Insurance Cover Drug Detox

Does Insurance Cover Drug Detox?

Over the years, legislative reforms in the US have included drug detox and related services as a part of one’s health insurance coverage. In simple cases, a detox session by may be covered as a part of a routine medical check-up and treatment. However, for complicated cases, a patient needs to go through a lot of processes to apply for drug detox treatment approval.

Coverage Inclusions

Withdrawal symptoms appear once a drug user stops taking the substance he is addicted to. Medical intervention is crucial at this time to manage the patient’s symptoms as some of them might be life-threatening. In line with the US government’s Affordable Care Act (ACA), all policies sold on the Health Insurance Exchanges or are given by Medicaid should provide coverage for care for substance abuse cases. The coverage includes a consultation with a doctor, the medications needed to address the symptoms, and some outpatient procedures recommended by the doctor. However, the patient must be prepared to pay for any co-pays. Also, it is at this point where the coverage specifics become complicated. Treatment plans and services differ from one provider to another, which makes it difficult to assess if the whole detox program can be covered under the policy or not.

Coverage Exclusions

Drug detox programs usually include several medications like methadone and buprenorphine. A detox treatment plan may include certain procedures, which may be either done as an outpatient, inpatient or through partial hospitalization. To be able to get his or her health insurance to cover the treatment, a patient must present supporting documents showing that their service and provider of choice is deemed medically necessary for the condition. Showing that the increase of risk for a relapse is higher if a lesser option is considered should also be presented to the health insurance provider.

Outpatient detox programs are usually given fast approvals. However, this becomes an entirely different scenario once the inpatient care is recommended. The patient will need to provide medical documents which state that the previous outpatient care done has been ineffective or that there is another underlying medical problem that needs to be addressed during the drug detoxification treatment.

Moreover, another concern is that health insurance providers might not provide coverage for medications that need to be taken for a long period of time and those that they think are not medically necessary. Usually, coverage is granted for the patient’s immediate care, especially for those who are presented with withdrawal symptom. However, this is not always the case. For example, heroin withdrawal symptoms are not life-threatening and may be resolved without any medical intervention. Because of this, health insurance providers might not cover all the costs for the care of the patient.


If you, a relative, or a friend needs to undergo drug detox, it is best to communicate well with the health insurance provider to know the process of getting coverage, the inclusions, and the exclusions of your health insurance policy. It is also best to work well with your medical care provider to understand if the proposed detox treatment plan is medically necessary or not.

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