Will Insurance Cover an Addiction-Caused Hospital Trip?

Will Insurance Cover an Addiction-Caused Hospital Trip?

Health emergencies requiring a trip to the ER are usually covered by insurance

Paying for addiction-related health expenses can be challenging. Co-pays and deductibles differ from policy to policy, but for the most part, addiction treatment is a covered expense. Often those struggling with addiction require emergency medical attention in a hospital. This is often the result of overdose, combining dangerous drugs or other complications caused by drug use. When you or a loved one needs the services of an emergency room, don’t wait. Go to the hospital immediately and seek treatment. It could mean the difference between life and death. However, having some knowledge of how the process works ahead of time can help you make the right decisions in times of crisis.

Insurance and Addiction

Most people with health insurance have some level of coverage for addiction treatment. The American Medical Association recognizes both alcoholism and drug addiction as diseases.[i] This requires health insurance companies to provide treatment to those in need. In addition, the Affordable Care Act and Mental Health Parity and Addiction Equity Act of 2008 require that insurance coverage for substance abuse conditions be comparable to coverage for other health conditions. Having these types of options encourages those who struggle with drug or alcohol addiction to seek treatment rather than try to get better on their own.

When it comes to coverage for rehab treatment, most insurance companies provide some level of benefits to subscribers. The typical length of a covered stay ranges from 30 to 90 days depending on the severity and duration of the addiction. There are programs that offer long-term treatment options that can last up to one year. Services covered while in rehab typically include the following:

  • Assessment and diagnosis of addiction – In Dual Diagnosis facilities this includes the diagnosis of any underlying mental health issues causing or contributing to the addiction.
  • Medically-supervised detox – Detox gives the body a chance to rid itself of the toxins of the drug before treatment begins. Detox dramatically decreases the likelihood of relapse.
  • Inpatient/Outpatient treatment – Both inpatient and outpatient treatment programs are covered. Treatment programs include psychotherapy, individual counseling, group therapy, family therapy and other programs, like nutrition counseling, meditation and exercise classes.

The coverage you have available to you or your loved one depends on your individual policy. The intake counselor at the facility you are considering will help you understand your benefits.

Health care crises that require a trip to the emergency room are covered by insurance in the same way that any trip to the ER would be covered. When it comes to emergency care, coverage is never based on the condition, but on the terms of the policy itself. For example, an insurance policy may have a $250 co-pay for each visit to the ER. After that, all expenses incurred are covered up to 80 percent. The remaining 10 percent would be paid by the patient.

Health Conditions Caused by Drug Abuse

Ongoing health conditions caused by drug abuse, such as liver or heart problems, are also covered under insurance policies in the same way as other health conditions. Long-time addicts have compromised immune systems and often have chronic conditions as a result of their drug use. However, these health conditions can not always be directly connected simply to the drug use alone. Diet, genetics and other lifestyle issues all contribute to many common disorders. However, heart disease, hypertension, liver issues, malnutrition, anemia, hepatitis and other conditions can be linked to a variety of other causes as well as to addiction. When it comes to treatment, insurance policies deal with the result rather than the cause. In recent years many insurance companies offer rewards to subscribers that make improvements in their health, such as the lowering of cholesterol or BMI (Body Mass Index), by reducing rates, but the coverage for the actual treatment of disease remains the same regardless of the cause.

Rehab For Those Without Insurance

For people struggling with drug or alcohol addiction who have no addiction treatment coverage, there is help available. Many facilities offer payment plans that spread out the cost of treatment over time. Others provide sliding scale payment options. Sliding scale payment plans base treatment fees on a person’s ability to pay. Each person pays something, but those who cannot afford the full amount pay less than those who can. Organizations sometimes offer rehab scholarships for those with the greatest need. The Substance Abuse and Mental Health Services Administration has a treatment services locator on their website for assistance in finding a program that offers flexible payment plans. [ii]

Finding Help for Drug and Alcohol Addiction

Realizing you or your loved one has a substance abuse problem and reaching out for help is the first step in recovery. Understanding your health insurance policy can help you make informed choices when it comes to getting care for chronic and acute health conditions related to your addiction as well as addiction treatment options. If you or a loved one struggles with substance abuse, we are here for you. Call our toll-free helpline 24 hours a day to speak to an admissions coordinator about available treatment options.


[i] The Journal of the American Medical Association. “The Definition of Alcoholism.” Accessed December 10, 2015. http://jama.jamanetwork.com/article.aspx?articleid=399449

[ii] Substance Abuse and Mental Health Services Administration. “Behavioral Health Services Treatment Locator.” Accessed December 10, 2015. https://findtreatment.samhsa.gov/