active addict determined to enter rehab

What to Do When Insurance Doesn't Cover You


Sober Recovery Expert Author

active addict determined to enter rehab

Insurance can be confusing and oftentimes seem unfair. I always find myself engaged in long conversations with a representative explaining to me why they cannot cover something I need. Sometimes I can’t help but wonder what I pay these companies for. One of the toughest situations is when they stop covering you while you’re in a facility or simply refuse to cover the level of care that you require.

When I was in rehab for my eating disorder, I met several patients who had to leave suddenly, scrambling for flights back home because their insurance stopped covering them. Most of these patients were not quite ready to leave residential treatment, but they were faced with no choice because they didn't have the financial means to pay for an out-of-network facility. I myself was refused treatment that my therapy team prescribed due to insurance issues like this.

If you or a loved one find yourself in a similar situation, don’t lose hope. You still have several other options you can work out to get care.

If you or a loved one find yourself in a similar situation, don’t lose hope. You still have several other options you can work out and ways to continue to get care.

1. Find out if your insurance will cover the next step below what you were prescribed.

If your therapy team suggests residential treatment but your insurance won’t provide coverage, see if they can at least cover a day program. Most day programs require a commitment of five days a week, eight hours a day, so you’ll only be unsupervised in the evenings and weekends. Then, you can supplement the program with activities that will keep your mind and body busy when you’re out of the facility. You can prioritize getting a good night’s sleep on weekdays, get a weekend job or make plans with friends and family. Also, prepare an emergency go-to activity for when plans don’t pan out and you find yourself more vulnerable.

Remember, anytime your insurance company says they’re unable to cover something you need, learn what the next step down is. While it’s not exactly what you need, you’ll at least be able to get some support.

2. Get treatment centers on your side.

Back when I was in a residential facility, the entire treatment team (the therapist, psychiatrist, nutritionist, etc.) would conduct conference calls with individual insurance companies to see if a patient who wasn’t ready to leave could get their coverage extended.

The team presents reasons regarding any inconsistencies in the patient’s behavior and overall progress. For example, in eating disorder patients, their insurance coverage would typically end because they would reach their goal weight and the insurance company assumes they are now healthy. However, insurance doesn’t know that the person is still skipping meals and only eating others—a sign they’re not quite recovered yet.

Other reasons include a lack of participation in group and therapy sessions, which leaves them unable to fully process their thoughts and get real help. This inability to openly communicate is what drives people back for their third or fourth rounds of rehab. The treatment team may also discuss the person’s depression or self-harm issues, but not as strongly because insurance companies tend to use these types of conditions to justify a transfer to a mental institution, which is a cheaper but likely less focused route that lacks the calm and nurturing atmosphere of a rehab center.

3. Use emergency hotlines in moments of crisis.

Sometimes, we find ourselves in situations where a family member or best friend doesn’t pick up the phone when we need them. In my experience, I remember finding myself just sitting in my car crying and feeling utterly alone.

As much as the individuals in your support system love and care about you, you have to accept that there will be times when you have to make it through the day or night without them. When this happens, don’t hesitate to call a crisis hotline. You don’t have to be suicidal or reach the point of desperation to call and, in fact, it’s smart to reach out long before you reach that point anyway. Try just talking to the person who answers about how you are feeling at the moment. See how you feel after you’ve let your emotions out. And if you decide you still need more support (and sometimes we do), call 800-891-8171 to inquire about other resources that may work with your insurance or unique financial situation.

4. Stay connected to people in the community.

It’s no longer difficult to find other people with common interests in our increasingly more digital and internet-centric world. In the recovery sphere, people from all walks of life are out there sharing their personal stories and eager to show support for one another. With just a few clicks, you can be part of a worldwide recovery community, such as the Sober Recovery forum.

For someone making a difficult life change, this can make a huge difference. Recovery can be a treacherous road, but being able to talk to people who just get you can provide enough catharsis to keep you going another day. It also broadens your scope of knowledge on how other people are approaching their situations so you can make more informed decisions for yourself. Most of all, learning of other people’s experiences can help keep you inspired.

5. Find another alternative.

As they say, “When there’s a will, there’s a way.” So if the insurance company absolutely cannot cover you for something that you know can help you, see if you can work out a manageable payment plan. Here’s a list of rehabs that have financing options. You can also try borrowing money from your retirement account, friends and family, or even the bank—just watch out for high-interest rates if you opt for the latter. If these aren’t attractive or viable options for you and you’re open to switching treatment teams, there are state-run rehab agencies that can help.

Recovery is not easy, especially when you do not have your insurance to assist you financially with the care that you need. It is important, however, to never lose hope. Just remember that you are entirely capable to overcome your situation.

With enough hard work, recovery is completely and without a doubt a possible reality.

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