Six Questions to Ask About Insurance Coverage for Outpatient Treatment

Authored By: Joe Gilmore

Table of Contents

Insurance Coverage for Outpatient Treatment

One proactive step to rehab is to talk to your insurance provider to see if your insurance plan provides for outpatient treatment for addiction. Since one of the most complicated parts of selecting a rehab or outpatient drug treatment facility is figuring out how to pay for it, exploring your options is important and keeping in touch with your insurance provider during the process is an absolute necessity. Outpatient treatment can be expensive, so it helps to know what insurance coverage for outpatient treatment is available to you.

Having a close relationship with your insurance company is important. Contacting your provider will help you check your insurance benefits against the treatment centers you’re considering and it’s important to make sure that you receive some official response from your provider before entering treatment.

Essentially, there are several types of health insurance. What type you have determines the portion of cost your provider will cover for rehab or outpatient treatment. Some health insurance options include:

  • Private insurance
  • Medicare/MediCal
  • Medicaid/MediCal
  • Military insurance
  • State-financed insurance

More often than not, outpatient treatment or rehab centers will completely handle the process of finding out whether your insurance benefits cover a portion of their center’s fees. While this is a convenient service, we still recommend that you also contact them yourself. Most insurance companies are willing to help you locate a facility covered by your insurance benefits. The first step in the process is to call your insurance company and ask them this list of questions.


Check your insurance coverage here.

FAQs About Insurance Coverage for Outpatient Treatment

1) How much will rehab and outpatient treatment cost?

The high cost of some outpatient therapy treatment centers may make it seem like an insurmountable challenge, but this is not the case. There are plenty of affordable rehabs available that should be within the coverage of your insurance coverage, assuming your insurance covers outpatient treatment at all. The cost of outpatient treatment also depends on the type of treatment program you select. There are four main types of rehab, each with varying price points:

  • Detox/Rehab starts around $1,000 and up per day
  • Inpatient-rehab costs anywhere from $6,000 to $30,000 for a 30-day stay, or more if you select a 60- or 90-day program
  • Outpatient rehab is generally around the $5,000 mark for 3 months of treatment, varying depending on whether you attend an Intensive Outpatient Program or a less intensive outpatient program.
  • Drug and alcohol counseling widely depends upon the counselor or therapist you see, but costs around $100 for an hour-long session

The prices you’ll be quoted by facilities are raw numbers, meaning that they are the numbers before insurance is applied. By contacting your provider to find out more about your insurance coverage you will be able to get a better estimate on your out-of-pocket cost of treatment. Sobriety is a priceless thing and as such, it’s a worthwhile investment.


Some employers cover an employee’s rehab our outpatient treatment services. This is courtesy of their insurance benefits as opposed to your own. You should ask to see if your employer has such coverage.

Some companies will pay the entirety of the cost while others will front the bill for your stay in treatment and then deduct a portion of your paycheck once you return to work. Normally, this is only available for those in higher-up positions at extremely profitable corporations, but it’s worth it to ask the question.

There are also some low- or no-cost options for addiction rehab treatment provided by nonprofits or that are state-funded. These facilities are available to those who have few options to pay for rehab or outpatient treatment. Though they are in the minority, it would still be beneficial for you to do some research and locate these locations. Other facilities offer a sliding-scale payment model and will help find a way for you to attend treatment whatever your budget may be.

2) What are my insurance benefits for outpatient therapy?

This information is likely available in the coverage packet you received when you signed up for your insurance benefits. If you don’t want to call your insurance company right away, you could read through the outline of your benefits package and look for the information that addresses addiction treatment. Sometimes this may be difficult to locate or understand on your own, though, so getting in touch with a representative from your insurance company will be quicker and more helpful.

Call your provider at the number located either on the back of your insurance card or on their website to be connected with an agent who will assist you regarding further details about your insurance coverage. They have the knowledge to find out more about your individual plan and what benefits you can receive.

Depending on your insurance plan, you may or may not have a deductible that must be met before they will begin paying for your treatment. Other companies will cover a portion and leave you to cover the rest. Some are lucky enough to have incredible insurance packages that will cover their entire stay.

Do not be intimidated by the possibility of what you may hear as you truly will not know their answer until you ask. As the adage says, “You’ll never know until you ask.” Give yourself a chance at recovery and explore your options; do not quit before you even begin.

3) Does my insurance coverage only cover a specific rehab or outpatient treatment facility?

