A Guide on Whether Insurance Covers Drug Rehab
Entering drug rehab can be stressful enough on its own, as the act of attempting to change an addictive behavior can be challenging in and of itself. But when you begin to throw the cost of rehabilitation stay into the mix, the prospect of entering treatment can become an overwhelming situation. Successfully overcoming a drug addiction often requires specialized treatment, which can include multiple interventions from various disciplines. In order to reduce one’s stress regarding their path to sobriety, it’s important to answer the question: does insurance cover drug rehab?
Understand Your Coverage
Before you take the critical step of entering a drug rehab program, it’s a good idea to get a firm understanding of what your current insurance policy will cover. Finding out the specifics of your policy will allow you to plan for the out-of-pocket expense that may accompany a drug treatment stay. Insurance policies may include very nuanced requirements, requiring clients to work with specific facilities and covering certain portions of the treatment process but not others.
Many individuals who are caught in the midst of their addiction will be wondering: does insurance cover drug rehab? As a way to ease one’s anxiety regarding the cost of treatment, a useful way to reduce the financial stress associated with rehab is to contact your insurance company to discuss the specifics of your coverage. Prior to doing this, it’s a good idea to write a list of questions to ask your insurance provider to make sure all of your bases are covered.
You will want to find out what parts of your drug rehabilitation will be covered, including detox, inpatient stays, and continuing care in an outpatient setting. You will also want your insurance company to discuss your out-of-pocket costs associated with treatment, including your copay and deductible. The more questions a person asks regarding their treatment, the more information they will be armed with prior to treatment, reducing uncertainty in the process.
In-network Vs. Out-of-Network
In the process of determining how much of a drug rehab stay is covered, a person will want to find out if their policy requires them to work with specific, in-network providers. Often times, insurance policies have strict parameters in terms of which preferred providers they will cover treatment for. In-network providers will usually be covered at a greater rate than out-of-network providers.
Many times, insurance policies will still allow an individual to seek treatment out of network, but will cover only a fraction of the cost as compared with in-network providers. If a person has a treatment facility they have their heart set on, it may be worth considering whether the increased out-of-pocket costs are worth it if the chances of successfully overcoming their addiction are improved. In the overall scheme of life, attaining lasting sobriety is nearly priceless, often making the decision to opt for an out-of-network provider a sensible one.
Most importantly, remember that ultimately you are in control of your recovery, and that may mean that you do not let your insurance company dictate where you feel the most comfortable getting help.
HMO Vs. PPO Policies
Another important distinction to make in regards to whether your drug rehab will be covered by insurance is to understand the difference between an HMO and a PPO. An HMO is defined as a health maintenance organization, which is a company that works with a set network of medical providers to meet their health needs. Within an HMO setting, patients work with a network-approved primary care physician to satisfy their general medical requirements. HMOs tend to have lower premiums, as they save money by requiring patients to use a stricter provider network within a centralized health care system.
A preferred provider organization, or PPO, is a health insurance group which facilitates a network of care with providers in your area, providing coverage discounts to patients who choose to work with preferred providers. However, PPOs tend to provide patients with more flexibility with regards to what providers they are able to utilize. If you have an HMO and need to seek treatment in an area that doesn’t have in-network providers, you will incur a greater amount of out-of-pocket costs as compared with individuals who choose to use a PPO. Quite simply, HMOs control costs for patients but provide less freedom, while a PPO allows more flexibility for patients but with the potential of incurring higher, less predictable costs.
Selecting a Drug Rehab that’s Right for You
When determining what your insurance will cover in regards to treatment, the most important component of the drug rehabilitation process is selecting a program which fits your unique needs and specific requirements. Choose a drug rehab facility that you are most comfortable with and then work directly with them to verify your insurance benefits.
Determining what your insurance will cover is an important part of the budgeting process, but it isn’t the only thing you should consider. Selecting a rehab program which saves on costs but skimps on effectiveness is not worth the immediate financial savings, as you should prioritize a program which will set you up for success and lasting sobriety.
If you or a loved one is struggling with addiction, of if you have questions on what your insurance will cover during rehab, contact Ocean Hills Recovery today. Our professional staff is ready to assist you with questions regarding our services and costs. Choosing the right rehabilitation center makes all the difference when you are ready to start your journey to recovery.
About the author:
Nicole earned her doctoral degree in Psychology with an emphasis on marriage and family therapy at California School of Professional Psychology. Her doctoral thesis was a grounded theory study exploring the role of alienation and connectedness in the life course of addiction. She specializes in treating addiction and trauma. She is certified in DBT and EMDR, two of the most highly regarded evidence-based methods in psychotherapy. Dr. Doss is a strong LGBT advocate and provides open and affirming support to her LGBT clients.
Dr. Doss’s earlier education included graduating cum laude from the University of California, Irvine in June of 2007 with a Bachelor’s degree in Psychology. While there, she received honors recognition by Psi Chi and Golden Key honor societies.
Nicole has been working with alcoholics and addicts in our California drug and alcohol rehab center as an advisor and counselor for many years. She is passionate about providing quality counseling and care to her clients. Her main focus is on integrating the 12 Step and disease models of addiction with experiential therapeutic theory. She is married to Greg; they have two adorable sons together and an energetic yellow Labrador Retriever.