Reasons Insurance Might Deny Rehab Coverage & What to Do
If you’re ready to get treatment for addiction, you may be counting on your health insurance company to cover some or all of the cost. Using health insurance to pay for rehab is a fairly simple process. That being said, sometimes, insurance companies deny coverage for rehab.
Here, we’ll explore why you might be denied coverage for rehab, how to move forward following a coverage denial, and how you can move forward with treatment if you end up paying for rehab without health insurance.
Understanding Why Your Claim Was Denied
There are many reasons why an insurance claim for rehab might be denied. Understanding why your claim was denied can help you gather the information you need to ask your health insurance company to reconsider their decision. These, while not exhaustive, are some of the most common reasons that health insurance companies deny claims for addiction treatment.
1. Lack of Medical Necessity
Health insurance companies offer coverage for medically necessary treatment. Your healthcare provider will need to provide documentation to show that you need rehab. Providing your physician with information regarding past treatment, your medical history, and other details of your experience with substance use disorder is necessary to show your insurance company that you need treatment.1 what if my child’s physician
2. Insufficient Coverage
Insurance plans offer varying levels of coverage for drug and alcohol treatment services. Some plans may only include standard outpatient rehab services, while others may offer inpatient care and more. Going over your policy with a representative from your insurance company can help you understand what your plan does and does not cover.
3. Lack of Prior Authorization
Many insurance plans require that you seek their approval (known as prior authorization) before they’ll cover drug and alcohol rehab. It’s important to work with your healthcare provider and insurance company to ensure that they’ll approve your rehab services.2 understanding insurance terms
What to Do If Your Insurance Denies Coverage for Addiction Treatment
If your insurance plan doesn’t offer coverage for addiction treatment, don’t panic. Review the reason for their denial carefully so you’ll know what to do if your insurance denies rehab.
After you understand why your coverage has been denied, you can begin to take the necessary steps related to the denial, such as acquiring documentation for pre-authorization, choosing a treatment option that’s covered by your care provider, or providing your doctor with additional information to help them document why your treatment is medically necessary.
After you gather the information necessary to appeal insurance denial, you’ll begin to move through the insurance appeal process. Click here for more information on how to get your insurance company to reconsider their position on whether they’ll cover drug and alcohol rehab treatment.
How to Avoid Insurance Denials for Rehab
While it’s often possible to overcome insurance denials for rehab coverage, taking steps to avoid denials can save you time and help you begin treatment quickly. Understanding the steps you can take to increase the likelihood that you’ll be approved for coverage can make it easier for you to begin the treatment process.
Steps you can take to avoid insurance denials for rehab include:
- Understand the parameters of your plan, including whether you need to have pre-authorization for rehab treatment or not.
- Talk with your care provider about any additional information they need from you before requesting pre-authorization from your insurance company.
- Have your insurance verified with a team like the one at American Addiction Centers.
How to Pay for Rehab Without Insurance
If you do not have health insurance or are unable to obtain coverage for rehab, other options can help you cover the cost of addiction treatment. Talking to your desired treatment facility about whether they offer sliding fee scales, getting a loan from friends or family, using a credit or debit card, or choosing a state-funded rehab program can all provide you with the help that you need to recover.
Start the Recovery Journey
No matter what challenges you face on your path to sobriety, it’s always possible to get well, and our team is here to help. At American Addiction Centers, we offer a wide range of treatment options, including medical detox, residential addiction treatment, and outpatient drug and alcohol rehab programs. Reach out to speak with an admissions navigator today at to learn more about how you can begin your recovery journey.
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