Are you or your loved one suffering from addiction? Is dependence on a substance slowly — or perhaps — rapidly destroying your life?

It sounds like you’re ready to explore drug and alcohol treatment options. But you’re wondering: what will it cost? Does Humana even cover drug rehab?

You’re not alone.

According to SAMHSA, in the US, over 20 million people suffer from substance abuse. That’s nearly 1 in 12.

7.7 million Americans have a dual diagnosis in which they suffer from substance abuse and a mental disorder such as anxiety or depression in conjunction with their addiction.

According to the CDC, 10% of people age 12 and up have used illegal drugs in the past month.

Addiction can begin early and continue into adult life. Without effective treatment, few substance abusers are able to find and stay on a healing path.

If Humana will help cover the costs of treatment, you need to know to avoid paying more than you have to.

In the following sections, we’ll answer your most pressing questions regarding Humana insurance coverage for drug rehab:

  • What does Humana insurance cover in regards to addiction treatment?
  • What, if any, treatments require a prior authorization from Humana?
  • What, if any, restrictions, are there for drug rehab coverage?

Please note: You’ll need to also refer to your individual plan since plans vary. This isn’t your final source of truth. But we will walk you through understanding what Humana typically covers.

If you need additional assistance with coverage questions, working through financial barriers or finding effective and respected treatment options in your area, our compassionate team is awaiting your call to our free, confidential helpline.

Identifying your Humana Rehab Network

To determine what’s covered you first need to identify the type of plan you have.

HMO – You have a select network of doctors and facilities. If you choose to go outside that network, services will not be covered. You will have a primary care physician (PCP). This doctor will refer you to other doctors and facilities as necessary. If you see a doctor without a referral from your PCP, Humana may not cover it. This network will work as a team to provide you with comprehensive care.

PPO – PPO still has a preferred network, but you don’t need referrals. You have the option to see doctors and go to facilities that are out of network, but you will pay more for doing so.

Follow plan referral and network rules to make sure services are covered.

Determining how Much Humana Insurance for Rehab Will Cover

You’ll need to be aware of 3 important terms:

Deductible – You must pay this amount in one year before services will be covered.

Copay/Coinsurance – This is a percentage or a flat fee that you are responsible for with each treatment. For example, if you have a PPO and are going out of network, Humana may pay 70% of the bill, leaving you with 30% of the bill. Or you may have a flat payment like $185/day of a hospital stay.

Out of Pocket Max – This is maximum that you will have to pay in one year before insurance will pay 100%.

Does Humana Require A Prior Authorization?

Mental health and substance abuse treatments require prior authorization. Inpatient stays also require prior authorization. Partial hospitalization, acute detox and related outpatient services also require an authorization.

What does Humana cover?

Diagnosis – You start with a visit to a doctor or doctors who will examine you, talk with you and run tests to determine the severity of the addiction. They will then write a doctor’s order (prescription) for the various services that they believe will be an effective course of treatment for your condition.

Medical Detox – During medical detox, you are in the care of medical professionals while the drug is eliminated from your body. Humana covers detox.

Drug Replacement Therapy – In this treatment, a “less harmful” drug is substituted for the drug of choice. The dosage is then slowly lowered, this is sometimes referred to as tapering. The intention is to prevent serious withdrawal symptoms and other health concerns. Drug coverage varies significantly with Humana and will be dependent on your plan.

Outpatient Rehab – Outpatient may be in the form of outpatient intensive care in which you receive treatment several days a week for several hours a day. Or it may be in the form of ongoing outpatient treatment. Both would include counseling, group therapy, education and other treatments.

Most outpatient services are covered with prior authorization.

Inpatient Rehab – Inpatient may be an acute inpatient stay that is similar to a traditional hospital stay. Or you could be in a residential program, which attempts to feel more like home while still giving you the 24 hour medical care and support you need.  Both are covered by Humana.

Relapse Prevention –  After drug rehab, those in recovery generally need ongoing support. Humana covers continued services under the behavioral health portion of their plans.

Getting Help With Insurance is committed to helping those who are addicted and their families find lasting healing through effective and respected treatment.

Our team of compassionate and knowledgeable mental health professionals, licensed counselors and those in recovery are here to help you and your loved ones find lasting healing on the recovery path.

Call our free, confidential helpline today.