Cost of Rehab and Insurance Coverage: Frequently Asked Questions

Insurance Coverage for Mental Health Treatment

1. Does Insurance Cover Mental Health Treatment?

A majority of insurance providers do.

Since the Affordable Care Act was passed, most individual and small-group health insurance plans in the U.S. are required to cover mental health and addiction treatment services.

These plans must comply with laws in the ​​Mental Health Parity and Addiction Equity Act (MHPAEA).⁵ This means coverage for mental health services cannot be more restrictive than coverage for medical and surgical services. If your employer-sponsored health insurance policy includes mental health and substance use disorder services (many plans today do) they are also subject to MHPAEA laws.

It’s always recommended to check directly with your insurance provider regarding your plan’s benefits and coverage levels.

2. Does Insurance Cover Eating Disorder Treatment?

Some, but not all, insurance plans include eating disorder treatment benefits.

If your insurance plan includes eating disorder benefits, it will typically cover the following feeding and eating disorders, as listed in the DSM-5:⁶

• Anorexia nervosa
• Bulimia nervosa
• Binge eating disorder
• Other specified feeding or eating disorder
• Avoidant/restrictive intake disorder
• Pica
• Rumination disorder
• Unspecified feeding or eating disorder
• Other (muscle dysmorphia, orthorexia nervosa, etc.)

Many insurance companies have their own guidelines–commonly called “level of care guidelines” or “medical necessity guidelines”—which will impact your coverage for eating disorder treatment.

For example, in order to receive coverage for inpatient treatment or partial hospitalization programs, some insurance companies require that you meet their “medical necessity” requirements. These requirements are often determined by factors like your weight, treatment history, vital signs, and more.

To fully understand your plan’s benefits, it’s best to speak directly with a customer service agent from your insurance company about their coverage policy for eating disorders.

Addiction Treatment Without Insurance

1. How Much Is Rehab Without Insurance?

Different rehab programs can have vastly different costs. That’s because treatment for different mental health and substance use disorders involves factors such as level of care, length of the treatment program, services offered, and amenities, all of which play into treatment costs.

Inpatient rehab programs without insurance can range from less than $10,000 for more affordable options to premium, luxury addiction treatment centers that cost over $80,000. A majority of private rehabs in the U.S. are priced between $10,000 to $25,000.

If you don’t have insurance, or if don’t want to use your insurance coverage to pay for treatment, you have other payment options for rehab:

• Financing directly from a treatment center, including scholarships
• Personal loans from family and friends
• Personal loans from a bank
• Paying via credit card

2. What Happens if My Insurance Stops Paying for My Inpatient Treatment?

You have the right to appeal their decision.

If your health insurance company stops paying for your residential rehab treatment program, you should start by speaking directly with an insurance customer service representative. If you filed a claim and your carrier denied it, you have the right to appeal their decision through two formal channels: an internal appeal directly with your carrier or an external review conducted by an independent third party.

If your insurance stops paying for your inpatient treatment coverage, here are steps you can take to make your case:

Step 1. Speak directly with an insurance customer service representative. Ask them to help you understand why your care is not covered.

It’s possible that your insurance company processed your claim incorrectly. In these instances, it’s up to you to follow up with your provider to make sure there were no mistakes in processing your claim.

Step 2. If you filed a claim and your health insurance company denied it, your carrier is legally obligated to notify you in writing and explain why your claim was denied within 30 days of any medical services you’ve received. In urgent care cases, they must notify you within 72 hours.

Step 3. Appeal the decision. If your claim was denied by your health insurance company, you have the right to appeal their decision through two formal channels:

1. Internal appeal: Ask your insurance provider to conduct a full review of their decision. You need to file an appeal within 180 days (6 months) of notice that your claim was denied. If your case is urgent, you can ask your carrier to speed the process up. If they still deny your claim, or if you need your appeal processed faster, your other option is to file for an external review.

2. External review: You can take your appeal to an independent 3rd party for review. In this instance, your carrier doesn’t get the final say over whether to pay a claim.

Step 4. Work with your addiction treatment provider. If the tactics above didn’t work, there are still other ways to dispute or reduce your treatment program costs. You may speak with someone from your rehab center’s finance department to see if you can negotiate options, such as:

• An interest-free payment plan
• A discount for paying off your balance
• A rehab scholarship

If your health insurance stops paying for your inpatient treatment, many rehab centers will work with you to sort out different financing solutions.

Disclaimer: This post is for general informational purposes only and should not be construed as legal advice from RehabPath, nor should it be substituted as legal counsel on any subject matter.

