Drug rehab is an important way to regain control of your life and insurance is often key to paying for this service. If you are interested in rehab, you need to understand your in-network insurance benefits. Typically, you’re going to want to stay in your network when at all possible when receiving treatment for addiction. The following information will help you understand in-network insurance, how coverage networks are defined, and why staying in-network is a good idea.


Understanding An In-Network Insurance Company

In-network insurance is that which works within a specific group and offers services at pre-negotiated rates. Typically, PPO, POS, and HMO plans fall within the realm of in-network insurance, types that do not include indemnity plans. Understanding the differences between the first three is important to gauging the types of benefits that you will receive with your insurance.

HMO stands for “health maintenance organization,” and under this plan, you have certain types of restrictions that limit your care outside the network. For example, your number of visits and tests might be limited. HMO plans require you to pick a primary care physician who helps you decide on a treatment. Unfortunately, you typically cannot use HMO plans outside of the network, but your premiums are lower than with other plans.

PPO plans or “preferred provider organization” also feature a network of accepted centers, but one that is much wider than an HMO. You can also see any doctor or specialist you would like without pre-authorization and out-of-network care will be covered at a lower rate. However, the premiums will be higher.

Between these two plans lies POS or “point of service” plans. They require visiting a primary physician from whom you must receive referrals before seeing network specialists, though you don’t have to worry about deductibles and can also have some (but not all) of your out-of-network treatment covered.  Choosing between these three depends on your unique addiction treatment needs, though all three offer quality in-network addiction treatment.

How Networks Are Defined

People often struggle to understand what is meant by the term “network” as applied to healthcare and insurance. This confusion is understandable; networks are typically broken down in two ways. The first is by geographical location. For example, an HMO is often defined to a specific area of a state which is covered by that specific insurance.

However, that geographical area will vary depending on the size of the network. PPO networks are typically larger than those of an HMO and can sometimes include multiple states or even entire regions of the country. Your geographical network is defined by the terms of your insurance, so make sure to carefully read this before signing up for any type of addiction recovery service.

Networks are also set by corporate ownership. For example, a single company may own multiple health providers or rehab centers, and will sign them all up to work with different insurance companies. As a result, a PPO network might include centers outside of a geographical area. Again, it all depends on your insurance company.


Why Staying In-Network Is Beneficial

When choosing a rehab center, staying within your network is beneficial for a variety of reasons. The first of these is financial. Your in-network benefits are always higher than out-of-network benefits, making it easier for you to pay for treatment. Any deductible or premium will be lower as well. It’s also cheaper to get treatment in a nearby network center by avoiding excessive travel costs.

That geographical closeness is also beneficial for support reasons. For example, it’ll be easier for you to visit friends and family members, should you need help during the hardest parts of recovery. It’ll also be easier for you to return home and regain your life, rather than investing in an expensive plane, bus, or train ticket.


Important Considerations When Starting A Treatment Program

Before you jump into treatment, you need to take account of certain considerations that will dictate your coverage and your treatment. The following information should be carefully investigated and discussed with your insurance company before beginning:

  • The type of treatment you want – Typically, inpatient stays of at last 90 days are recommended for most addiction cases, and most insurance companies will cover this is if it is deemed medically necessary.
  • Where you want to receive treatment – Staying in-network usually means staying close to home, but you don’t have to stay in your hometown. There should be multiple treatment centers in your network from which you can choose.
  • What is covered by insurance – Types of treatment, as well as maximum coverage, will vary depending on insurance types. For example, some will cover only outpatient services, while others will go as far as to offer holistic treatment methods.

Talk to your insurance agent about these and other questions before receiving addiction therapy. They can help you choose the type of insurance that is right for your needs and find an in-network treatment center that works well for your addiction recovery.


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