Authored by Chris Schumacher | Medically Reviewed by Dr. Elizabeth Drew,
Last Updated: January 15, 2026

Once you understand that Act 106 likely applies to your insurance, the next step is finding out exactly what your specific plan covers.

Start by locating your insurance card and the policy documents that came with your insurance. Most insurance companies also provide access to policy information through their websites or mobile apps.

Look for a phone number on your insurance card, usually labeled “member services” or “customer service.”

When you call, have your member ID number ready along with some basic information about yourself.

Ask specific questions:

“Does my plan cover inpatient substance use disorder treatment?”

“How many days of inpatient treatment does my plan cover per year?”

“What is my deductible and copayment for inpatient addiction treatment?”

“Do I need prior authorization before entering treatment?”

“Which treatment facilities are in my network?”

Write down the date and time of your call, the name of the person you spoke with, and their answers to your questions.

This documentation becomes important if you later have coverage disputes.

Many insurance companies have separate numbers for behavioral health or substance use services. If the general customer service line can’t answer your questions, ask to be transferred to the behavioral health department.

An easier option is to contact treatment centers directly and ask them to verify your benefits.

Most rehab facilities have staff who specialize in insurance verification. They can call your insurance company on your behalf and find out exactly what’s covered. This service is usually free, and it can save you hours of frustration trying to navigate insurance bureaucracy yourself.

When a treatment center verifies your benefits, they’ll typically provide you with information about whether inpatient treatment is covered, how many days are authorized, your out-of-pocket costs, whether prior authorization is required, and whether the facility is in your insurance network.

In-network facilities have negotiated rates with your insurance company, which usually means lower out-of-pocket costs for you. Out-of-network facilities might still be covered, you’ll typically pay more.

Understanding your coverage is one thing. Actually accessing it often requires navigating the prior authorization process.

Many insurance plans require prior authorization before you can enter inpatient treatment.

This means your insurance company needs to approve the treatment before you start. Going to treatment without prior authorization can result in the insurance company denying coverage, leaving you responsible for the full cost.

Prior authorization exists because insurance companies want to verify that inpatient treatment is medically necessary before they agree to pay for it. The good news is that treatment centers usually handle this process for you. When you contact a facility about admission, their admissions staff will ask for your insurance information and permission to verify your benefits and request prior authorization.

The timeline for prior authorization varies. Some insurance companies make decisions within 24 hours, especially for urgent situations. Others take several days.

If you’re in a crisis situation, such as experiencing severe withdrawal symptoms or having a medical emergency related to substance use, you should seek immediate medical care rather than waiting for prior authorization. Emergency treatment is typically covered even without prior authorization.

When submitting a prior authorization request, treatment centers include specific clinical information about your substance use, previous treatment history, current medical and mental health status, assessment scores that indicate your level of need, and recommendation for level of care based on standardized criteria.

Insurance companies review this information against clinical criteria to determine whether inpatient treatment is appropriate.

If your insurance approves prior authorization, they’ll typically authorize a specific number of days. This might be the full 28 days allowed under Act 106, or it might be a shorter period with the option to request more days if you need them.

Even with Act 106 protections in place, insurance companies sometimes deny coverage. Knowing how to respond to denials can help you access the treatment you’re legally entitled to.

Getting a denial from your insurance company doesn’t mean you’re out of options.

Insurance companies deny coverage for various reasons, and many denials can be appealed successfully.

Common reasons for denial include the insurance company determining that inpatient treatment isn’t medically necessary, prior authorization not being obtained before treatment started, the treatment facility being out of network, claims that you’ve already used your annual benefit, or missing clinical documentation in the authorization request.

When you receive a denial, the insurance company must provide a written explanation of why they denied coverage.

This explanation should include the specific reason for denial, which policy provisions they’re citing, information about your right to appeal, instructions for how to file an appeal, and deadlines for filing an appeal.

Read this denial letter carefully. Understanding why your claim was denied helps you address those specific issues in your appeal.

Pennsylvania law requires insurance companies to have an internal appeals process, which typically has multiple levels.

First-Level Appeal

You or your treatment provider submits additional information explaining why coverage should be approved. This might include more detailed clinical documentation, letters from doctors, or clarification about medical necessity.

The insurance company reviews this new information and makes another decision.

Second-Level Appeal

If the first appeal is denied, you can usually request a second review by a different reviewer within the insurance company. Some plans require this second level of review before you can pursue external options.

