Paying for addiction counseling for someone you care about can feel overwhelming. You want them to get the best care possible, but you also need to understand how to afford it. The good news is that there are several ways to cover the cost of addiction treatment—including insurance, Medicaid, and self-pay options. Knowing how insurance works and what types of treatment are covered can make the process feel more manageable. Our Idaho drug counseling is here for you.
How Insurance Classifies Addiction Treatment
In the United States, addiction treatment is considered a mental health service. That means insurance companies must cover it, at least in part, under the Mental Health Parity and Addiction Equity Act. This law requires insurance plans to treat mental health and substance use disorders the same as other medical conditions. However, how much is covered and what’s included can vary from one insurance plan to another.
Insurance companies usually break addiction treatment into different levels of care:
- Detox – Helps someone safely stop using drugs or alcohol. This is usually the first step and is often considered “medically necessary.”
- Inpatient or residential treatment – This is 24/7 care at a facility. It can last from a few weeks to several months.
- Outpatient counseling – This includes therapy sessions a few times a week while the person lives at home. It’s a more flexible option and usually less expensive than inpatient care.
- Aftercare services – These are ongoing support services after treatment ends, like relapse prevention or continued therapy.
What Types of Counseling Are Typically Covered?
Most major insurance plans will cover different types of counseling for substance use disorders, including:
- Individual therapy – One-on-one sessions with a counselor
- Group therapy – Sessions led by a therapist where multiple people share and support one another
- Family counseling – Helps families understand addiction and learn how to support recovery
- Cognitive-behavioral therapy (CBT) – A common type of therapy that helps people change their thinking and behavior
Private Insurance, Medicaid, and Self-Pay
Private Insurance
If your loved one has private insurance (through work or a family plan), check to see what treatment services are covered. Most plans include some level of addiction treatment, but the details can vary.
Medicaid
In Idaho, Medicaid does cover substance use disorder treatment for eligible individuals. This includes detox, inpatient and outpatient care, and counseling. You’ll need to apply and qualify based on income and other factors.
Self-Pay
If insurance doesn’t cover the full cost—or if you don’t have insurance at all—many treatment centers offer self-pay options. Some offer sliding scale fees or payment plans to make care more affordable.
How to Verify Insurance Coverage
Verifying insurance coverage is one of the first steps to take. You can:
- Call the insurance company – Ask what addiction treatment services are covered, whether pre-approval is needed, and what your out-of-pocket costs might be.
- Use an online form – Many treatment centers, including Zelus Recovery, have easy online insurance verification forms.
- Talk to the admissions team – The team at the treatment center can help you understand what services are covered, what paperwork is needed, and whether you’ll owe anything up front.
What to Do If an Insurance Claim Is Denied
Sometimes, insurance companies deny coverage for part or all of the treatment. If this happens:
- Call the insurance provider – Find out why the claim was denied. It might be due to missing paperwork or a misunderstanding.
- Ask the treatment center for help – The staff can often advocate for you and resubmit the claim with more information.
- File an appeal – You have the right to appeal the decision if you believe the treatment should be covered.
Idaho-Specific Resources and Help
Idaho offers a few resources for people trying to pay for addiction treatment:
- Idaho Department of Health and Welfare – Offers treatment services for people with low income, especially those who qualify for Medicaid.
- Behavioral health crisis centers – Located in different areas of Idaho, these centers provide short-term help for people in a crisis, including substance use.
- Zelus Recovery – Based in Idaho, we work with many major insurance companies and can help you verify coverage and set up payment plans if needed.
Ready to Get Help?
Helping a loved one start addiction counseling is a big step—but you don’t have to do it alone. At Zelus Recovery, we’re here to walk you through every part of the process, from checking insurance to planning for care. Fill out our online form or call 208.518.0797 to get started today. The sooner you reach out, the sooner your loved one can begin their journey to recovery.
