Understanding In-Network and Out-of-Network Rehabs

Choosing the right treatment center for addiction treatment is crucial for helping you reach and sustain recovery for the long term.  If you have health insurance, an HMO, or a PPO, you may be required to choose from in-network rehabs.  However, some insurers allow you to choose an out-of-network facility.  In either case, finding the best program for your situation can be confusing.

Determining which option is right for you takes time and research.  Therefore, we’d like to help you make an informed decision to ensure you get the best treatment possible.  Here are some things you should know about out-of-network and in-network rehabs.

What Does In-Network and Out-of-Network Mean?

An out-of-network rehab is one that is not included in your insurance company’s approved network of treatment providers.  While out-of-network treatment tends to cost two or three times more than in-network programs, you may find one that is affordable.  

An in-network program is one that has an agreement with the insurer to charge a preset amount for treatment.  Facilities must adhere to strict standards as far as client care and safety to qualify as an in-network provider.

Out-of-pocket cost is often a determining factor when choosing in-network vs. out-of-network rehab.  Sometimes, co-pays and deductibles with an in-network provider can be high.  Before making a choice, review your insurance to determine how much financial responsibility you will have to bear.  This will help you determine which is the more affordable option for your budget.

Of course, the price of treatment should not be your sole deciding factor, but it can make a difference in the level of care you choose. Typically, an in-network treatment program is more affordable than an out-of-network program.  However, lower costs may mean you get less than optimal care with some facilities.  Finding an ethical in-network program that offers evidence-based, full continuum of care programs is the best option.  

Benefits of In-Network Rehabs

In-network rehabs are also known as participating providers.  This means the rehab has a contract with the insurer that establishes a fixed price for certain services provided.  Typically, you’ll pay less for in-network rehab than you would for an out-of-network program. 

Some of the many benefits of in-network rehabs include:

• Affordability – An in-network program is more economical than other programs, and you’ll pay fewer out-of-pocket expenses.  Of course, you’ll have to pay deductibles and copays, but these costs are often reduced by the in-network contract.
• Choice – You can choose from in-network rehabs that you can search for through your insurance company’s online personal portal.  By having a choice, you’ll feel more in control of your treatment and gain an improved sense of well-being.
• Trust – When your insurer lists a rehab as an in-network provider, that means the rehab has earned the insurer’s trust by providing excellent client care.
• Credentials – Choosing a credentialed rehab facility is crucial to ensuring you get high-quality treatment.  Look for a  JCAHO-accredited facility.  The accreditation seal proves that the facility consistently meets or exceeds stringent standards in client care and safety.  JCAHO audits the facilities annually to ensure that the facility is being run ethically.

Benefits of Out-of-Network Rehabs

Despite costing more for treatment, out-of-network rehabs do provide some benefits.  For instance, if someone needs immediate care and no in-network facilities are available, an out-of-network facility can fill the gap.  

People choose out-of-network rehabs because they provide treatment services, locations, or amenities that are not available through an in-network facility.

What Does Insurance Cover for In-Network Rehabs?

Insurance companies generally cover partial or full coverage for detox, outpatient, inpatient, and partial hospitalization programs, dual-diagnosis treatment, and aftercare services.  They may also provide coverage for medication-assisted treatment (MAT) for individuals with opioid or alcohol use disorders.

If you’re exploring treatment options, talk with a treatment advisor at the facility you’re considering.  They have the expertise to evaluate your insurance and determine the best treatment plan available under your policy limits.  

Why Choose Design for Change Recovery?

Whether you are looking for in-network or out-of-network treatment, Design for Change can help.  We are in-network with many major insurance companies to ensure affordable, high-quality addiction treatment.  If you don’t have insurance, Design for Change will help you find alternate payment resources.  We will assist you in any way to ensure you get the right program for your situation.  

Design for Change provides evidence-based, full continuum of care programs that help clients gain the skills, confidence, and motivation to maintain long-term sobriety.  Our goal is to help clients look inward to identify the underlying reasons why they abuse drugs or alcohol.  To achieve this goal, we offer therapies that target the physical, emotional, mental, and spiritual aspects of SUD that promote whole-person healing.

Reach out to us by phone, email, or online to learn more about how we can help you achieve freedom from substance use and enjoy the many wonders of sober living. 

Sources:

cms.gov/ – What You Should Know About Provider Networks

ncbi.nlm.nih.gov/ – Creating the Continuum of Care