3. What Can I Do if My Insurance Doesn’t Cover Addiction Treatment?

Most private health insurance policies in the U.S. cover addiction treatment.⁷

It’s possible that your policy already covers treatment for substance use disorder to a certain degree, but they may require you to choose a rehab center within their network.

If you’ve already spoken with your health insurance provider and your policy doesn’t cover addiction treatment, you can look for a new plan. Open enrollment for health insurance plans in the U.S.⁸ runs from November 1st until December 15th in most states, with coverage starting January 1st.

You can also work out financing solutions directly with your addiction treatment center or through other avenues. Rehab treatment payment options include:

• Financing directly from a treatment center, including scholarships
• Personal loans from family and friends
• Personal loans from a bank
• Paying via credit card

4. What Happens if I Lose My Job and Insurance While Attending Residential Rehab?

Usually, you’ll have temporary insurance coverage for a limited time.

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA),⁹ most group health insurance plans must temporarily continue coverage to employees who have been terminated for reasons other than gross misconduct. This continuation of coverage often extends from the date of the qualifying event for a limited period of 18 to 36 months. During that time frame, you’re entitled to the same coverage you received under your group health care plan before losing your job.

To be eligible for COBRA continuation coverage:

• Your group health plan must be covered by COBRA
• A qualifying event (such as employee termination) must occur
• You must be a qualified beneficiary for that event
• You must opt in for COBRA within 60 days from the date you lose coverage

COBRA applies to most private-sector employers ( with a minimum of 20 employees), and state and local governments health plans.

If COBRA applies to your employer’s group health plan and you opt for continuation coverage, your employer may require you to pay the full cost of the coverage plus a 2 percent administrative charge.

You also have alternatives to COBRA continuation coverage. Under the Health Insurance Portability and Accountability Act (HIPAA),¹⁰ you have the right to special enrollment. This means you can enroll in other health insurance plans without waiting until the next open enrollment season (this is often between November and December each year in the U.S.). You must request special enrollment within 30 days of the loss of your job-based coverage. Following that, you must select a plan within 60 days of losing your job-based coverage.

5. Can I Get Drug Addiction or Mental Health Help Without Insurance?

Yes, you can. However, if you’re concerned about treatment program costs and need help choosing a health insurance policy to help cover expenses, a rehab center admissions specialist can provide guidance.

If you’re unable to receive insurance, you can work out financing solutions directly with your addiction treatment center or through other avenues. Rehab treatment payment options include:

• Financing directly from a treatment center, including scholarships
• Personal loans from family and friends
• Personal loans from a bank
• Paying via credit card

6. How Much Is Eating Disorder Treatment Without Insurance?

Eating disorder treatment programs at luxury rehab centers in the U.S. often cost between $25,000 to $50,000 per month. A few eating disorder treatment programs in the U.S. cost less than $10,000 per month without insurance.

If you travel to a country with a lower cost of living for luxury rehab, such as India, you can find many eating disorder treatment programs that cost under $10,000 per month.

7. How Much Is Dual Diagnosis Treatment Without Insurance?

Several dual-diagnosis treatment programs at luxury rehabs around the world range from $10,000 to $50,000 per month without insurance.

In countries around Southeast Asia or South Africa, you can find plenty of dual-diagnosis treatment programs that cost around $15,000 per month without insurance.

8. How Much Is Alcohol Rehab Without Insurance?

Several alcohol addiction treatment programs at luxury rehab centers around the world are priced between $10,000 to $50,000 per month without insurance.

If you travel to a location with a lower cost of living, such as countries around Asia or South Africa, you can find plenty of alcohol addiction treatment programs that cost around $15,000 per month without insurance.

Medicare Coverage for Addiction and Mental Health Treatment

1. Does Medicare Pay for Substance Abuse?

Medicare can help cover alcohol and substance abuse disorder treatment in both inpatient and outpatient settings if you meet certain requirements:

• Your provider declares the services are medically necessary.
• You receive services from a Medicare-approved provider or facility.
• Your provider sets up your plan of care.

Medicare covers several types of addiction treatment programs:

• Inpatient (residential rehab)
• Partial hospitalization programs (PHPs)
• Intensive outpatient programs (IOPs)

Inpatient (residential rehab)
Once you pay your deductible and coinsurance costs,¹¹ Medicare covers inpatient alcohol and drug rehab for up to 90 days per benefit period. A benefit period starts when you are admitted to an inpatient addiction treatment program and ends 60 days after you haven’t received any inpatient care.

