1. Kratom Is Not a Federally Scheduled Substance

The U.S. Drug Enforcement Administration (DEA) has not classified kratom as a controlled substance—yet. While it is banned or restricted in some states, it remains legal at the federal level and is sold over-the-counter as a supplement. This legal gray area makes it hard for insurance companies to categorize kratom use as a diagnosable “substance use disorder” under traditional policy guidelines.

2. Lack of FDA Approval and Recognition

The Food and Drug Administration (FDA) has not approved kratom for any medical use and actively warns against its safety. However, it is not officially recognized as an addictive or treatable substance in the way opioids, alcohol, or benzodiazepines are. As a result, insurance providers may deny claims that list kratom as the primary substance of abuse due to lack of recognized medical necessity.

3. Limited Clinical Research

There is limited large-scale research on kratom’s long-term effects, addiction potential, or evidence-based treatment protocols. Insurers rely heavily on established clinical guidelines and diagnostic codes (like those from the DSM-5 or ICD-10), which have minimal references to kratom-specific addiction. Without sufficient research-backed data, insurers may not reimburse treatment centers for kratom-specific care.

4. Coding and Diagnostic Limitations

Insurance billing and reimbursement rely on standardized medical codes. Kratom addiction does not have a unique diagnostic code, and providers may have to code it under a general category like “other psychoactive substance abuse” or “non-specified substance use disorder.” These vague codes may trigger rejections or denials during claims processing.

5. Stigma and Misunderstanding

There is still a significant lack of awareness and stigma around kratom addiction—even in medical and insurance circles. Many still perceive kratom as “natural” or “safe,” contributing to its underestimation as a substance of concern and its exclusion from coverage.

What Can Be Done?

Despite these barriers, individuals addicted to kratom can still access treatment, often by:

• Having the provider code the primary issue as a generalized Substance Use Disorder or use co-occurring diagnoses such as anxiety, depression, or opioid use disorder if applicable.

• Working with a treatment center experienced in navigating insurance complexities.

• Pursuing out-of-network benefits or appealing denied claims with documentation of medical necessity.

The gap in insurance coverage for kratom addiction is a frustrating and dangerous oversight in the behavioral health system. As awareness grows and more data becomes available, it’s likely insurance policies will evolve to address this unmet need.

If you or a loved one is struggling with kratom use, treatment is still possible—and often necessary—even if insurance doesn’t cover it fully. Reach out to a treatment center familiar with alternative financing options, advocacy, and appeals.

Hope and Healing

Kratom addiction is real, but so is recovery. If you or someone you love is struggling with dependence on kratom, don’t wait. Our compassionate, experienced team is here to help you reclaim your life.

Contact us today to learn more about our treatment programs and start your path to recovery.