WellPoint Insurance Coverage for Heroin

Last updated on March 16th, 2021

  • Is Heroin Addiction Treatment Covered by WellPoint?
  • What Type of Rehab Will WellPoint Cover?
  • Outpatient Rehab vs. Inpatient Rehab
  • What Are My Options if I Don't Have Insurance?
  • Call Our Helpline and We'll Help You Determine Your Options

Is Heroin Addiction Treatment Covered by WellPoint?

Yes, it is. But it hasn’t always been. This positive change came from the passing of President Obama’s healthcare law. In the past insurance companies weren’t required by law to cover substance addiction treatment. They are now required to offer coverage.

What Type of Rehab Will WellPoint Cover?

WellPoint offers benefits for several types of rehab treatment, such as:

  • Inpatient addiction treatment
  • Outpatient addiction treatment
  • Addiction treatment therapy
  • Aftercare treatment programs

WellPoint typically excludes treatment for:

  • Wilderness treatment programs

What Portion of the Cost of Treatment Does WellPoint Cover?

Obama’s healthcare law requires health insurance companies to cover heroin addiction rehab similarly to how they cover any other medical event.
If your policy has a low deductible and covers a high percentage of costs for surgery, the benefits for addiction treatment will be rich as well. If you have a high deductible and your policy covers a low percentage of your medical expenses, you’ll pay more out of your own pocket when you receive treatment.
The idea behind mental health parity is to align substance abuse and mental health coverage with other benefits offered in your policy.

Once my Insurance Benefits are Exhausted, Can I pay for Extended Treatment Myself?

WellPoint will typically pay for treatment benefits for the length of time that’s been agreed upon by your doctor and your insurance company.
For many recovering addicts, WellPoint Coverage for Heroin Addiction Rehab/Treatment will be sufficient. But, some recovering addicts may determine that they need more treatment than their insurance company will pay for.

Once your benefits are exhausted, you are welcome to pay out of your own pocket to continue treatment. For instance, if WellPoint pays for a 30-day treatment program, and you feel like you need 60 days of treatment, you can pay for the extra 30 days and continue your treatment program.

Outpatient Rehab vs. Inpatient Rehab

Both types of treatment can be effective. However, each type of treatment is used in different scenarios. Outpatient treatment allows the recovering addict to maintain daily functions of life.

Since their treatments are only during certain hours of the day, they can still maintain a job and a family life. Of course, there’s also a risk to this method. If the recovering addict has deep social roots that are causing them to further their addiction, maintaining the lifestyle they’ve been accustom to may not be the best approach.

Often times the recovering addict needs to escape their current daily activities and remove themselves from the social situations and influences that are perpetuating their addiction. This is where inpatient treatment centers come into play. Because the recovering addict sleeps, eats and lives in the treatment center, there’s little chance of relapsing.

Should I Choose a Residential Rehab Center?

“In the past insurance companies weren’t required by law to cover substance addiction treatment. They are now required to offer coverage.”
According to SAMHSA, 80 percent of heroin addicts had been admitted to treatment prior to the current episode. For this reason, many heroin addicts seek help from residential treatment centers.

However, there are differing opinions as to the long-term effectiveness of residential rehab centers. Some medical professionals see value in them because they allow the addict to recover in an artificial environment.

Some medical professionals take issue with that because they believe that when the recovering addict returns to their daily life, they’ll fall right back into their old ways. Discuss your situation with a medical professional and let them help you determine which type of treatment is most appropriate for you.

Will WellPoint Pay for Local Rehab & Out-of-State Treatment?

This depends on how your plan covers other medical events. If your plan allows you to receive out-of-network benefits for other medical events, you can also receive them for addiction rehab. Typically, provider networks that allow you to receive benefits outside of the network are called PPO or POS networks.

However, many plans require you to stay in-network to receive benefits. If this is the case, you’ll end up paying for the entire cost of treatment yourself if you use an out-of-state rehab center. Networks that require you to stay in-network to receive benefits are called EMO’s or HMO’s.

Does WellPoint Pay for Private or Luxury Treatment?

No. Because private & luxury treatment centers aren’t considered medically necessary for an addict to recover, most insurance companies will deny coverage.

What Does Executive Treatment Offer Over Standard Rehabs?

Executive treatment differs from standard treatment in a couple of ways. Standard inpatient treatment often limits communication with the outside world. However, professionals, celebrities and other individuals have a need to conduct business from the treatment center. Executive treatment centers allow them to do this.

What Different Treatment Lengths Will WellPoint Pay For?

insurance-and-addictionMost health insurance companies limit the number of days of treatment they’ll pay for. These are the most common lengths of treatment:

  • 30 days
  • 60 days
  • 90 days
  • 180 days
  • 365 days

Instead of limiting treatment to a pre-specified number of days, WellPoint will work with your doctor or the therapist to determine a treatment plan. The number of days covered by WellPoint will be decided according to recommendations made to WellPoint by your doctor or therapist.

What Are My Options if I Don’t Have Insurance?

If you find yourself needing treatment, without having health insurance, there are several treatment options you can explore.

    • Narcotics Anonymous (NA)

Narcotics Anonymous is a 12-step program where recovering addicts meet and share their stories about recovery. Most cities have local support groups. If there are no support groups in your area, you can access support groups for NA online.

    • Paying for Treatment with Credit

Many treatment centers offer credit lines. If you qualify for a credit line, you can use the available balance to pay for standard treatment.

    • Government Treatment Programs

Some city and state governments offer treatment programs and other addiction support services. Call your state’s Department of Human Services to find out what options are available.

    • Annual Open Enrollment Period

Each year, there’s an open enrollment period, where you get can individual or family insurance through the national or local state health insurance exchange. WellPoint Insurance for Heroin Addiction Treatment might be available to you right now!

Verify Your Benefits at an American Addiction Centers Facility

The cost of alcohol or drug addiction treatment may appear to be an obstacle, but we are here to help. Insurance may cover all or some of your rehab.

Find out if your insurance covers long-term addiction rehabilitation.

Check Online Now

Call Our Helpline and We’ll Help You Determine Your Options

If heroin is causing problems in your life and you’re ready to get help, call us at 1-888-716-9806 and we’ll help you sort through your options, including WellPoint Insurance for Heroin Addiction Rehab!


    • Will Using my Rehab Benefit Increase my Premiums?

No, it won’t. Before healthcare reform, this was the case. However, President Obama’s new healthcare law prohibits insurance companies from using your claims history to influence your premiums in any way.

    • Will WellPoint Cover More than One Treatment?

WellPoint will cover one treatment per year.

    • Does WellPoint Pay for Aftercare?

Yes, if it’s been pre-authorized by the insurance company.

    • Has Obama’s Healthcare Reform Law Changed Substance Abuse Coverage?

Absolutely. The new law requires that substance abuse coverage be on-par with regular medical coverage. Healthcare reform has greatly improved substance abuse coverage from what it was before.

Disclaimer: This information is not a guarantee of benefits. If you have coverage-specific questions about WellPoint Insurance for Heroin Addiction Rehab, please call us at 1-888-366-2645.

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