Does Insurance Cover Heroin Treatment?

heroin-treatment-costHeroin is one of the most commonly abused drugs in the United States. According to the National Survey on Drug Use and Health, in 2012 alone approximately 669,000 people admitted to using the drug over the past 12 months. Furthermore, this number has been increasing since 2007.

While heroin use has been declining among individuals in the 12 to 17 age group, it is on the rise among those in the 18 to 25 age group.

When a person becomes addicted to heroin, they have three basic choices:

  • Continue to use the drug with hopes that it does not have an impact on their life
  • Quit cold turkey
  • Seek professional addiction assistance from a rehab facility

Continued use of heroin is extremely dangerous, as this drug can take its toll on a person’s mental and physical health.

Quitting cold turkey is an idea to consider, and one that many people attempt. However, it can be a challenge to overcome this drug without professional help, due to its addictive powers.

Most people soon realize they need professional help, as this is the best way to overcome a heroin addiction. An experienced rehab facility can assist with every aspect of the recovery process, from detoxification through staying sober.

The Cost of Heroin Treatment

Many factors hold people back from seeking heroin treatment, including the cost. There is no denying that addiction treatment, including detox and methadone maintenance, can be expensive. Fortunately, you have many options for dealing with the cost.

If you don’t have insurance, speak with the facility about your options. You may find there are programs available that still allow you to receive treatment.

Conversely, if you have medical insurance, it is a must to learn more about your coverage. More specifically, whether or not it provides coverage for addiction treatment, detox, and methadone treatment.

Insurance Companies

heroin-insurance-coverageEvery insurance company takes a different approach to covering heroin treatment. As a general rule of thumb, check with your insurance provider before seeking treatment for any type of drug addiction. This will help you better understand what is covered, including how much your policy will pay.

Highmark Blue Shield

Highmark Blue Shield covers rehab, but the finer details are based largely on your policy. The company provides both outpatient and inpatient rehab. For those interested in residential treatment, this insurer requires precertification.

Note: if you neglect to go through precertification, you are required to pay an upfront fee of $500.


Not every type of Cigna insurance policy covers rehab services, so it is essential to double check with the company before seeking service.

Fortunately, Cigna does cover a variety of behavioral health services and substance abuse problems. Your medical team can evaluate your situation and determine what type of treatment you require. From there, Cigna care management staff compares your recommended treatment to its Clinical Practice Guidelines. It is only then that the company can determine if benefits are available.


When it comes to drug and alcohol treatment, including heroin, Humana is one of the best insurance companies to have. There are many reasons for this, including the fact that you are not restricted to specific facilities, doctors, and hospitals. Instead, you can choose to receive treatment from any facility, including those that are considered out of network.

Just the same as most policies, you will have to pay a set amount of out of pocket costs before your policy kicks in. If you have Humana group insurance, your company should cover your heroin treatment. If you have purchased an individual policy through the HumanaOne program, contact the company for information regarding the cost of rehab and how much coverage you have.

UPMC Health System

UPMC is dedicated to helping individuals live a sober life. The insurance company notes the following on its website:

“UPMC Health Plan elected to adopt substance abuse clinical practice guidelines to aid practitioners in making objective treatment decisions based on scientific evidence of the efficacy of various treatment approaches.”

Most importantly, the population covered by this guideline includes all adult members who have been diagnosed with or are at risk of developing a substance abuse disorder.

UnitedHealth Group

UnitedHealth Group provides most members with coverage for the cost of a rehab program. Some policies cover all the costs, while others only pay for some of the expenses.

There are conditions that apply, including the length of the program your policy will cover. UnitedHealth Group provides this service through its OptumHealth branch.

Are you Covered?

Most insurance companies are well aware that substance abuse has become a major problem. For this reason, they provide coverage for heroin treatment.

If you or a loved one requires professional treatment, consult with your insurance company regarding what your policy covers.

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