When it comes to drug rehab (especially in emergency situations), you often don’t have time to make sure that your treatment center is within your network. Out-of-network treatment means that you are outside of the range of your insurance plan’s treatment area. This can change a lot about your rehab experience, so it’s important to understand as much about this topic as possible.

What Out-Of-Network Means

Out-of-network providers are those that lie outside of your insurance coverage area in terms of the specific company or plan. The range of a network varies depending on the type of insurance you receive. For example, HMO insurance is typically bound to a strict geographical area and venturing outside of it is impossible, should you want coverage. However, PPO insurance usually has a wider coverage area and one in which you can receive benefits, as long you’re willing to pay more.

The same is true of POS plans and indemnity plans. The first is a combination of HMO and PPO style plans, by requiring a primary physician who must approve all coverage, but also allowing you to get coverage outside of your network.

Another major difference is that out-of-network providers don’t have to follow any type of fee schedule and can charge what they like. When it comes to out-of-network coverage, your benefits (if you have any) will be based on your Maximum Allowable Amounts level. This will cover much of the cost of your care, but will be lower than if you received in-network coverage.

Many Providers Do Have Out-Of-Network Coverage Options

The difficulties of out-of-network drug rehab benefits have forced many insurance providers to create coverage options that better manage these situations. These options typically manage your benefits based on a “reasonable and customary amount,” which is gauged based on the payment that is typical for the healthcare professionals in that area.

Typically, you will be charged the lower of either the out-of-network provider’s actual bill or the “reasonable” amount mentioned above. The exact value of these charges will vary, but it’s worth knowing that drug addiction treatment is usually covered here under the “mental health treatment” segment of most insurance policies.

Receiving A Fair Charge

Out-of-network options like these are designed to keep you from paying too much for your service. For example, if an out-of-network rehab sends you a bill that is higher than the “fair and reasonable” amount, your insurance company will send a check for the latter amount. Though it won’t cover the totality of your treatment, it can help alleviate most of your financial burden.

It can also help you set up a schedule of charges which out-of-network providers may deny you otherwise. A schedule of charges lets you create a payment system that is fair to you and the health service provider.

For example, you might pay for inpatient treatment with a payment system for the remainder of your bill over a two- to five-year period. This helps get you the treatment you need without costing you too much money. It’s worth noting that a majority of rehab centers will offer some form of “sliding-scale” fee based on your income. This helps make treatment costs easier to manage.

Why Go Out Of Network?

Typically, most people will stay in-network when receiving drug rehab, but there are many times when that is not an option. In fact, going out-of-network can actually be beneficial in several different circumstances, including the following:

  • Separation from a negative environment – Drug abuse is heavily affected by your environment, and sometimes you need to pull yourself from a negative one in order to recover successfully. An out-of-network rehab center can often provide that productive isolation.
  • Specialized care – There’s a possibility that you want or require specialized treatment, such as wilderness therapy, in order to recover. If no in-network centers offer you these benefits, out-of-network coverage might be required.
  • Changing insurance coverage – If you are moving to a new area or changing your insurance, it might be worth utilizing out-of-network insurance simply to receive some benefits. This is especially true if your insurance might be canceled soon and you have no other choice.
  • Emergency situations – Life might take you out of your service area, so if you suffer from a drug-related emergency, such as an overdose, out-of-network rehabs can help you get back on your feet more quickly.

Maximizing your out-of-network benefits is a hard game that can be difficult for anyone to master alone. If you’re suffering from drug addiction and need help managing out-of-network benefits, please talk to your insurance agent as soon as possible.

Get Help Now