17 Sep Inpatient Rehab Insurance Coverage: What to Verify Before Admission
Addiction Notice: If you or someone you know needs help with substance use, contact SAMHSA at 1-800-662-4357 (free, confidential, 24/7) or visit findtreatment.gov. Do not stop using alcohol or other substances abruptly without medical supervision, as withdrawal can be life-threatening.
A call to the admissions line usually ends with some version of the same sentence: yes, we take your insurance. That statement does not necessarily mean the insurer has approved the specific admission. A facility's participation with an insurance plan is separate from the insurer's decision about whether a particular stay meets the plan's requirements. Inpatient rehab insurance coverage sits at the meeting point of three things: what your plan covers, what it considers medically necessary, and how long it authorizes treatment. HealthCare.gov confirms that Marketplace plans are required to cover inpatient behavioral health and substance use disorder treatment among the service categories the Affordable Care Act sets out. The distance between that requirement and a paid claim is where most families get stuck.
[caption id="attachment_76065" align="aligncenter" width="500"] Photo by Vitaly Gariev[/caption]