living at home or in a sober living facility. PHP typically involves 5-7 days per week of treatment for 6-8 hours daily. Provides a step down from residential care or a step up from standard outpatient treatment.
Structured treatment 3-5 days per week for 3-4 hours per session. IOP allows you to maintain work, school, or family obligations while receiving intensive treatment. Often used as a step down from higher levels of care or as the initial level for less severe cases.
Navigating substance use treatment coverage can feel overwhelming, but understanding your benefits helps you access the care you need:
Federal law requires insurance plans to cover substance use treatment equally with medical and surgical benefits. This means your plan cannot impose stricter limitations on addiction treatment than on other medical care. If something seems unfair, you have the right to appeal.
Most plans require prior authorization for residential treatment and may require ongoing authorization for continued stays. Treatment facilities typically handle this process, communicating with your insurance company to obtain necessary approvals.
Using in-network treatment centers significantly reduces your costs. Many quality rehabilitation facilities accept insurance. Our member services can help you find accredited treatment programs in your network.
Recovery is an ongoing process. Your coverage includes aftercare services like continued therapy, medication-assisted treatment, and support groups. Don't stop treatment prematurely because of concerns about coverage duration.
Coverage continues as long as treatment is medically necessary. The appropriate length of treatment varies by individual, with some needing short-term programs and others requiring extended care. Your treatment team determines medical necessity and works with your insurance to ensure adequate coverage.
Yes, MAT medications like Suboxone (buprenorphine), Vivitrol (naltrexone), and methadone are covered as part of substance use treatment. These FDA-approved medications are highly effective when combined with counseling and behavioral therapies.
Your substance use treatment records are protected by federal confidentiality regulations (42 CFR Part 2) that are even stricter than standard HIPAA protections. Your employer cannot access your treatment information through insurance claims.
Relapse is often part of the recovery process, and prior treatment doesn't disqualify you from coverage. Each treatment episode is evaluated independently based on current medical necessity. Multiple treatment attempts may be necessary, and insurance continues to cover medically necessary care.
Look for accredited programs (such as Joint Commission or CARF accreditation) that offer evidence-based treatments. Our member services can help you find in-network facilities that meet quality standards. Consider factors like location, program philosophy, and aftercare support.
Recovery is possible, and you don't have to do it alone. With comprehensive insurance coverage for substance use treatment, the help you need is within reach. Take the first step today by speaking with a licensed agent about plans that cover addiction treatment services.