What Does That Word Mean? Treatment and Insurance Terms in Plain English

On admissions and insurance calls, words go by fast. “We verified your benefits” sounds like a promise to pay. It isn’t. Before you call the plan, pair this page with the 10 questions to ask your insurance company.

How do I use this glossary?

Look up a word the moment you hear it, and write down what it means for your loved one. On a phone, use “Find in page” to jump to a term. Before a call, read the words you expect, such as deductible and prior authorization.

Definitions are general and U.S.-based; your plan’s documents and your state’s rules decide the details. For more printables, see our free family tools.

Glossary of treatment and insurance terms, A–Z

0–9

• 42 CFR Part 2: A federal rule that protects records from federally assisted addiction programs, on top of HIPAA.⁶¹ Programs generally need your loved one’s written consent to share with you.²³ An updated version has applied since February 16, 2026.²² See why the program won’t tell you more.
• 988: The Suicide & Crisis Lifeline. Call, text or chat 988, 24/7, in a suicidal, mental health or substance use crisis, for yourself or your loved one.⁴³

A

• Acamprosate, disulfiram: Two of the three medications approved in the U.S. for alcohol use disorder; naltrexone is the third. None is addictive.¹⁹
• Aftercare (continuing care): Support after a program ends, such as outpatient care, medication or recovery housing. Book it before discharge: after a break from opioids, overdose risk rises.²⁶ See the first 30 days at home.
• Against medical advice (AMA): Leaving treatment before the clinical team recommends discharge, often with no discharge plan.
• Allowed amount: The most your plan will pay for a covered service. Coinsurance is a percentage of this amount, not of the program’s full price.²⁵⁰
• Appeal (internal appeal): Asking your plan to reconsider a denial. Most private plans must decide within 30 days for care not yet received and 60 days for care already received, faster when health is at serious risk (an expedited appeal).¹¹ See how to appeal a denial.
• ASAM Criteria: The American Society of Addiction Medicine’s standards for matching a person to a level of care after an assessment. The 4th edition (2023) looks at six dimensions, or areas, of a person’s life.¹⁵⁵² See how an assessment decides the level of care.
• AUD, OUD: Alcohol use disorder and opioid use disorder, two kinds of substance use disorder (SUD).⁵⁴

B

• Balance billing: When a provider bills you for the difference between its charge and the plan’s allowed amount. In-network (preferred) providers may not, for covered services.⁴ See in-network vs out-of-network rehab.
• Benzodiazepines (“benzos”): Medicines such as Xanax (alprazolam) used for anxiety, insomnia and seizures. Physical dependence can develop even when taken as prescribed, and stopping suddenly can cause seizures.³³ See why benzo withdrawal needs a doctor.
• Buprenorphine: An FDA-approved medication for opioid use disorder that eases withdrawal and cravings and can be prescribed in doctors’ offices.¹⁷⁵³ Like other opioid use disorder medications, it lowers overdose risk.³⁴ Suboxone is one brand.⁵³

C

• CBT (cognitive behavioral therapy): Counseling that helps people build healthy coping skills and change unhealthy patterns.⁵¹ SAMHSA lists it as an evidence-based practice, along with motivational interviewing.³⁵
• Coinsurance: Your share of a covered cost as a percentage of the allowed amount, such as 20%, after you’ve paid your deductible.⁵⁰ Out of network, it’s usually higher.³
• Contingency management: Small, immediate rewards for verified progress, such as negative drug tests.²⁷ It’s often used for stimulants such as cocaine and meth, for which there are no FDA-approved medications to help prevent a return to use.²⁷³⁵ See what good treatment includes.
• Co-occurring disorders (dual diagnosis): A mental health disorder and a substance use disorder at the same time.⁵⁷ ASAM expects every program to assess mental health needs and treat both in one plan.¹⁶ See treating addiction and mental health together.
• Copayment (copay): A fixed dollar amount you pay for a covered service. Copays, coinsurance and the deductible count toward the in-network out-of-pocket maximum.¹
• CRAFT (Community Reinforcement and Family Training): A skills-based approach that teaches families to encourage a resistant loved one toward treatment. In a randomized trial, it got more loved ones into treatment than a confrontational intervention.³⁸ See how CRAFT works.

D

• Deductible: What you pay for covered care before the plan starts to pay.⁶⁰ It resets each plan year, so a stay that crosses into a new plan year can mean a new deductible.¹
• Detox (withdrawal management): Medical care to get through withdrawal safely. It’s a first step, not the treatment: ASAM says withdrawal management alone isn’t an effective treatment for alcohol use disorder.⁴⁶ It can happen in an outpatient program, a residential program or a hospital, depending on risk.¹⁶ See what medical detox involves.