These are the coinsurance costs you’ll need to pay for each benefit period:

• $1,484 deductible
• Days 1 to 60: $0 coinsurance
• Days 61-90: $371 coinsurance per day of each benefit period
• Days 91 and beyond: You will start using your “lifetime reserve days” for $742 coinsurance per each “lifetime reserve day.”

Medicare gives you 60 “lifetime reserve days,” which refers to additional days of inpatient hospital coverage during your lifetime. After you’ve used these 60 reserve days, any time you go over 90 days of inpatient treatment in a benefit period, you will need to cover all costs out-of-pocket for the days you went over during that period.

Partial Hospitalization Programs (PHPs)
Medicare may cover a portion of partial hospitalization program costs¹² if your doctor certifies that you need at least 20 hours of therapeutic services per week. You will pay a percentage of the Medicare-approved amount for PHP and you’ll pay coinsurance for each day of PHP services you receive in an outpatient setting.

Outpatient Programs
Medicare may help cover parts of Medicare-approved outpatient treatment services, as well as any medication prescribed as part of your treatment plan.

2. Does Medicare Cover Residential Treatment?

Yes, Medicare can help cover residential rehab programs if you meet certain requirements:

• Your provider declares the services are medically necessary
• You receive services from a Medicare-approved provider or facility
• Your provider sets up your plan of care

After you’ve paid your deductible and coinsurance costs,¹³ Medicare will help cover inpatient alcohol and drug rehab for up to 90 days per benefit period. A benefit period starts when you are admitted to an inpatient addiction treatment program and ends 60 days after you haven’t received any more inpatient care.

Addiction Treatment Costs for Family Members

1. Do Rehabs for Teens Accept Insurance?

Oftentimes, yes.

Since the passage of the Affordable Care Act, a majority of teen rehab centers in the U.S. accept health insurance. Depending on your policy, your carrier may cover a portion or the entire cost of residential rehab for adolescents. In the U.S., your children can stay under your health insurance plan until they are 26 years old.

2. Which Adolescent Rehabs Accept Insurance?

Most adolescent rehabs in the U.S. accept health insurance. Many also offer payment options, including scholarships, to help finance treatment costs. Depending on your insurance plan, your provider may help cover a majority of inpatient program costs.

While many treatment centers list accepted insurance providers on their websites, insurance for adolescent rehab is always on a case-by-case basis. It’s best to discuss whether your insurance policy covers program costs with someone from the admissions team and your insurance carrier.

3. Do State Employees’ Insurance Cover Spouses With Drug Addiction Problems?

Most states offer employees the option to enroll in health insurance coverage for their spouses with substance use disorders.¹⁴

However, the extent of coverage, premium contributions, and who is eligible to enroll will vary from state to state.

No matter what state you’re in, it’s likely that you’ll need to opt in for insurance coverage for your spouses’ mental health or addiction treatment. This is usually not automatically covered. In certain states, your spouse’s mental health or addiction treatment will be covered under the conditionality of increased premiums.

It’s best to check directly with your state employer and health insurance company regarding your spouses’ mental health and addiction treatment coverage.

Depression Treatment Costs

1. How Much Does It Cost to Treat Depression?

Costs vary depending on the type of program you’re in, level of care, and length of treatment.

According to a study on the costs, charges, and payments for inpatient psychiatric treatment in community hospitals¹⁵ in the U.S., the price for 8.4 days of depression treatment is $6,990 on average.

Depression treatment programs at inpatient luxury rehabs range from under $10,000 per month to upwards of $80,000 per week at single-client rehabs.

If you travel to countries with lower living costs, such as India or Thailand, depression treatment programs can range from under $5,000 to $15,000 per month.

2. Is Inpatient Depression Treatment Covered by Insurance?

Yes, a majority of inpatient depression treatment costs are covered by insurance.

This has been the case ever since the passage of the Affordable Care Act,¹⁶ which listed mental health and substance use disorder services as essential health benefits.¹⁷

A customer service representative from your insurance company can offer greater details regarding inpatient depression treatment coverage. An admissions specialist at a treatment center can also help guide you through insurance coverage policies.

You can also browse private rehabs that accept insurance.

3. How Much Does Outpatient Depression Treatment Cost?

In the U.S. the average cost of therapy¹⁸¹ with a private practitioner in an outpatient setting is $65 to $250 per hour.

Meanwhile, the cost of an intensive outpatient program (IOP) ranges from $3,500 to over $10,000, depending on the length of the program and number of treatment sessions.

Outpatient program costs across Europe can range from under $10,000 per month in countries like Greece, to over $80,000 per week in countries like Switzerland, depending on factors that include levels of care and length of the treatment program.

