Using Health Insurance for Luxury Addiction Treatment Centers

Due to mental health and substance use parity laws, most insurance plans are required by the government to offer the same level of coverage for behavioral health services as they do for primary care services. This includes rehab and detox.^{1, 2, 3}

Luxury drug rehab centers are residential or inpatient treatment programs that offer their clients upscale amenities that are often considered to be like the type of services available at resorts.

Will Health Insurance Cover Luxury Drug & Alcohol Rehab?

Health insurance may cover luxury drug and alcohol rehab, but it depends on the specific insurance policy. Typically, your plan will limit the amount of facilities covered to its care network or require you to pay a larger share of the costs if you go outside the network. If a luxury rehab facility is within your care network, your insurer should provide coverage.⁴

In most cases, using insurance to cover rehab at an inpatient facility will require that you pay a co-insurance rate. For example, if your co-insurance rate is 30%, your insurer will cover the remaining 70%.⁵ Therefore, if the total cost of treatment at a luxury facility is higher, you can expect your out-of-pocket rate to be higher as well, even if you have coverage.

Some luxury rehab facilities may have treatment services that are covered by insurance but then charge separately for certain amenities, alternative therapies (i.e., non-evidence-based treatments), or recreational activities. In these situations, the additional services would not be covered by your insurer.

To learn more about what services might be covered, use our . We’ll just need a little information to verify your insurance benefits, and then you will receive an email right back with details and next steps.

What Is Luxury Rehab?

Luxury rehab facilities are designed to be very attractive, comfortable, and attentive to their clientele. The ratio of patients to staff members is much lower than it is in other treatment centers. Luxury rehabs are very often located in vacation-type settings, such as beaches, the countryside, or away from the hustle and bustle of urban areas.

Some services typically offered at luxury drug rehabs that may be unavailable at traditional rehab centers include:

• Spa-like amenities: Think steam baths, saunas, whirlpool baths, state-of-the-art exercise equipment, swimming pools, massage services, meditation classes, and more.
• Nutritional counseling: Many luxury drug rehab programs employ nutritionists to assist their clients in developing a diet that will help reduce cravings, eliminate toxins from the body, and recover from substance misuse.
• Fitness and exercise coaching: Keeping physically active in recovery is important, and many luxury drug rehabs offer fitness counseling and supervised exercise programs as part of recovery.
• Outdoor activities: Many of these facilities offer various outdoor sports and activities, such as horseback riding, tennis, golf, skiing, and hiking.
• Complementary and alternative treatments: Luxury drug rehab programs often advertise the use of complementary and alternative treatments, such as art therapy, music therapy, yoga therapy, wilderness therapy, and acupuncture.
• Privacy: Luxury drug rehab programs have the added feature of offering the highest level of privacy to their clients. This may include having a private room as opposed to sharing a room, which is typical of standard residential treatment programs.

What Determines If Insurance Will Cover Rehab or Not?

 Your insurance plan determines which treatment centers are covered. Check with your insurer or the rehab facility of your choice to make sure treatment is covered.

 Most insurance policies offer some coverage for the following services:⁶

• Detox: Medical detox, or withdrawal management, is often covered under most insurance policies to some extent.
• Medications: Medications used in the treatment of withdrawal symptoms, to control cravings, or for other associated symptoms are often covered to some extent under most policies.
• Inpatient or residential treatment: Most insurance policies offer coverage for inpatient treatment services to some extent. Residential treatment services also may be covered. There are often limits on coverage related to the number of days in treatment.
• Outpatient treatment: Outpatient treatment services are often covered to some extent under most policies, with limits on the number of sessions covered in a given time period.
• Counseling and psychotherapy: Therapy for substance abuse is a vital part of inpatient or outpatient treatment and is covered by most insurance policies.

Because insurance companies receive numerous claims, they are very meticulous in deciding which claims satisfy the stipulations of the individual’s insurance policy and which claims are not covered under the policy. The person’s particular policy will dictate whether someone can pay for luxury rehab with insurance and the length their coverage will last, but there are also some general concerns that individuals who are seeking treatment for substance use disorder should consider.

• Medical necessity: Medical necessity means that a treatment must be considered essential for recovery and some other less expensive or less intensive treatment cannot equally address the issues associated with the condition.⁷ For instance, some cases may not be considered appropriate for inpatient treatment programs, because they do not require 24-hour medical care, whereas others may be approved for this type of program due to their condition.
• Empirically validated or supported treatments: In addition to satisfying the concept of medical necessity, insurance companies also may require that the treatment being applied to the individual has sufficient documented and accepted research evidence to support its use for that condition. Very often, insurance companies and providers look to the criteria set by the American Society of Addiction Medicine (ASAM) for guidance on the appropriate route for treatment. Treatments that do not have empirical validation for use in the treatment of substance abuse will often not be covered. These can include acupuncture, rapid detox, nutritional counseling, exercise programs, etc. While some programs, such as exercise and nutrition, can help an individual in their recovery, these programs may lack empirical validation and are not considered to be medically necessary by many insurance coverage providers. Therefore, they may not be covered.
• Deductibles, copays, and other out-of-pocket expenses: It’s also important to understand how one’s specific policy works. This means understanding the plan’s deductible (how much a person is responsible for paying before their policy kicks in) and copays (the amount of a particular covered service that the person is responsible for) when evaluating potential programs.⁸

To find out what will and won’t be covered under your policy, simply contact the customer service department of your insurance provider and discuss specific coverage for drug or alcohol rehab with a customer service representative.

In many cases, prior authorization from the insurer must be obtained before you start treatment. Admissions navigators at Oxford Treatment Center can assist you with this process, verify your benefits, and provide detailed information about your coverage. Contact them anytime at . 

Paying for a Luxury Rehab Without Insurance

Even with expanded access to insurance and laws ensuring coverage for addiction treatment, there are still many Americans without health insurance or sufficient coverage.⁹ This is especially true when it comes to luxury rehab, which is often more difficult to afford. In these instances, it can be helpful to review other ways to handle the cost of addiction treatment. These may include:

• Financing and payment plans, which enable you to borrow money from the bank to pay for treatment and pay it back gradually through monthly payments. This can make luxury rehab more affordable. However, beware of high interest rates. Many treatment facilities offer payment plans, which similarly divide the cost into monthly payments without involving a bank loan.
• Credit cards. Like borrowing a loan, monthly payments with a credit card may make luxury addiction treatment more affordable, provided you can make the monthly payments.
• Treatment centers that use a “sliding scale.” Some treatment facilities may provide rehab services to low-income individuals at a reduced cost.

To learn more about your insurance benefits and how to pay for treatment, simply fill out the form below. You can find out immediately whether your insurance will cover care at Oxford Treatment Center.

Reaching out for help is a brave first step on the journey to recovery. We are here for you, to provide the support and care you need along the way.