Will Insurance Cover an Addiction-Caused Hospital Trip?

Will Insurance Cover an Addiction-Caused Hospital Trip?

Many insurance plans cover drug and addiction-related treatment whether it occurs at an emergency room or a rehab facility

Addiction can be the cause of many unexpected trips to the emergency room. As people misuse or abuse drugs regularly, they run the risk of several health consequences, like overdose, alcohol poisoning or serious accidental injuries. In fact, according to the Drug Abuse Warning Network (a public health surveillance system managed by the Substance Abuse and Mental Health Services Administration), drug-related trips to emergency rooms are commonplace among addicts. Their 2009 survey shows that approximately 4.6 million drug-related emergency room visits occurred in that year alone, 2.1 million of which were caused by substance abuse rather than adverse reactions to prescribed drugs. These visits consisted of the nonmedical use of pharmaceuticals, illicit drugs and alcohol, which means these drugs devastate people whether they think it will or not[1].

The consequences of a drug-related emergency can be irreversible or even fatal, so it is imperative to seek medical attention for any drug issue you think demands help. Some people may avoid medical attention if they are embarrassed, ashamed or fearful that someone will uncover their addictions; other people fear how much money a hospital trip will cost. In response to the first concern, over 2.1 million people seek emergency treatment every year for drug-related issues—medical professionals see and treat addicts every day, so they recognize these situations as medical emergencies in which they can provide life-saving care. In short, there is no need to feel timid about treatment, because it is a courageous and responsible act. In response to the second concern, your health insurance may pay for all or some of the hospital visit. While every insurance plan is different, most will cover emergency care, hospitalization and rehab related to overdose or drug-related emergencies.

The Affordable Care Act has forced most health insurance policies to cover essential health benefits, such as emergency services and treatment that is related to mental health and substance abuse disorders. Depending upon an individual’s policy, drug-related emergency room visits and hospitalizations could be covered like any other visit to the hospital. Some policies also cover continued behavioral health treatment, such as counseling and other treatment methods that occur after rehab ends[2]. In short, get familiar with your insurance policy by asking for a summary of benefits. You could also look into the following aspects of your plan:

  • Deductibles, the amount you must pay out of pocket before an insurer will pay anything
  • Out-of-pocket maximums, the most you must pay during a policy period for healthcare services. Once you meet this maximum, the insurance plan will cover 100% of the allowable covered services.
  • Co-pays, the amount you must pay out-of-pocket for a specific healthcare service at the time the service is rendered; the insurer will pay the remaining costs
  • Co-insurance, the amount you must pay out-of-pocket for a certain percentage of a healthcare service once you meet your deductible; the insurer will cover the remaining percentage

Also ask about visit limitations, restrictions, services maximums and policy terms. You can always contact your insurance provider to review your benefits. You can find a number to call your insurance company by looking on your insurance ID card. Most medical facilities now look into a potential patient’s insurance benefits before providing treatment, as they know what healthcare charges will occur once services are provided. A hospital and rehab facility should help patients understand insurance benefits and other financial options so they can afford treatment.

How Can I Afford Detox or Addiction Rehab?

Many factors keep people from seeking rehab. When problems like fear, denial and the risk of job loss block people from recovery, the last thing addicts want is to worry about money. Rehab is expensive, but the long-term cost of addiction will cost much more than rehab. Aside from the money addicts spend on drugs or alcohol, addiction can cost someone his job and health insurance while it may also significantly increase the risk for health complications, accidents and injury. The short-term financial cost of addiction treatment is nothing compared to the countless consequences and financial risks that come along with untreated addiction.

Still, plenty of addicts understand the need for rehab in spite of the financial costs, but they sincerely do not know how they can afford to pay for it. Many options exist for detox and addiction treatment, but just as many options exist for funding that treatment. If rehab costs prevent you from getting the treatment you need, then please pick up the phone now to call our toll-free helpline. Our admissions coordinators are available 24 hours a day to answer your questions, address your concerns and to provide all the information you need to find the treatment that will help you get and stay clean. To learn more about how you can afford detox or rehab, call and speak with our staff today.


[1] (2011, May). Drug-Related Hospital Emergency Room Visits. National Institute on Drug Abuse. Retrieved from http://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits.

[2] Does Health Insurance Cover Drug Overdose? Personal Health Insurance. Retrieved from http://www.personalhealthinsurance.com/does-health-insurance-cover-drug-overdose/.