Does Insurance cover detox?

The cost of detox from drug and alcohol is a common and serious concern among individuals and families in dire need of treatment.

Recovery from alcohol or drug addiction is a stressful process, and it is only logical that our clients would be concerned about the cost of receiving proper care.

Whether you intend to arrange for insurance coverage or pay out-of-pocket to get the necessary treatment, you require a dedicated admissions team that will be with you or your loved one, every step of the way.

If Your Insurance Covers Treatment is Probably Covers Detox

Many of our clients do not realize that a good number of health care plans cover alcohol and drug detox at minimal or no out-of-pocket cost.

In fact, most states – 43 to be exact – have laws that require health coverage plans to include drug rehabilitation.

However, there are some insurance companies that can deny you coverage, despite the requirement to comply with state law.

This is because some states are hesitant about enforcing drug treatment law due to the stigma associated with addiction.

As such, it is important that you research your state laws before contacting your health insurance carrier.

What kind of health coverage do you have?

Insurance carriers offer different coverage plans, but those that include substance abuse treatment typically have separate allocations for the different parts of drug rehabilitation.

So, for the detox phase, you will find that most health insurance, including Medicare, cover 3 to 10 days.

This will be influenced by your evaluation upon admission into the detox facility, as well as the drugs that you were using.

For instance, insurance carriers usually cover a safe medical detox for clients with alcohol or benzodiazepine addiction, since withdrawal from these substances can be life-threatening.

However, some insurance companies to not offer cover for medical detox from narcotic pain medication or opiates like heroin.

What is Inpatient Detoxification

Inpatient services are covered during the severe stages of alcohol or drug abuse withdrawal.

This is when detoxification for acute alcoholism or alcohol withdrawal increases the risk for medical complications like confusion, unconsciousness, trauma and delirium, among others, necessitating the constant availability of physicians or intricate medical equipment that is only available in a detox facility or hospital.

Usually, your stay at a detox center will last a minimum of three days, but the client’s condition can push it to 5 days or more.

So, while Medicare has a limit of five days, the coverage can be extended for particular patients. The Medicare plan also does not limit patients to the number of treatment episodes that they require per year for detoxification.

It is the responsibility of the center to send your insurance company detailed reports of your progress, so that they can reassess the covered period and determine whether additional treatment is required. Normally we are able to get your insurance company to cover the detoxification process for as long as you need to rid your body of all toxic substances.

How Do I Qualify for Outpatient Detoxification

Outpatient treatment is sometime adequate for most cases of alcohol toxicity and/or substance abuse, unless there is another medical condition that demands close inpatient monitoring.

Outpatient Programs or Intensive Outpatient Programs (IOP) are usually offered as a separate allocation in your insurance plan, and usually go for a bit longer than inpatient treatment.

You have to check with your insurance provider to find out the kind of coverage they offer. Some providers can cover your stay in a halfway house, while others cover a specific number of sessions with a mental health counselor.

Covered Detoxification services

If you are using the Medicare plan, it is important to know what detox services are included in your plan.

These include:

  1. Chemical aversion therapy for the treatment of alcohol addiction, which is typically done on an outpatient basis
  2. Withdrawal treatment of addiction if the physician deems it reasonable and necessary

There are, however, some detoxification services that are not covered by Medicare, including;

  1. Acute inpatient detoxification aimed at changing the client’s environment to inhibit their access to alcohol or substance abuse  
  2. Transportation, meals and recreational activities for outpatient treatment  
  3. Methadone maintenance  
  4. Electrical aversion therapy  
  5. Court-ordered drug-abuse testing  

At The Recovery Way, we care about your treatment, and acknowledge that finances can be a problem.

Although we do not accept Medicare, their detox coverage plans are more or less the same as those of other insurance carriers that we work with, like Blue Cross Blue Shield, Aetna, United, and Humana Inc.

So, to have peace of mind during your stay at our in patient drug rehab NY, research your coverage.

Find out the terms of your cover, like deductibles, co-payments, or handling of additional costs while in treatment.

Other things to find out from your insurance carrier include:

  1. Whether they have any recommendations for facilities
  2. Whether you are required to choose a facility within a certain network
  3. Their restrictions for choosing a detox facility
  4. The requirement for a referral from a physician to receive coverage
  5. The amount of co-payment
  6. Maximum limit in terms of amount and period
  7. What is covered for substance abuse treatment
  8. Whether there are additional restrictions


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Address: 1324 Lexington Avenue #265 New York, NY 10128 • Local: (516) 519-3068 • Toll Free: (866) 636-2670