How to verify insurance for addiction treatment in Dallas
You can check your own benefits in one phone call.
The short answer
Call the member services number on the back of your insurance card and ask about substance use treatment benefits. Then ask the program to confirm it is in network for your plan. You do not need to give your details to a third party to do this.
Checking your benefits
- Call the number on your insurance card
- Ask about each level of care you may need
- Confirm with the program before you start
What to ask your insurance
Ask what your plan covers for detox, residential, partial hospitalization, intensive outpatient and outpatient treatment. Ask if you need prior approval, how many days are covered, what your deductible and out-of-pocket maximum are, and which Dallas programs are in network.
Write down the date, the name of the person you spoke with, and a reference number for the call.
Why coverage exists
Plans sold on the Marketplace must cover mental health and substance use disorder services as an essential health benefit, according to HealthCare.gov. Your plan still decides details such as networks and approval rules.
A word on insurance forms online
Some websites ask you to submit your insurance details through a form to “check coverage”. Before you do, ask who will receive your information and whether they will share it. This site has no forms and does not collect insurance details.
For more on costs, see using private insurance and Medicaid in Texas.
Questions for your insurance company
- Is this program in network?
- Do I need prior approval?
- How many days are covered?
- What will I pay myself?
Common questions
Can the program verify my insurance?
Yes. Most programs will check your benefits when you call. It still helps to call your insurer too, so you hear the answer yourself.
What if I do not have insurance?
Call OSAR for Dallas County at 844-275-0600 for screening and referral, or see free and nonprofit programs.
What does in network mean?
The program has a contract with your insurer. Out-of-network care usually costs you more, and some plans do not cover it at all.
What is prior approval?
Some plans must approve a level of care before it starts. Without it, the plan may not pay. Ask the program who requests it.
