Understanding what your insurance will cover — and what you may owe — before you begin treatment.
The short answer: Most insurance plans cover a significant portion of addiction treatment costs. The exact amount depends on your specific plan, your deductible status, and the level of care recommended. The only way to know for certain is to verify your benefits — which our team does for free.
There is no single answer to how much insurance will cover — it depends on several factors that are specific to your plan and situation. Here is what matters most:
Your Specific Plan
Coverage varies significantly between plans. A PPO may cover out-of-network residential treatment; an HMO may require a referral and only cover in-network providers. The only way to know exactly what your plan covers is to verify your benefits.
In-Network vs. Out-of-Network Status
If Keystone Health Group is in-network with your insurer, your cost-sharing will be lower. If we are out-of-network, your plan may still cover treatment, but at a higher coinsurance rate. Our team will clarify this during verification.
Your Deductible Status
If you have not yet met your annual deductible, you will pay out of pocket until that amount is reached. If your deductible is already met, insurance will begin covering its share immediately.
Medical Necessity Determination
Insurers use clinical criteria (typically ASAM criteria) to determine which level of care is medically necessary. If a higher level of care is not authorized, insurance may only cover a lower level. Our clinical team documents your case thoroughly to support the appropriate level of care.
Length of Stay
Insurance typically covers treatment in increments, subject to ongoing utilization review. Coverage may be extended if continued medical necessity is documented. Our clinical team manages this process throughout your stay.
Your Out-of-Pocket Maximum
Once you reach your annual out-of-pocket maximum, insurance covers 100% of covered services for the rest of the plan year. If you have already paid significant medical costs this year, you may owe less than expected.
The figures below are general estimates based on typical commercial insurance plans. Your actual coverage may differ. Verify your benefits for an accurate estimate.
| Level of Care | What Insurance Typically Covers | Your Estimated Cost |
|---|---|---|
| Medical Detox (5–10 days) | Typically 80–100% after deductible | Deductible + coinsurance |
| Residential Rehab (30 days) | Typically 60–80% after deductible | Deductible + 20–40% coinsurance |
| PHP (4 weeks) | Typically 70–90% after deductible | Deductible + 10–30% coinsurance |
| IOP (6–8 weeks) | Typically 70–90% after deductible | Deductible + 10–30% coinsurance |
| Outpatient Therapy | Typically 70–90% after deductible | Copay or coinsurance per session |
After your insurance pays its portion, you are responsible for any remaining cost-sharing — your deductible (if not yet met), copay, or coinsurance. Once you reach your annual out-of-pocket maximum, insurance covers 100% of covered services for the rest of the plan year.
Keystone Health Group's billing team works with you to understand your financial responsibility before treatment begins. We do not believe in financial surprises. If you have concerns about cost, speak with our admissions team — we will work with you to find a path forward.
Verify your benefits and get a clear cost estimate — free, confidential, same-day.
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