Reasons An Insurance Company May Deny Your Rehab Claim


Most health insurance policies cover patients who have need to enter a drug rehabilitation program. Drug addiction is a disease and has been recognized as such by the medical community for some time now. Even so, many patients who enter drug rehabilitation may find their insurance claims denied or covered to far less of a degree than they had originally anticipated. If you are wondering how and why your rehab claim was denied, you are not alone. Many recovering addicts may be surprised or confused by this decision on the part of their health insurance provider. Here are a few reasons why a health insurance company may reject a rehab claim.

The Type of Substance You Are Detoxifying From

Many health insurance companies have specific guidelines about the type of drug that they will cover detoxifying from, and how long of a detox they will cover. Often, these guidelines are based on the degree of danger associated with detoxifying from a certain drug. Alcohol, for example, can be lethal to detoxify from, so insurance companies may have little grounds by which to rule that assistance with alcohol is not medically necessary. Other drugs, like opiates, may not pose immediate and imminent danger to users, but their use certainly poses a threat in and of itself, so you should not give up on your attempts to have a claim paid simply because your type of detox is not deemed as quite as dangerous by your insurance company.

The Length of Your Stay

Most insurance companies also cover a specific timeline in inpatient treatment. This timeline varies from policy to policy and if possible, you should check with both your insurance provider and the rehab facility you are planning on attending to make sure that the number of days your treatment provider anticipates you will be in rehab is consistent with the amount of time that your policy covers.

This, of course, can be relatively difficult to assess as no two addicts and no two recovery processes are the same. It may be the case that when you first entered rehab, it seemed that your stay may have fallen within the timeline allotted by your insurance policy, but that as you moved through the recovery process you and your counselors found that your stay would need to be longer than anticipated.

The Assessment From Your Health Care Providers

Certain insurance companies and policies approve patients for rehab care for a certain number of days, while other policies approve stays in shorter increments, pending reports from rehab physicians. Regardless of how many days treatment is approved for, your insurance company receives reports from your caregivers that detail the type of treatment you are receiving as well as what kind of progress you are making. It is possible that based on the content of these notes, your insurance company may find that the type of treatment you are receiving is not medically necessary.

Unanticipated Costs

It is not uncommon for expenses to arise during the course of a rehab program that are not part of what is often considered standard rehabilitation care. Your treatment center may offer services or treatments that do not fit within the type of care that is covered under your policy. Your treatment may also include certain elective activities that are highly beneficial, but may be deemed as medically unnecessary. If this is the case, it is not uncommon for medical bills to reflect certain amounts that are not covered by insurance.

If you believe that your insurance company has wrongfully denied your claim, you should ask about their appeals process or contact Omneity Billing.