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Insurance and Substance Abuse Treatment

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Insurance and substance abuse treatment is a common concern many people have when seeking assistance in overcoming their addictions. They may be concerned about whether their health insurance will cover treatment costs. They might not be aware of deductibles and co-pays they may be required. This guide will help answer some of the more common questions about insurance and substance abuse treatment to better equip them with the knowledge they need.

Will Health Insurance Cover the Costs of Alcohol and Drug Rehab?

The short answer is yes. Many health insurance plans offer coverage for alcohol and drug rehab, including treatment centers, medications, and other related services. However, what type of coverage you have will depend on your individual policy. It is also important to understand the specifics of your coverage, such as deductibles, co-pays, and in-network and out-of-network providers. 

Important Insurance and Drug Rehab Terminology

It is essential to understand the following insurance and drug rehab terminilogy when looking for a treatment facility. 

  • Insurance Premiums: The monthly or annual payment made to an insurance company in order to have health coverage. 
  • In-Network Provider: A healthcare provider that has a contract with the insurance company and agrees to provide services at pre-negotiated rates. 
  • Out-Of-Network Provider: A healthcare provider that does not have a contract with the insurance company and typically charges higher fees for services provided. 
  • Deductible: An amount of money, usually set by the individual’s policy, which must be paid out of pocket before any benefits start paying out. 
  • Co-Pay: A fixed fee is required when accessing certain types of medical care, such as doctor visits or prescription drugs; this is typically a lower cost than what would be charged without it
  • Coverage Limits: Maximum amounts an insurer will pay toward particular treatments or expenses over a given period of time (usually one year). 
  • Out-of-Pocket Costs: Any costs incurred above and beyond what is covered by your plan. These can include co-pays, deductibles, and other related expenses associated with treatment.Out-of-Pocket Maximum: The maximum amount a person is responsible for paying in one year before the insurance begins to cover all costs.

What Is the Difference Between HMO, PPO, and POS?

There are three different types of healthcare plans you also need to be aware of – HMO, PPO, and POS. An HMO (Health Maintenance Organization) is a type of health insurance plan that requires members to receive care from providers within the network in order to be eligible for coverage. 

A PPO (Preferred Provider Organization) is an insurance plan that allows members to use both in-network and out-of-network providers. However, using in-network ones may provide more cost savings. A POS (Point of Service) plan combines aspects of both HMO and PPO plans by allowing members to choose between using an in-network provider or seeking care out of network with higher costs.

What Options Are There for Finding Out My Coverage for Rehab?

There are several options to find out about the type of coverage you have available for rehab treatment. One way is to speak to your plan administrator at your place of employment. However, many people may be reluctant to do so, as they may not want their employer to know they are struggling with substance use. 

Another option is to contact your insurance provider directly. Your insurance provider can answer questions about your coverage and provide you with details about what your expected out-of-pocket costs will be. Your insurance provider is not legally allowed to discuss or share any information with your employer, so this option is entirely confidential.

A third option that can help save you time is to speak to one of our intake specialists and insurance administrators. Once you provide details about your insurance provider, we can quickly find out the details and information you need to know. In addition, we eliminate any confusion or stress you may feel about calling your provider. Furthermore, any information we discuss is held to the strictest confidence. 

Insurance and Drug Rehab Coverage

Drug rehab coverage is covered by insurance because it is considered a medical expense and can be beneficial for improving overall health. Addiction is considered a disease because it alters the brain’s chemistry and disrupts normal functioning. It is a chronic condition that can cause physical, mental, emotional, and behavioral changes in an individual. 

Addiction often leads to compulsive behaviors such as substance abuse, which can have serious consequences for the individual. In addition, addiction has both physical and mental effects, and treatment can help manage these effects in order to improve one’s quality of life. 
Therefore, insurance companies recognize the importance of drug rehab and provide coverage as part of their plans to ensure that individuals have access to this type of care. As such, they view and handle the treatment for addiction like any other medical condition.

People discussing insurance options through Pacific Sands Recovery.

What Insurance Does Pacific Sands Accept?

Pacific Sands accepts most insurance providers with addiction coverage. Some of the more common providers we work with include Anthem, BlueCross BlueShield, Cigna, MultiPlan, Aetna, GEHA, Magellan, and Tricare. It is best to contact us directly to verify your insurance coverage with one of our intake specialists or insurance administrators. You may also fill out our insurance verification form online. 

What If I Have Insurance Through the Marketplace?

If you have insurance through the Marketplace, you will most likely have coverage for alcohol and drug rehab. All of the plans available through the Marketplace include mental health and addiction treatment services. However, they can be variances in deductibles, co-pays, and out-of-pocket maximums.  

What If I am Out-of-State?

If you are coming from out-of-state to our recovery center, your insurance may still cover the treatment costs depending on your coverage. It will also depend on whether your provider considers our treatment center as in-network or out-of-network. 

What Types of Substance Abuse Treatments Does Insurance Cover?

Insurance plans typically cover a wide range of substance abuse treatments, including inpatient and outpatient programs, dual diagnosis programs, medication-assisted treatment (MAT), counseling and therapy sessions, detoxification services, and aftercare support. Additionally, many plans offer coverage for alternative therapies, such as yoga or acupuncture, for those struggling with addiction. 

It is important to check your individual policy for specifics about what treatments are covered and what costs you could potentially incur. 

What If I Do Not Have Insurance?

If someone does not have insurance, they should not be deterred from seeking substance abuse treatment. There are still several options available that can make going to rehab possible. For example, payment plans or sliding fee scales may be offered based on income levels. 

There may also be assistance through public programs, Medicaid, or Medicare to help people receive the treatment they need. It is worthwhile to contact us directly to discuss what options are available, as we want you to be able to start your recovery journey.  

Let Us Help You Take the First Steps Toward a New Life

At Pacific Sands Recovery Center in Orange County, CA, we can help determine what insurance and substance abuse treatment coverage you have. We can also provide assistance if you do not have insurance at our IMS and JCAHO-accredited treatment center. So start your recovery journey today by contacting us now.


  • I would just like to share how Grateful I am with my experience through my addiction at this facility. I couldn’t possibly ask to be in such a “SAFE/COMFORTABLE” environment while receiving treatment for my addiction. I would just like to say Thank you sooo much to ALL the staff there from the Nurse’s to counselors and therapist all of you are a True Blessing in helping me through my journey of sobriety. I couldn’t feel more comfortable there on how they monitored my physical health and on dealing with my emotional health with there therapy sessions and groups I truly see them ALL as Family!

    Andrew N.
  • As a professional in the recovery field I have worked with many detox centers and none compare to The this one. Their staff is incredibly attentive and knowledgable regarding the needs of individuals seeking recovery from the very start. Their facility is welcoming and homey while remaining very luxe. I would recommend this facility to any loved one or friend looking to start down their journey of sobriety.

  • This place helped saved my life, and a great stepping stone to get my life on the right track. Was there first client under new management, caring staff and owners, comfortable place to get you on your feet in sobriety.

  • Great Staff. Comfortable Environment. Awesome place to Get Clean and Sober. Thank you guys for everything.


    Pacific Sands Recovery Center

    1909 W Carlton Pl
    Santa Ana, CA 92704


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