Paying for Rehab With Insurance
Mental and health services are considered essential medical services, meaning addiction treatment is covered — by law — through major national and regional health insurance providers. Plans must cover services provided by inpatient detox and rehab centers, addiction therapy and counseling and other substance use disorder treatment options. Types of addiction treatment covered by health insurance providers include:
The Affordable Care Act (ACA) went into effect in 2010. According to the U.S. Department of Health and Human Services, “The ACA provides one of the largest expansions of mental health and substance use disorder coverage. The law requires that most individual and small employer health insurance plans, including all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services. Also required are rehabilitative and habilitative services that can help support people with behavioral health challenges.”
What does this mean? Essentially, it means addiction treatment services must be covered by most insurance providers. When it comes to paying for rehab, looking into your current insurance provider is always a recommended first step.
Your specific addiction treatment benefits depend on what state you live in and what insurance coverage policy you choose, though there is a very good chance your current provider will cover some or all of the treatment services provided by the rehab center you are looking into. Most rehab centers also offer free, no obligation health insurance benefit checks which can be completed over the phone in a matter of minutes. If you are considering seeking treatment through Immersion Recovery Center, we offer health insurance benefit checks to help you quickly determine how much of our recovery program is covered.
Using Out-of-Network Insurance for Rehab
If a specific rehab center is “in-network” it means it will provide addiction treatment services at a discounted rate. If the treatment center you are looking at is “out-of-network” with your current provider, it means it does not accept a pre-approved amount for the addiction services it provides.
Essentially, this means the rehab center can charge you the full price for services and you will likely have more out-of-pocket costs. However, out-of-network facilities often offer nicer amenities and have more ancillary services.
When looking into using out-of-network insurance for rehab it is important to understand the difference between PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization). HMO coverage restricts patients to in-network medical professionals and treatment services, and those with HMO coverage must see their primary physician to receive a referral before receiving specialized treatment. PPO coverage allows patients to choose any healthcare service they’d like, whether it is in-network or out-of-network. PPO plans allow people to see an addiction treatment specialist or seek drug and alcohol rehab without a referral.
Using In-Network Insurance for Rehab
Finding an in-network rehab center is often easier, and it means the majority of the addiction treatment services offered are covered either partially or in full. However, there are some negative aspects to choosing an in-network rehab center. Costs might be lower, but your stay in treatment will likely be shorter. In-network treatment centers might not offer the best amenities. Treatment groups are often larger and the clinical care provided is often less individualized and tailored to the unique needs of each client. It is a good idea to weigh all of the pros and cons before making any final decisions.