Modified: 22nd Jul 2019

Last updated on July 22nd, 2019 at 12:44 pm

One question that always comes up when a person is struggling with addiction is, “How do I know if I’m covered for alcohol and drug rehab?”

Considering that successful recovery from a substance abuse or alcohol addiction depends on specialized treatment, it’s no surprise that this question is a major concern for so many American families. The most straightforward and honest answer to the question is, “It depends on your insurance provider.”

Whether you have insurance coverage for substance abuse and alcohol rehabilitation will depend on a long list of factors, including the structure of your insurance plan, specific health insurance coverage policies and the size of the insurance company’s preferred provider network.

There is no one-size-fits-all answer to this question. However, following these steps will help you and your family get the right answers to important insurance coverage questions.

Review Your Insurance Coverage

Start by reaching out to your insurance company directly. It helps to prepare a list of specific questions before making the call.

Discussing the nuances of insurance coverage can quickly become overwhelming, but having a list of questions relating to your policy and the specific details you’re looking for will help you to focus your thoughts.

These are just a sample of the types of questions that will get you the information you need:

  • “Does my insurance coverage include every phase of drug or alcohol rehab (detox, inpatient and aftercare)?”
  • “Will my policy cover any of the medications prescribed to me during drug and alcohol rehab?”
  • “Does my policy cover the different types of counseling programs that are often included in substance abuse rehab treatment programs?”
  • “What will my copay and/or deductible be if I choose to seek treatment for addiction?”
  • “What rehab treatment programs are covered by my current policy?”
  • “Does my policy require me to seek rehab treatment within a provider network?”

What Types of Addiction Treatment Programs Are Covered By Insurance?

Contact Us Today to Get a Professional Review of Your InsuranceAgain, the answer to this question will greatly depend on your insurance provider and your coverage plan.

Generally speaking, detoxification is the most likely service to be covered by your insurance, especially since patients face fatal addiction withdrawal symptoms if their detox process is not monitored by experienced health care professionals.

Outpatient and inpatient rehab coverage vary widely between insurance plans, but most policyholders should expect their insurance provider to at least mitigate these costs with partial coverage for their addiction treatment.

The Difference Between HMO and PPO Insurance Plans for Rehab

Do you have an HMO or a PPO health insurance plan? Understanding the differences will help give you a clearer idea of whether an addiction treatment center will accept your insurance.

Click on one of the following options to better understand the differences between HMO and PPO plans:

What is an HMO?

A health maintenance organization, more commonly known as an “HMO,” is a company that works with insurance providers to make care available within an established network of local medical professionals. Patients rely on a network-approved primary care physician (PCP) to handle their general medical needs. When patients require a specialist, their PCP will recommend another health care provider within the same network.

The main reason that most people elect to sign up with an HMO is to save money on their premiums. Other benefits of insurance through an HMO include:

  • Centralized Health Care Services
  • Streamlined Care Though Primary Care Physician
  • Lower Premiums and Deductibles

There are some cases where an HMO offers little benefit to a patient, however. Individuals must carefully evaluate their own medical history, as well as the plan options available through an HMO, before deciding on which insurance plan is the best fit for their needs.

Potential reasons to avoid an insurance plan through an HMO include:

  • Care Limited to Network Members
  • PCP Has the Last Word
  • Annual Visitation and Procedure Limits

What is a PPO?

A preferred provider organization, more popularly known as a “PPO,” is a health insurance group that establishes a network of care through participating local providers. The medical professionals who participate are guaranteed a pipeline of potential patients, while members enjoy a discount on premiums and deductibles.

Whereas HMO customers enjoy the security of their plans, PPO policyholders enjoy the flexibility of theirs. While in-network coverage under an HMO plan is guaranteed, those customers have considerably fewer options if they need medical help out of network, such as if an emergency occurs while they are on vacation.

The key benefits of insurance through a PPO include:

  • Freedom of Choice Among Providers
  • No Need for Primary Physician Referrals
  • Partial Out-of-Network Coverage

There are some cases where a PPO is not the best option, though. This may be related to cost savings or coverage options, but it’s clear that the PPO is not the right fit for every insurance customer.

Potential disadvantages of acquiring an insurance plan through a PPO include:

  • Less Predictable Costs
  • Potential for Disorganized Care
  • Additional Paperwork for Claims, etc.

Work With an Insurance Coverage Professional

Navigating complex insurance policies on your own can be extremely difficult. You may find that speaking to your insurer directly leaves you with more questions than answers. In cases like these, you and your family are better off reaching out for extra support rather than making an uninformed decision.

Our team of addiction professionals offer over a decade of experience with addiction and finding rehab treatment options, such as inpatient or outpatient treatment programs. We are more than willing to lend our expertise to families when they have questions about insurance coverage. We have experience in working with a wide range of providers, including:

Our professionals are dedicated to educating families about the best ways to get a loved one into an effective rehab program without breaking the bank.

Learn About Your Provider

Consider Drug and Alcohol Rehab Without Insurance

If the answer to, “Do I have insurance coverage for drug and alcohol rehab programs?” is a no, don’t give up hope. There are still multiple options for covering the costs of a life-saving inpatient or outpatient addiction treatment program.

Many treatment centers offer affordable payment plans to patients who are in need of help but aren’t covered by their insurance providers. Some even offer financial assistance in extreme cases where patients need immediate help and care.

Families may have to do some digging to find a solution, but opportunities for covering rehab treatment are certainly available. Consider working with an industry expert to help you identify new ways to save money on the addiction recovery treatment you or your loved one desperately needs.

Begin Your Addiction Recovery Process Today

You shouldn’t have to let a confusing insurance policy stop you from asking your provider for hard answers about coverage. Granted, that’s easier said than done. Knowing what to ask and how to ask is much easier when you have an industry expert at your side.

At Northbound Addiction Treatment Services, our mission is to help families make informed decisions about alcohol and drug rehabilitation and treatment options. Give us a call or contact us online if you’d like some straight answers about your convoluted insurance plan.

Article Reviewed by Dr. Keerthy Sunder, MD, DFAPA

Dr. Keerthy Sunder, MD, DFAPADr. Keerthy Sunder, MD is an accomplished and internationally recognized expert in the field of addiction. He has earned diplomates from the American Board of Psychiatry and Neurology, the American Board of Addiction Medicine, and the Royal College of Obstetricians and Gynecologists.

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