Paying for Treatment

If you or your loved one is struggling with addiction, it is common to have questions and concerns about paying for treatment. If this is your first time considering addiction treatment, you may feel lost as you try to understand your options and the role insurance plays in paying for care. If you or your family member have already been in treatment but experienced relapses despite multiple treatment attempts, you may be apprehensive about spending the time and emotional and financial resources on another recovery attempt. By understanding the types of treatment and payment options available, you can make the best decision for you or your loved one to optimize chances of lasting recovery.

Types of Treatment

Addiction treatment programs exist on a spectrum of varying levels of intensity, duration, and focus, from short-term outpatient care to long-term residential treatment:

Outpatient Treatment

Outpatient addiction treatment programs such as intensive outpatient programs (IOP) and partial hospitalization programs (PHP) are often the first place people seek help for substance abuse issues. For some, these programs can provide the treatment necessary to successfully begin the recovery process and develop the skills to achieve sobriety, particularly if you do not have complex needs such as a co-occurring mental health disorder and do not require medical detox. Many people also “step-down” from residential treatment into an outpatient program. Depending on the structure of the program, outpatient options may allow you to continue working or going to school while in treatment.

Residential Treatment

Residential treatment offers a higher level of care for people who require more intensive treatment than outpatient programs can provide, or who have not found success with outpatient care. The typical length of stay in residential facilities is 28-30 days and the course of treatment includes detox services in addition to a comprehensive recovery curriculum.

Longer-Term Residential Treatment

If you have experienced relapse following shorter stays in residential treatment or have complex withdrawal or mental health needs, longer-term residential treatment may be needed. Typically lasting 90 days or more, these programs can offer the depth and breadth of services necessary to attend to the full scope of your needs and create a strong foundation of sobriety to minimize risk of relapse.

If You Need to Use Insurance

Many people rely on health insurance to cover the cost of addiction treatment either in full or in part. Fortunately, insurance companies are increasingly recognizing addiction treatment as an important health care benefit. In fact, under the Affordable Care Act, treatment of substance use disorders is now considered an essential health benefit and many states now require all insurers to cover addiction treatment, giving millions of people expanded access to treatment services.

If you need to use insurance to pay for addiction treatment, it is possible to receive high quality, effective care. However, since you may be working within strict limits set by the insurance company,it’s important to understand your benefits in order to get the treatment you need. The first step is to call your insurance company and find out what in-network options are available to you for the lowest out-of-pocket costs. If you are willing to pay part of the cost of treatment, you may also ask about out-of-network coverage, which gives you more choices.

Regardless of whether you are using in-network or out-of-network treatment providers, most insurers have specific requirements regarding the type, duration, and quality of treatment you receive, which may conflict with your own wishes or even with best medical practices. Insurance companies typically operate under the following guidelines:

  • If you have never been in addiction treatment before, your insurance company may only cover an outpatient program (following a short residential stay for detox, if required).
  • Residential addiction treatment may only be covered if you have relapsed following outpatient treatment and length-of-stay is typically limited to 30 days or less.
  • Longer-term residential treatment may only be covered if you have relapsed following multiple shorter-term residential stays.

Insurance companies also often do not cover what they consider to be extras or luxury components of addiction treatment, such as private detox rooms, private accommodations during treatment, or holistic therapies. Despite these limitations, many people do have success in insurance-funded addiction treatment programs and they are invaluable resources for people who cannot afford the cost of care out-of-pocket.

If You Don’t Need to Use Insurance

If you do not need to use insurance to pay for the cost of addiction treatment, your options open up considerably. As a private payer, you can choose the treatment program that works best for you as dictated by your unique needs and preferences. This means that you do not have to go to outpatient treatment before going to residential care or go to short-term residential treatment multiple times before qualifying for longer-term residential care; instead, you can get the kind, quality, and duration of care you need the first time, without the limits imposed by insurers.

By not relying on insurance, you can:

  • Seek treatment at renowned private pay programs that do not take insurance.
  • Determine your length of stay based on your individual needs, not insurance requirements.
  • Participate in a full spectrum of clinical and holistic therapies without worrying about insurance approval.
  • Take the whole treatment experience into consideration, including accommodations and the comforts offered by the facility.

If You Want the Best Possible Care

Addiction treatment is one of the most important investments you can make and ideally that investment should only be made once. In order to create the truly transformative treatment experience needed to ensure lasting recovery the first time, treatment must be personalized, evidence-based, and client-centered. Private pay treatment programs are optimally positioned to offer the level and quality of care necessary to create a foundation of on-going wellness that buoys you for a lifetime, giving you both freedom from addiction and an expanded capacity to live the life you want. Because you and your healthcare professionals are not limited by arbitrary insurance guidelines, your treatment can truly be client-led and designed to address the full scope of your addiction as well as any co-occurring mental health disorders or medical issues in a way that is meaningful and relevant to you. This also means that the complex needs of people who have experienced multiple relapses can finally be treated to end the cycle of treatment and relapse once and for all.

The cost of private pay programs tends to reflect the extraordinary treatment offered, from the expertise of leading addiction specialists to sophisticated clinical care to the comforts of the facility itself. While it’s important to consider your financial means when electing this option, it is also critical to consider the cost of not getting the right treatment:

  • Over time, multiple stays in lower-cost programs can add up to much more than a single course of effective treatment.
  • The longer addiction goes untreated, the more complex your treatment needs become, requiring more extensive and costly care.

Choosing a private pay addiction treatment program doesn’t necessarily mean that you will ultimately be responsible for the entire tab; many insurance plans will cover a portion of the cost of treatment in out-of-network facilities. By working with an experienced insurance advocate who will bill your insurance company for you, you can maximize your reimbursement and may recover a significant proportion of the cost.

Connecting to the Right Treatment

Alta Mira is committed to helping people struggling with addiction find relief from suffering, freedom from substance use, and an expanded ability to live with joy and purpose. We invite you to contact us at any time to learn more about addiction treatment and to find answers to any questions you may have about paying for care. Even if Alta Mira is not the right place for you, we will help you connect to the resources you need to create the best outcomes for you and your family.