Addiction Treatment Costs Around the World

Asia Pacific Region

1. What Is the Cost of Rehab in India?

The cost of luxury rehab in India ranges from $4,000 to $7,000 per month. On average, most private inpatient addiction treatment programs in India cost $5,000 per month.

2. What Is the Cost of Rehab in Australia?

The cost of luxury rehab in Australia ranges from $10,000 to upwards of $100,000 per month, depending on the level of care and therapies offered. On average, most inpatient addiction treatment programs in Australia cost $37,000 per month.

3a. What Is the Cost of Rehab in Thailand?

The cost of private rehab in Thailand ranges from $4,500 to $15,000 per month. On average, most luxury inpatient addiction treatment programs in Thailand cost $11,000 per month.

3b. How Much Does Alcohol Rehab in Thailand Cost?

The cost of alcohol addiction treatment programs at a luxury inpatient rehab in Thailand ranges from $8,000 to $15,000 per month. On average, private alcohol addiction treatment programs in Thailand cost $10,000.

4. How Much Does Rehab Cost in the Philippines?

The average cost of luxury rehab in the Philippines is $3,000 to $5,000 for a 28-day program.

United Kingdom

1. How Much Does Rehab Cost in the UK?

The cost of private rehab in the United Kingdom ranges from less than $10,000 to upwards of $75,000 per month, depending on the level of care and therapies offered. On average, most private inpatient addiction treatment programs in the UK cost between $10,000 to $25,000 per month.

Europe

1. How Much Does Rehab Cost in Ireland?

The cost of luxury rehab in Ireland ranges from less than $17,000 to upwards of $174,000 per month, depending on the level of care and therapies offered.

2. How Much Does Rehab Cost in Spain?

The cost of private rehab in Spain ranges from less than $10,000 to over $50,000 per month, depending on the level of care and therapies offered. On average, private inpatient addiction treatment programs in Spain cost $28,000 per month.

3. How Much Does Rehab Cost in Switzerland?

The cost of luxury rehab in Switzerland is over $50,000 per month, on average. Switzerland is home to a number of world-famous luxury single-client rehabs, including Paracelsus Recovery and The Kusnacht Practice.

4. How Much Is Rehab in Greece?

The cost of private rehab in Greece ranges from $17,000 to over $75,000 per month, depending on the level of care and therapies offered. On average, most luxury inpatient addiction treatment programs in Greece cost $17,000 per month.

Africa

1. How Much Does Rehab Cost in South Africa?

The cost of luxury rehab in South Africa ranges from under $10,000 to over $50,000 per month, depending on the level of care and therapies offered. Because the cost of living in South Africa is lower than the cost of living in the U.S. and Europe, you can find luxury rehabs that cost under $5,000 per month.

North America

1. How Much Does Rehab Cost in Canada?

The price of private rehab in Canada ranges from less than $10,000 to over $75,000 per month, depending on the level of care and therapies offered.

2. How Much Does Rehab Cost in California?

Most luxury rehabs in California cost between $25,000 to $50,000 per month, while ultra-exclusive programs can go for upwards of $80,000 a month. Almost all California rehabs offer options for financing your stay.

3. How Much Is Rehab in Florida?

Most luxury rehabs in Florida cost between $25,000 to $50,000 per month. You can find addiction treatment centers in Florida priced under $10,000 and on the other side of the spectrum, some luxury treatment centers cost $85,000 per month.

4. How Much Does Rehab Cost in Texas?

Most luxury rehabs in Texas cost between $25,000 to $50,000 per month. You have options for rehabs that are under $10,000 per month, or ultra-exclusive programs that go for over $129,000 per month.

Many addiction treatment centers in Texas accept insurance to help cover program costs. If you don’t have private insurance, some centers accept Medicare or Medicaid.

5. How Much Does Rehab Cost in Arizona?

Most luxury rehabs in Arizona cost between $25,000 to $50,000 per month, while ultra-exclusive programs can go for upwards of $75,000 a month.

Many addiction treatment centers in Arizona accept insurance to help cover program costs. If you don’t have private insurance, some centers accept Medicare or Medicaid.

6. How Much Does Rehab Cost in Mexico?

Prices of luxury rehabs in Mexico can range from $10,000 to $50,000 per month. Because the cost of living in Mexico is lower than the cost of living in the U.S. and Europe, you can find luxury rehabs that cost $8,000 per month—some include unique therapies, such as ibogaine-assisted-treatment.

1. Leonhardt, M. (2021, May 10). What you need to know about the cost and accessibility of mental health care in America. CNBC. https://www.cnbc.com/2021/05/10/cost-and-accessibility-of-mental-health-care-in-america.html [↩]