E

• EKRA (Eliminating Kickbacks in Recovery Act): A 2018 federal law that makes it a crime to pay or receive kickbacks for referrals to recovery homes, treatment facilities or labs, sometimes called patient brokering.²⁸ See how brokering scams work.
• EPO (exclusive provider organization): A plan that covers care only from in-network providers, except in an emergency.⁸ See how your plan type affects coverage.
• External review: An independent reviewer outside the plan looks at a denial. For most private plans, ask in writing within 4 months of the denial notice or final decision.¹²

F

• Fentanyl: A synthetic opioid 50 to 100 times more potent than morphine. Illegally made fentanyl is mixed into other drugs and pressed into counterfeit pills, often without the buyer knowing.³¹ See fentanyl and overdose risk.
• FindTreatment.gov: SAMHSA’s locator of state-licensed providers.⁴⁴ SAMHSA doesn’t endorse individual services, so check any program yourself.⁵⁹
• FMLA (Family and Medical Leave Act): Up to 12 workweeks in 12 months of unpaid, job-protected leave for eligible employees with a serious health condition, or caring for a spouse, child or parent with one.³⁹ Treatment for substance use can qualify, as can caring for a family member in treatment; missing work because of use itself does not.⁴⁸ See taking leave from work for treatment.

H

• HIPAA: The federal health privacy law. A provider may share what’s directly relevant to your role in their care if your loved one doesn’t object, or can’t agree and it’s in their best interest.²⁴ Many addiction programs must also follow 42 CFR Part 2’s consent rules.²³
• HMO (health maintenance organization): A plan that generally covers only in-network care, except emergencies.⁸ Many HMOs require a referral from a primary care doctor before other care.⁴⁷
• Hospital inpatient (ASAM Level 4): Round-the-clock care in a hospital, which can manage withdrawal and serious medical or psychiatric problems.¹⁵¹⁶⁵¹ Programs sometimes use “inpatient” for residential care too, so ask which they mean.¹⁶

I

• In-network: A provider that has a contract with your plan.⁹
• Intervention: A planned group conversation to urge someone into treatment. In a head-to-head trial, CRAFT got more loved ones into treatment.³⁸ See whether you need an intervention.
• Involuntary commitment: A court process under state law that can order a person into evaluation or treatment, often started by a family member. Most states’ mental health commitment laws leave out substance use disorders, so whether commitment is possible depends on your state’s law.⁴⁵ See what state laws allow.
• IOP (intensive outpatient program): Group and individual therapy several times a week while living at home, more intensive than standard outpatient visits.²⁶⁵¹ See PHP vs IOP.

L

• Level of care: How intensive a treatment setting is. ASAM groups care into four broad levels, 1 (least intensive) to 4 (most), with decimals for steps between.¹⁵ Moving to a less intensive level as someone progresses is often called a “step-down.”⁵² See the levels of care, compared.
• License and accreditation: A state license lets a program operate; accreditation is a separate review by groups such as The Joint Commission or CARF, both SAMHSA-approved accreditors for opioid treatment programs.⁵⁸ SAMHSA’s quality checklist asks for both.³⁵ See how to check a license.

M

• MAT, MOUD: Medication-assisted treatment (also called medications for addiction treatment); medications for opioid use disorder. Three are FDA-approved for opioid use disorder: methadone, buprenorphine and naltrexone (as a monthly extended-release shot).⁵³¹⁸ See how addiction medications work.
• Medetomidine: A sedative approved for dogs, not people, increasingly found in the illegal fentanyl supply. On April 2, 2026, CDC warned that stopping it after regular use can cause severe withdrawal with dangerously high blood pressure and a racing heart.²⁹ See when withdrawal is dangerous.
• Medicaid: Free or low-cost coverage for some people with low incomes; benefits vary by state.⁵⁶ Federal law requires state Medicaid programs to cover medications for opioid use disorder; other addiction services vary.⁴⁰⁶² See Medicaid and addiction treatment.
• Medical necessity: Care needed to diagnose or treat a condition that meets accepted standards of medicine.⁷ The federal parity law includes disclosure requirements, so ask the plan for the criteria it used.¹³ See how insurers approve treatment.
• Medicare: Federal insurance for people 65 and older and some younger people with disabilities.⁵⁵ It covers opioid treatment program services with no copayment at an enrolled program; the Part B deductible applies.⁴¹ See Medicare and addiction treatment.
• Methadone: An FDA-approved medication for opioid use disorder. For addiction, it comes only from certified opioid treatment programs (OTPs); once stable, some doses may be taken at home.²⁵ It lowers overdose risk.³⁴