Some insurance benefits will require you to attend specific rehab our outpatient treatment facilities that are within their network. For example, HMO plans, in particular, have a list of locations that they cover and anything not on that list is your responsibility. On the other hand, PPO plans often allow you to go to any facility you would like, and they will still cover a portion of the full amount of the cost.

Still, it is absolutely necessary that you call your insurance provider to find out more about your insurance coverage and know for certain. Although there are general rules of thumb, they do not apply to everyone. Not every plan is the same even though they exist under the same umbrella and you need to find out whether or not your plan covers any facility or if you need to go to a certain set of facilities.

This is particularly true for state-sponsored insurance. Not every location is covered. Many of the luxury rehabs will be outside of your scope of possibility, but this does not mean you cannot get sober. Luxury rehab is not necessary to get clean; you can get clean at any type of rehab facility.

4) Do my insurance benefits include out of state rehab or outpatient treatment?

Some addicts and alcoholics prefer to attend rehab far away from where they currently live. This minimizes the chances that they will run into someone they know or previously used with which can cause a conflict of interest or trigger feelings that will encourage the desire to use. Other times it is helpful to simply get out of your regular environment and start your recovery in a new location.

However, if you’re seeking insurance coverage for your stay in an addiction rehab facility, this is only an option for some people. Similar to the question above, whether or not out of state rehab will be covered depends upon your insurance benefits. Certain insurance plans will allow you to attend any rehab facility you wish or will cover treatment centers that aren’t in your state of residence. This isn’t always the case, though. The only way you will receive an answer to this question is to call your insurance provider and inquire about your insurance coverage.

5) Am I limited in the type of drug treatment my insurance coverage will provide?

There are a few different types of addiction rehab treatment options:

  • Detox: Drug and alcohol detox is a 1 to 10 day stay in a facility that most often uses medication-based treatment to separate an individual from drugs and alcohol and clear the toxins from their system. Detox is often considered the first step in addiction rehab treatment as many times addicts and alcoholics will experience withdrawal symptoms when suddenly separated from substances they’ve used for an extended period of time.
  • Inpatient rehabilitation: Inpatient rehabilitation takes place in either a 30-, 60-, or 90-day stay where an addict or alcoholic is able to spend their first few weeks of sobriety in a supervised environment. Inpatient rehab provides intensive addiction treatment through both individual and group therapy sessions that teach about substance dependence and how to overcome it and remain sober. These sessions teach about trigger management and coping skills necessary for recovery. Oftentimes 12-step programs are incorporated into inpatient rehab.
  • Partial Hospitalization Program (PHP): Partial Hospitalization Programs utilize the intensive methods used in an inpatient program while letting participants go home or to a residential facility at the end of the day. PHP provides 4.5 to 5 hours of treatment per day, 5 days a week.
  • Intensive Outpatient Program (IOP): Intensive Outpatient Programs are often confused with Partial Hospitalization Programs, but there is a distinct difference in the amount of services provided. IOP consists of 2.5 to 3 hours of therapy per day, 3 to 5 days a week, for 9 hours total per week. IOP educates individuals on the nature of substance abuse and dependence by combining individual and group therapy sessions. Addicts and alcoholics learn the coping skills and trigger management necessary for recovery.
  • Outpatient Treatment: Outpatient programs are less intensive than IOP and usually take place in individual therapy sessions scheduled on the addict or alcoholic’s request. Some outpatient programs offer group therapy in addition to individual therapy for those who benefit from the socialization provided in group sessions. Like IOP, coping skills and trigger management are taught but on a more individualized basis, pertaining specifically to the individual’s life.

6) How do I go to rehab if I don’t have insurance?

In some states, including California, it has been said that “the best insurance is no insurance.” For people suffering from addiction, it’s not uncommon for them to have no coverage at all. Programs like MediCal will step in and pay for rehab or outpatient treatment. While your options are admittedly more limited than for those who have insurance benefits, but there are facilities who provide treatment to low-income individuals.

Your best option would be to contact the facility or center directly to find out more about their process of admittance as well as the wait-list for their program.

Get Treatment Today

If you’re ready to get treatment, call Renaissance Recovery Center. We offer a variety of addiction treatment programs, including:

To enroll in our programs, or to learn about insurance coverage for outpatient treatment, call our team today to learn more.866.330.9449

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“I owe my life and my happiness to these people. October 8th, 2019 marked two years of sobriety for me, and prior to finding Renaissance I hadn’t had 24 hours sober in nearly 20 years.”

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Diana is an addiction expert and licensed marriage and family therapist who has been in the field of mental health for over 10 years.

Joseph Gilmore

Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country