Many insurance plans provide some coverage for addiction and mental health treatment, since these are generally categorized as essential health benefits under many plans. However, coverage amounts, network status, and prior authorization requirements vary significantly.
The only way to know your specific coverage is a direct benefits verification, which our team can help you start.
Factors That Affect Coverage
Whether a facility is in-network or out-of-network for your specific plan is one of the biggest factors in what you will pay. Prior authorization requirements, medical necessity criteria, and plan-specific exclusions for certain levels of care (like residential treatment) can also significantly affect your actual benefit.
In-Network vs. Out-of-Network
In-network facilities have negotiated rates with your insurer, generally resulting in lower out-of-pocket costs. Out-of-network facilities may still be covered under some plans, often at a lower reimbursement rate, and some offer single-case agreements in specific circumstances. Ask directly about both options.
What to Confirm With Your Insurer
- ✓Whether the specific facility is in-network or out-of-network for your plan
- ✓Your deductible status and how much has already been met this plan year
- ✓Whether prior authorization is required for residential or inpatient care
- ✓Any plan-specific exclusions for certain levels of care or diagnoses