N

• Naloxone (Narcan): Reverses opioid overdose. The FDA approved Narcan nasal spray without a prescription in March 2023.²⁰ It won’t hurt someone who isn’t overdosing on an opioid.²¹ It lasts about 30 to 90 minutes and the overdose can return, so call 911 and stay.³²²¹ See naloxone steps.
• Naltrexone: Approved for alcohol use disorder (pill or monthly shot) and opioid use disorder (monthly shot).¹⁸¹⁹ It blocks opioids, so a person must be off opioids for 7 to 14 days first. After stopping it, tolerance is lower, so even a smaller amount than before can be deadly.¹⁸
• NARR (National Alliance for Recovery Residences): A national organization that certifies recovery residences that meet its standards. SAMHSA has studied NARR-certified homes.³⁷ See how to vet a sober living home.
• No Surprises Act: Protects you from surprise bills for most emergency care and some out-of-network care at in-network facilities, and in most cases entitles uninsured or self-pay patients to a good faith estimate. It doesn’t cover every out-of-network bill.⁵

O

• Out-of-network: A provider with no contract with your plan. PPOs cover it at a higher cost to you; HMOs and EPOs generally don’t cover it except in emergencies.⁸
• Out-of-pocket maximum: The most you pay for covered in-network care in a plan year; then the plan pays 100% of covered care. Premiums, out-of-network care, charges above the allowed amount and uncovered care don’t count.¹
• Overdose: An emergency. If someone can’t be woken up or is breathing slowly or not at all, give naloxone if opioids could be involved and call 911.²¹ Not sure? Use the 30-second emergency check.

P

• Parity (MHPAEA): The federal law that generally stops plans from making addiction care harder to get than comparable medical care. The parity law itself doesn’t require a plan to cover addiction treatment,¹³ though Marketplace plans must cover it as an essential health benefit.⁴⁹ On May 15, 2025, federal agencies said they would not enforce the new parts of a 2024 parity rule while they reconsider it; the 2008 law and earlier rules still apply.¹⁴
• Peer recovery specialist (recovery coach): A person with lived experience of recovery who helps others stay engaged in recovery, for example by mentoring and leading recovery groups.³⁶ See support groups and peer recovery.
• PHP (partial hospitalization program): Structured treatment for at least a few hours at a time, more intensive than standard outpatient care, while living at home.⁵¹ ASAM now calls it “high intensity outpatient” (Level 2.5).¹⁶
• Physical dependence: The body’s adaptation to repeated use of a drug, so withdrawal happens if it’s stopped suddenly. It can happen even when a medicine is taken as prescribed, and FDA treats it as separate from addiction.³³ See addiction explained in plain English.
• PPO, POS: Plan types where you pay less in network. A PPO covers out-of-network care at extra cost without a referral; a POS plan requires a referral from your primary care doctor to see a specialist.⁸
• Prior authorization (preauthorization): Your plan’s decision, before some services, that they’re medically necessary. It isn’t a promise to pay.⁶

R

• Recovery residence (sober living): Shared housing that supports people in recovery. SAMHSA notes it has been linked to less substance use and a lower chance of relapse. Ask whether the home is certified.³⁷
• Relapse (recurrence, return to use): Using again after a period of recovery. It can happen at any time, and many people need more than one try before lasting recovery. It’s a reason to adjust or step up treatment, not proof it failed.²⁶ See what to do after a relapse.
• Release of information (ROI): A signed consent form that lets a program share specific information with specific people. It covers only what it names, has an expiration, and your loved one can revoke it in writing.²³
• Residential treatment (ASAM Level 3): Living at a treatment program, usually for a few weeks to a few months.¹⁶⁵¹ See who residential treatment is for.

S

• SAMHSA National Helpline: Free, confidential, 24/7 treatment referral and information, in English and Spanish: 1-800-662-4357.⁴²
• SUD (substance use disorder): A treatable medical condition in which a person keeps using despite significant problems and has trouble controlling it, rated mild to severe.³⁴ Clinicians use DSM-5 criteria; for alcohol, there are 11.⁵⁴
• Summary of Benefits and Coverage (SBC): An easy-to-read summary of what a plan covers and costs. You can request one from your plan.¹⁰

T–U

• Tolerance: Needing more for the same effect.⁵⁴ After a break from opioids, even a short one, tolerance drops, so the old amount can be fatal.²⁶
• Utilization review: The plan’s check on whether treatment, including a continued stay, is medically necessary.⁷ Ask how often it will re-review.

V–X

• VOB (verification of benefits): A check of what the plan says it covers, not a guarantee of payment. Even prior authorization isn’t a promise to pay.⁶ See what a VOB tells you.
• Withdrawal: Symptoms when someone who is dependent stops or cuts back. Alcohol and benzodiazepine withdrawal can cause seizures and can be life-threatening.³³⁴⁶ See whether it’s safe to stop at home.
• Xylazine: A sedative not approved for people, often mixed with fentanyl. It isn’t an opioid, so naloxone won’t reverse it, but give naloxone in any suspected overdose because opioids are often involved.³⁰

How do these terms add up on a bill?

You usually pay the deductible first, then coinsurance, until you reach the out-of-pocket maximum.⁵⁰¹ Our worked example of a 21-day residential stay shows how the same care can cost a family about $5,800 in network and far more out of network.

Check what you’ve learned