A 30-day inpatient rehab stay in California costs an average of $56,654 without insurance. Under California law, most people with private insurance can access inpatient treatment with significantly lower out-of-pocket costs.
Source: Recovery.com citing National Center for Drug Abuse Statistics (NCDAS)California SB 855: What It Means for You
California Senate Bill 855 took effect on January 1, 2021 and fundamentally changed addiction treatment coverage in this state. Under SB 855, all state-regulated insurance plans — including HMOs and PPOs sold in California — must cover treatment for all substance use disorders listed in the DSM-5. That includes alcohol use disorder, opioid use disorder, stimulant use disorder, and any other diagnosable substance condition. The law also requires insurers to use 'generally accepted standards of care' when making medical necessity determinations — not internal cost-cutting criteria.
What Insurance Plans Cover Rehab?
Most major private PPO insurance plans cover inpatient addiction treatment, including Aetna, Cigna, Blue Cross Blue Shield, United Healthcare, Anthem, and Humana. Coverage levels vary by plan — some cover 80–90% of residential costs after a deductible. Covered California plans (ACA marketplace) are required to cover addiction treatment as an essential health benefit. Note: Self-funded employer plans (large employers who pay claims directly) follow federal ERISA law rather than California law, but must still comply with the federal Mental Health Parity and Addiction Equity Act (MHPAEA), which provides similar protections.
How to Verify Your Insurance Benefits
Call (213) 461-2298. A placement advisor will ask for insurance information and run a full benefits verification — typically within a few hours. They'll explain exactly what the plan covers, what the deductible is, what the estimated out-of-pocket will be, and whether prior authorization is needed. There's no obligation, and verification is free.
Call (213) 461-2298 — Free Verification
What Does Insurance Actually Cover?
For inpatient residential treatment, most PPO plans cover: medical evaluation and detox, room and board at the treatment facility, individual and group therapy sessions, psychiatric evaluation and medication management, and discharge planning. What insurance may not cover: amenities (private rooms, luxury services), certain holistic or experimental therapies, and treatment at out-of-network facilities at out-of-network rates. Under California law, if no in-network option is available for the required level of care, the insurer must cover out-of-network care at in-network rates.
Why Is My Prior Authorization Being Denied?
Insurance companies sometimes deny prior authorization for inpatient treatment, claiming outpatient would be sufficient. Under SB 855, this is only permissible if supported by generally accepted clinical standards — not internal cost criteria. If prior auth is denied, there is a right to appeal. The California Department of Managed Health Care (DMHC) and California Department of Insurance (CDI) both have complaint processes for insurers who wrongly deny coverage. Placement advisors can help navigate an appeal.
How Much Will I Pay Out of Pocket?
This depends on the specific plan — the deductible, out-of-pocket maximum, and coinsurance rate for inpatient services. With a typical PPO plan, many people pay $2,000–$8,000 out of pocket for a 30-day inpatient stay after insurance. Some plans have deductibles that bring this higher; others hit an out-of-pocket maximum quickly and then cover 100%. The only way to know for sure is to verify benefits. Call (213) 461-2298 for an accurate estimate.
What If I Don't Have Insurance?
Call (213) 461-2298 to discuss options. Covered California plans are available through the ACA marketplace. Placement advisors can discuss self-pay options at programs in the network. This is a private-pay placement resource focused on licensed programs accepting private PPO insurance.