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How to get Insurance to Pay for Inpatient Rehab

Making the decision to come to treatment is often a daunting task. It takes courage to recognize that there is a problem and that it’s time to seek professional help. Once individuals take this critical step, they may experience fear when figuring out how to pay for inpatient treatment.


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How to get insurance to pay for inpatient rehab can be confusing. Thankfully, it’s certainly possible if you follow the right steps.

  • Verify your insurance coverage: Start by contacting your insurance provider to confirm your coverage for inpatient rehab. Ask about the type of rehab services covered, any limitations, and the extent of your coverage. 
  • Understand your policy: Familiarize yourself with the terms and conditions of your insurance policy. This includes knowing your deductible, co-pays, co-insurance, and out-of-pocket maximums.
  • Get a referral or assessment: To initiate the process, you may need a referral or assessment from a healthcare professional. They will evaluate your condition and determine if inpatient rehab is medically necessary.
  • Choose an in-network facility: Opt for a rehab facility that is in-network with your insurance provider. In-network facilities usually have negotiated rates with insurance companies, which can help reduce your out-of-pocket costs.
  • Pre-authorization: Many insurance plans require pre-authorization before you start inpatient rehab. Your healthcare provider or the rehab facility will typically assist with this process.
  • Appeal if necessary: If your insurance denies coverage or only offers partial coverage, you have the right to appeal their decision. Be prepared to provide documentation and medical records supporting the necessity of inpatient rehab. Consult with your healthcare provider or the rehab facility for assistance in the appeals process.
  • Keep detailed records: Maintain copies of all correspondence, bills, and documents related to your rehab treatment. This will be valuable to appeal a denial or resolve billing issues.
  • Maximize your benefits: Utilize all available benefits, including mental health and addiction coverage. These may be a separate part of your policy. Understanding the specific coverage for substance abuse treatment can be crucial.
  • Review bills and explanations of benefits (EOBs): Regularly review your medical bills and EOBs. Confirm that your insurance is covering the appropriate costs. Contact your insurance company or the rehab facility if you notice any discrepancies or errors.

Remember that each insurance policy is unique, and the process depends on your provider and the specific policy you have. It’s essential to be proactive, stay informed, and advocate for yourself to get the coverage you need for inpatient rehab. If you encounter difficulties or need further guidance, you may want to consult with an insurance expert.

The Affordable Care Act (ACA) is a healthcare bill that passed in 2010. This act expanded healthcare to lower income households. It also prevents health insurance companies from denying coverage to individuals with pre-existing conditions- including addiction and alcohol abuse.

The ACA also requires insurance providers to cover drug and alcohol treatment. All providers cover treatment now. The question is no longer how to get insurance to pay for inpatient rehab. It’s now the amount of treatment they will cover, and for how long.

How Does Insurance Apply to Treatment?

Insurance benefits vary from plan to plan. When an individual is looking to go to inpatient rehab, there are a few factors to consider.

In Network Coverage: Being “in-network” means that healthcare providers or facilities are a part of a specific health plan. They have agreed to discounted rates. This passes savings on to the policy holders.

When individuals covered by insurance seek care from in-network providers, it often results in lower out-of-pocket expenses. This is because these providers offer services at rates that are more budget-friendly for the insurance companies they partner with.

The provider’s contractual agreement with the insurer makes them accept the insurer’s payment, along with the patient’s share of the costs. This includes deductibles, copays, or coinsurance payments. Importantly, in-network providers can’t send patients additional bills for the balance, a practice known as “balance billing.”


HMO- HMO plans belong to specific medical groups. If you have this type of insurance plan, you have to go to a facility in-network with your provider. You can call the phone number on the back of your insurance card to speak with a representative. They can help you find a treatment center in-network.

PPO- These plans provide both in network and out of network coverage. There are more options available to you with these plans, however, utilizing out of network can be a bit more costly. Hotel California by the Sea is contracted with most major PPOs.

What is a Deductible?

