What Should You Do When Insurance Denies Your Rehab?

Every single one of us has dealt with some sort of issue relating to insurance companies. There’s nothing more stressful than getting that envelope in the mail saying that you owe a huge amount of money that should’ve encumbered.

Health insurance is meant to cover a portion of any medical services that you or your family members require. It’s often offered by employers or by state or private companies. It’s immensely important in offsetting the thousands of dollars that even simple medical procedures can end up costing.

Unfortunately, insurance is a minefield of policies and loopholes. For those suffering from addiction, the last thing they need is to get a letter denying coverage of their treatment. This can leave them feeling helpless at a time when they’re already extremely vulnerable.

Addiction is a serious disease that often requires extended inpatient stays in rehab facilities. This is done to facilitate detox and to help the individual receive the therapies needed to live their lives free of drugs and alcohol.

Many people suffering from addiction are unable to stop without professional help. An inpatient facility can end up costing tens of thousands of dollars that most addicts can’t afford. This is when they turn to their insurance companies to help provide them with this very necessary form of treatment.

Insurance companies are notorious for trying to deny claims relating to the treatment for addiction. It’s very important that each and every person understand their rights and exactly how to deal with an insurance company that refusing coverage.

Know Your State’s Laws

Forty-three of the fifty states in the US have laws that prohibit insurance companies from denying treatment for addiction—this is primarily centered on group policies. Group policies are those that are generally provided by your employers, or that are available through your affiliation with larger organizations.

Before attempting to put in a claim, check the laws relating to addiction treatment in your state. You should be able to find out whether or not yours is one that requires these insurance companies to pay for treatment.

Even if the insurance company’s main office is located in another state, they can still be required to follow all of the acting laws that apply to your location. Go through your insurance handbook that should’ve been supplied by your employer or directly from the company and see if you can find any notations on their policies regarding rehab.

Speak directly to the insurance company and ask them why they denied your claim. Having the information directly from the handbook along with the state laws can help you to shoot down their excuses.

If they continue to deny your claim regardless of your states laws and policies listed in the handbook, there’s a good chance that what they’re doing is illegal. Communicating with the insurance company can give you some excellent insight into any loopholes or reasons they’re using to justify their denial of your claim.

Work with the Treatment Facility

Most rehabs have been through this before; they’ve dealt directly with a huge number of insurance providers that have more than likely been difficult. Don’t be afraid to approach the rehab facility and ask them for advice on dealing with your insurance company.

They may have advisors or office personnel that can help you submit your claim in a way that makes it impossible to deny. Most are also incredibly compassionate when it comes to dealing with people trying to fight their addiction.

This results in more patience, and people who truly understand your situation. Someone in the office may be able to show you how to write an appeal letter for your insurance.

An appeal letter is a response to their denial that directly appeals their decision and asks them to reconsider. There are times when an appeal letter can communicate the desperation of the situation and will actually sway an insurance company in your favor.

It’s very important that it be written in a way that’s both intelligent and honest about your current situation.

If the insurance company continues to deny the claim, regardless of any actions that you take, you may be able to start a different kind of treatment via the rehab facility. See if they can offer you another option aside from a residential rehab program that can at least get you started on the right path.

There’s a good chance that the facility will understand how important it is that you start treatment immediately even if the insurance company doesn’t.

Arm Yourself with Information

Most people who are trying to stop using drugs and alcohol aren’t exactly in the mood for heavy research. Consider asking friends and family if they’ll help you to understand why the insurance company denied your claim, and what can be done about it.

Having a good support network is integral to treatment and most of these people will do as much as possible to get the person that they care about into rehab. As the person receiving the coverage, you may be forced to deal with the insurance company at the face-to-face level.

It’s possible to ask about appointing someone to speak for you if you’re unable to represent yourself at the time. This is usually a family member or someone who’s close to you who understands the situation.

Comb through the policy that you have and do a search online: see if other people have had a similar problem with the same insurance company and how they might’ve solved it.

Continue to reach out to the insurance company and make every attempt to talk to someone in the upper echelons of the office. This will be the person with the power to accept your appeal or who can direct you on the best possible way to get approved.

Treatment is absolutely vital to those suffering from addiction, and it’s not something that can be brushed aside. For some, fighting for that treatment is the same as fighting for their lives.

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