External Review

If internal appeals don’t resolve the issue, you can request an external review by an independent third party.

Pennsylvania has a process for external review of denied claims. An independent reviewer who isn’t employed by your insurance company looks at your case and makes a binding decision.

Your treatment facility can often help with appeals. Many rehab centers have staff who specialize in working with insurance companies and appealing denials. They understand what clinical information insurance companies want to see and how to present it effectively.

Time matters with appeals.

Insurance companies have specific deadlines for when you must file an appeal after receiving a denial. These deadlines are typically 30 days for standard appeals and shorter for expedited appeals when you need urgent care.

Beyond the appeals process, Act 106 gives you specific protections that apply throughout your treatment journey.

Parity requirements mean insurance companies must treat substance use disorder benefits the same as medical and surgical benefits.

They can’t impose stricter limitations on mental health and addiction treatment compared to other medical care. If your plan covers 60 days of inpatient care for other medical conditions, they can’t limit inpatient addiction treatment to fewer days based solely on the type of condition.

Insurance companies can’t require higher copayments or deductibles for addiction treatment compared to other medical care. If you pay a $50 copay to see a specialist for a medical issue, your copay for addiction treatment specialists should be similar.

You have the right to treatment in a facility appropriate for your needs.

Insurance companies sometimes try to steer people toward cheaper options even when those options aren’t clinically appropriate. If a doctor recommends inpatient treatment and you meet medical necessity criteria, your insurance can’t deny that level of care simply because outpatient treatment costs less.

Privacy protections apply to substance use disorder treatment. Federal law provides extra privacy protections for addiction treatment records, which means your insurance company has limitations on what information they can share about your treatment.

If you believe your insurance company is violating these rights, you can file complaints with the Pennsylvania Insurance Department.

The department handles complaints about insurance companies operating in Pennsylvania and can investigate whether your insurance company is following Pennsylvania law. You can file complaints online, by phone, or by mail.

All of this information matters most when you’re actually trying to access treatment. Here’s what to do if you need help immediately.

Call treatment centers directly. Explain that you need help now and ask about your insurance coverage. Give them permission to verify your benefits and request prior authorization. Many facilities can complete this process within hours for urgent situations.

If you’re experiencing medical emergencies related to substance use, such as severe withdrawal symptoms, overdose, or injuries, go to an emergency room.

Emergency medical treatment is covered regardless of prior authorization requirements.

Ask about financial assistance if insurance doesn’t cover everything. Many treatment centers offer sliding scale fees, payment plans, or financial assistance programs for people who qualify. Some facilities have grants or scholarships available.

Contact your Employee Assistance Program if you have one through work.

EAPs often provide short-term counseling and can help navigate insurance benefits. They can also provide referrals to treatment programs and help with authorization processes.

Reach out to county assistance programs. Bucks County, Montgomery County, and Philadelphia County all have drug and alcohol programs that help residents access treatment. These programs can provide information about insurance coverage, help with appeals, and sometimes provide funding when insurance doesn’t cover needed treatment.

Don’t let insurance confusion prevent you from getting help.

Treatment centers deal with insurance issues every day. They have experience navigating these systems and can often get authorizations quickly when they understand you’re in crisis.

At Peace Valley Recovery, we understand that insurance coverage feels like one more overwhelming obstacle when you’re trying to get help. Our admissions team specializes in verifying insurance benefits and obtaining prior authorization.

We work with most major insurance plans serving Bucks County, Montgomery County, and Philadelphia, and we know how to navigate the system to help you access the coverage you’re entitled to under Pennsylvania law.

We’ll verify your benefits at no cost to you.

This means calling your insurance company, determining exactly what’s covered, and explaining your out-of-pocket costs before you make any commitments. We handle the prior authorization process and work to get approval as quickly as possible.

If your insurance denies coverage, we help with appeals. Our clinical team provides the documentation insurance companies need to understand why inpatient treatment is medically necessary for your situation.

We’ve successfully appealed many denials and helped people access coverage they were initially told they didn’t have.

Contact Peace Valley Recovery at (267) 662-2442 to verify your insurance benefits and learn about your options.

Our admissions staff is available to answer questions about Act 106, explain your coverage, and help you understand what treatment will cost with your specific insurance plan. You deserve access to quality treatment, and we’re here to help you get it.