Does Insurance Cover Medical Detox?

Understanding Medical Detox and Its Necessity

Medical detox is an important part of most people’s recovery journey. It’s usually the first step, and can often be the most difficult, as substance abuse can cause the body to become accustomed to having drugs and alcohol in your system. They can make changes to the way the brain works, causing physical dependence which leads to addiction. 

When you stop using drugs or drinking, the body needs time to adjust again. Because the brain’s chemistry has been altered and the production of certain neurotransmitters has been affected, people who have been abusing substances may experience withdrawal symptoms. The severity and the symptoms depend on the type of substance that was being used, how much was taken each time, and how long they have been using the substance. Mixing drugs and alcohol, or having a co-occurring health problem can also make withdrawal symptoms more severe. 

Quitting some substances like alcohol and benzodiazepine drugs without medical care can result in severe withdrawal which can lead to death. In other cases, people may find the discomfort and drug cravings so bad they relapse before the substances are out of their system. 

This is why a medical detox program is important. If you join a medical detox program you will stay inside a safe, clean, and comfortable facility, with 24-hour medical supervision and clinical care. You will also have the option to take prescription and over-the-counter medications to ease discomfort, pain, anxiety, and restlessness, and to prevent serious symptoms like seizures, fever, and high blood pressure. 

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Overview of Insurance Coverage for Addiction Treatment

Different types of health insurance will cover some or all of the costs associated with addiction treatment. Some will cover everything, while others will require a referral from your primary care physician, and others may only cover certain treatments and therapies, for a specific length of time. Some types of insurance plans require you to cover a copay on each visit, and you may also need to meet a yearly deductible amount before the insurance kicks in. 

It can feel confusing, especially if you’ve never used insurance for rehab before but you can always call your insurance provider to ask any questions or look through your policy carefully to gain a better understanding of what is and is not covered. In some cases, like at WhiteSands, you can call the treatment center and ask them for help, and they can speak to the insurance company on your behalf. 

Types of Insurance Plans and Their Coverage for Detox

So does your insurance cover detox? The following are the most common types of insurance plans and their policies on detox for alcohol and other substance use disorders. 

  • HMO (Health maintenance organization) – services will only be provided if you get a referral from your primary care physician, but you can often choose treatment centers that offer integrated health and wellness treatment plans
  • PPO (Preferred provider organization) – basic detox services are covered by PPO insurance, as long as your physician demonstrates the medical necessity for treatment, but additional holistic services or specialty services like acupuncture or rapid detox plans may not be included
  • EPO (Exclusive provider organization) – you must choose a provider from in-network, but no referral is needed, so you can go directly to the detox center directly for care
  • POS (Point of service) – with POS insurance, you can choose between an in-network provider, or attending an out-of-network provider with higher costs
  • Medicaid – coverage varies by state, but all basic detox and rehab treatments are covered. That said, some facilities don’t accept Medicaid so you must check with the treatment center before enrolling
  • Medicare – coverage varies, depending on the type of Medicare you have, and whether you have additional prescription drug coverage or supplemental insurance policies

Navigating Your Insurance Plan for Detox Coverage

To navigate your insurance plan, you should speak to your insurance provider before you start treatment. When you call, ensure you have your membership number and insurance information ready. Take notes on what they tell you, including the name of the person you’re talking to, and the date. You can ask them:

  • What type of insurance plan do you have?
  • What types and stages of treatment are covered?
  • What lengths of stay are covered?
  • Are all prescribed medications covered?
  • Where can you find a list of in-network providers?
  • Do you need pre-approval or prior authorization before starting treatment?
  • Do you need a referral?
  • Can they send you a list of criteria for “medically necessary” addiction treatment coverage?
  • Are there co-pays or deductibles you have to pay out-of-pocket before insurance kicks in?

Common Challenges with Insurance Coverage for Detox

One of the most common challenges people find when it comes to insurance is that it can be confusing and overwhelming, especially when they’re already dealing with substance use and mental health disorders. With the help of your insurance representatives and your treatment center, you can overcome this challenge. 

Some other challenges you may face include:

  • Denied claims
  • Coverage is not available for high-quality detox centers
  • Coverage is inflexible when it comes to inpatient vs outpatient care, only paying for one or the other
  • There may be time limits on treatment programs 

How to Advocate for Coverage of Medical Detox

medical detox insurance coverage

Without insurance, detox can be very expensive, as can inpatient and outpatient rehab, so advocating for coverage is important. If you’re not comfortable with speaking with insurance agents on your own, you can always ask the treatment center if they can do it on your behalf. At WhiteSands, everybody on our staff has plenty of experience dealing with all kinds of insurance policies and is more than willing to help you understand yours, or speak to an insurance representative on your behalf. We know you are going through a challenging time, but you are not alone. 

The Role of Medical Detox in a Comprehensive Treatment Plan

Medical detox is the key to a safe and comfortable start to successful rehabilitation for many people. It keeps you healthy and safe while helping you avoid the worst withdrawal symptoms. At WhiteSands, we customize each person’s detox plan to best suit their unique health needs and personal preferences. You will have 24-hour medical care available, as well as medications to keep you comfortable and safe while the drugs and alcohol leave your body. 

Detox is only the first step down the long road to recovery. We can assist you in choosing an appropriate inpatient or outpatient rehabilitation plan for your needs while working with your insurance company to maximize your coverage. 

How WhiteSands Treatment Can Help with Insurance Coverage for Detox

At WhiteSands, we offer inpatient medical detox, and medication-assisted treatment (MAT) programs, along with short-term and long-term inpatient and outpatient programs. We also have aftercare options for those who have completed their programming but want to remain connected to a supportive, sober community. Our team knows how complex insurance coverage can be, and we will do all we can to help you navigate your coverage. 

Whether you are ready to start detox today or simply want to know what your insurance would cover if you came to WhiteSands for treatment, you can call us, day or night, at 877-855-3470. We will help you figure out your next step.

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.

About the Author

Jackie has been involved in the substance abuse and addiction treatment sector for over five years and this is something that she is truly eager about. She has a passion for writing and continuously works to create informative pieces that not only educate and inform the public about the disease of addiction but also provide solutions for those who struggle with drug and alcohol abuse.