A deductible is the amount the individual has to pay before insurance will start paying for medical services. If you have a $1,000 deductible and get a $2,000 bill, you will need to pay $1,000 first. After that payment, your insurance will cover the remaining $1,000.

What is Co-Insurance?

Co-insurance begins after the deductible is met. A co-insurance is the percentage that the insurance covers for medical services. This percentage is always higher than the policy holder’s responsibility.

The exact percentage depends on the policy. For example, if you have a 30% co-insurance, that means that your insurance will be paying 70% of all expenses. You will be responsible for 30% of your medical bills.

What is Out of Pocket?

Your Out of Pocket limit is how much you will pay out of your own money before insurance covers all services. Once you reach the amount of money on your limit, insurance covers every medical service at 100%. This does however exclude prescriptions and other separate benefits.

How do these factors affect treatment payment?

It is important to know the specifics of your plan when entering treatment. This way, you can be fully prepared for any costs associated with inpatient rehab.

You are covered at 100% by your insurance once you meet both your deductible and your Out of Pocket. This lasts until the end of the year. This also means that your insurance will cover you regardless of how long you stay in treatment. It will also cover all followup care. 

What is an Inpatient Rehab?

When figuring out how to get insurance to pay for inpatient rehab, it’s important to consider all levels of care. Some insurances have separate benefits and plans for different levels of care. 


Detox is the first step in the inpatient rehab process. Patients are assessed by a physician to determine what treatment is necessary for a comfortable and safe removal from substances. From there, individuals are monitored 24/7 to ensure all their needs are met.

This period of sobriety is crucial. It’s a point in which cravings can be very intense, and the risk of relapse is high. Making sure to take this step in a controlled and structured environment is essential for long lasting sobriety.

Residential Inpatient:

Once the detox process is complete, patients move to residential care. While they are still under 24/7 care, there is more freedom associated with residential treatment. Here they attend group therapy, receive individual counseling, and create a treatment plan for the rest of their stay.

This portion of treatment may be classified under different categories, depending on the insurance policy. We take care of the details of how to get insurance to pay for inpatient rehab. Hotel California by the Sea employs staff specifically for this to ensure that everything is billed accurately and timely.

Outpatient Programs:

The next step after residential treatment is a Partial Hospitalization Program (PHP). When patients reach this portion of treatment, the amount of group therapy they participate in lessens. We begin to focus on setting them up for success as they reintegrate back into their normal lives. 

Our Intensive Outpatient Program (IOP) is on a similar basis. Individuals come in for group therapy and individual therapy. At this point they may be continuing their care from home, or from a sober living.

Sober living is housing where the occupants regularly drug test and breathalyze. They are given structure in the house to help create positive habits in their new sober life. 

interior of gorgeous inpatient rehab home with a comfortable tan couch, modern art on the walls, and a small fireplace

The decision to seek inpatient rehab is a courageous one, representing a significant step toward a healthier, substance-free life. Understanding how to get insurance to pay for inpatient rehab is crucial for many individuals, and it can initially seem complex. However, with the right approach, it’s entirely achievable.

Understanding factors like HMO vs. PPO plans, deductibles, co-insurance, and out-of-pocket limits are important. These factors significantly affect treatment payments and coverage. Additionally, the different levels of inpatient rehab, including detox, residential care, and outpatient programs, may have specific billing and coverage guidelines. 

Hotel California by the Sea employs experts who are well trained in how to get insurance to pay for inpatient rehab. They work with insurance daily to acquire prior authorization for all services.

There are a lot of factors in how insurance works. Hotel California by the Sea dedicates skilled teams to handle these aspects of treatment. We ensure that the patient doesn’t have to worry about coverage throughout their stay.

We don’t want our patients to have to deal with the intricacies of insurance. We prioritize helping our clients get sober above all else. Ultimately, with the right information and support, individuals can embark on their journey to recovery with confidence and peace of mind.

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The road to recovery is full of uncertainty, leave your worries behind…
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