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Differences in Addiction Treatment Insurance Coverage

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Once you’ve made the decision to seek treatment for drug or alcohol addiction, you may find yourself overwhelmed with options. Higher quality programs tend to produce better addiction recovery outcomes, and residential treatment programs have been linked to lower relapse rates. However, these may cost more than the alternatives. Before you write these off due to financial constraints, check to see if your insurance provider may cover some of the costs. Keep in mind that HMO and PPO health plans may differ in the kinds of drug rehabilitation services that are covered.

What is an HMO?

A Health Maintenance Organization, or HMO, is a company that works with insurance providers to deliver care from within a local network of doctors and specialists. You have a network-approved primary care physician (commonly referred to as a PCP) that provides a centralized source for all your general healthcare needs. If you need services they can’t provide, they can refer you to other doctors or specialists. This system usually provides lower premiums and deductibles, but it might be more difficult to find treatment outside of the network as your PCP’s authorization is required. Most services are limited to specialists who are network members, and you may encounter limits on procedures and annual visitation.

What is a PPO?

Alternatively, a Preferred Provider Organization (PPO) is a health insurance group that uses a local provider network to bring you medical services at discounted premiums and deductibles. It’s generally easier to receive care outside of the network as you aren’t required to have a primary physician’s authorization. However, organizing your healthcare could be a little more complicated due to this decentralized nature. More paperwork is usually required, and the costs could be less predictable than an HMO.

Finding Your Level of Substance Abuse Insurance Coverage

Detoxification is usually covered by most insurance providers as withdrawal symptoms may have serious or even fatal complications if not monitored by professional medical personnel. With both kinds of insurance plans, at least some level of assistance for inpatient and outpatient services is typically provided to help mitigate the costs. It’s a good idea to check with your insurance representative to clear up any confusion before committing to a program. This can help you avoid any surprises in payment. Ask questions like:

  • Am I covered throughout the rehabilitation process (detox, inpatient and aftercare)?
  • Are there limitations on the length of coverage for these services?
  • Will prescribed medications be covered under my plan?
  • How much is my copay or deductible?
  • Am I required to choose from a list of authorized facilities?

Design for Change Can Help Find Answers

If you have questions about your insurance and treatment at Design for Change, our admissions specialists are here for you. We also have scholarship programs that can help with payment. Addiction is a serious disease, and we understand that no two situations are exactly alike. That’s why you’ll receive a personalized treatment plan after meeting with our staff. We will advocate for you to the insurance company to make sure they understand your needs. Take the next step on your road to recovery and call now for a confidential consultation.

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