Group medical insurance and rehab--hypothetical question.

[raccoon]

I hear of someone's spouse being in rehab (I mean, drug or alcohol rehab) several times. I would imagine that these days, insurance companies are becoming more and more strict about how much of that stuff they'll pay for. And I doubt very many companies would pay for 28 days of rehab.

Anybody know?

[ikojo]

1. I would think the insurance company would push

for outpatient day treatment, after all the insurance company is interested only in its bottom line. Also, some policies limit the number of days per year or per lifetime of inpatient rehabilitation.

It also depends upon whether the rehabilitation benefit falls under the mental health portion of the person's plan or the medical portion.

Trust me the insurance company will not pay for what they do not want to pay for.

[cbayer]

2. Pretty much unheard of for many years.

If they pay for substance abuse at at all, they may pay for brief inpatient treatment for detox and then some outpatient treatment. Inpatient rehab and residential treatment (the treatment most positively correlated with real recovery) hasn't been covered by private insurers for a long time.

Hope that helps.

[serrano2008]

3. It just depends on the plan. There are many that will pay for multiple 28 day rehabs in a year...

as long as each one is considered a new "episode". So you could be in rehab for 28 or 30 days, then out for a couple of weeks then relapse and go back in.

It's true thought that they're going to try to get them to Intensive Outpatient ASAP, to save money and to make room for more.