Insurance Coverage for Addiction Rehab
We want to help you get started on your journey to sobriety, so we will provide you with information that can help to answer some of the most common questions people typically have regarding qualifying plans.
Preferred Provider Organization
Preferred Provider Organization, or PPO, plans allow individuals to see any provider of their choosing without needing a prior referral. Providers included within the plan’s network are typically the most affordable, but insurance will still cover a portion of the costs of seeing an out-of-network provider.
High Deductible Health Plan
This group of plans is usually abbreviated as HDHP. Individuals with an HDHP will usually pay much lower monthly premiums, but they will also have to pay a lot more in out-of-pocket expenses before the insurance company will cover any medical services.
Health Maintenance Organization
These are what are generally referred to as HMOs, and they are a bit more limiting than a PPO. Out-of-network providers are not covered at all, and patients must receive referrals to see in-network specialists. You may use your HMO Insurance policies with Cigna. More HMO’s to come…
Health Savings Account
A Health Savings Account, or HSA, is a specialized account that can be paid into throughout the year. It has special tax advantages and allows a lot of flexibility when it comes to paying medical expenses. HSAs are often paired together with HDHPs for more comprehensive care.
Basic Insurance Terminology
In order to help you understand how to use your insurance to help pay for rehab services, you should also be able to decipher the jargon insurance companies use. Below are the explanations behind the most common terms so that you can navigate conversations about coverage more easily.
To put it simply, this is the amount of money you will be expected to pay before your insurance company will cover the rest of the bill. This is money that must be paid in addition to your premium, and your premium does not count towards the total amount.
For most plans, the deductible is an annual amount, and once you’ve paid that amount, everything beyond that will be covered at a predetermined rate by your insurer.
A copay is a small, fixed amount of money that you are expected to pay upfront at the time of service. It can range anywhere from $50 to $750, depending on your plan and the type of policy you have.
Like your premium, this payment does not count towards your yearly deductible.
This is the amount that you pay each month in order to remain covered by your insurance plan. As mentioned above, it does not count towards your deductible.
This is the amount that your insurance agrees to pay after you’ve reached your deductible. For some plans, patients are covered 100 percent, but others may only cover 75 to 80 percent, which leaves a portion that the patient is still responsible for.
The term “in-network” refers to a select group of providers that your insurance company has made agreements with in order to lower costs. By choosing in-network care, you typically receive the most discounted services. We are In Network with Cigna currently.
You will usually hear this as either “out-of-pocket expenses” or “out-of-pocket maximum.” Out-of-pocket expenses refers to the money you will be expected to pay for your care. The out-of-pocket maximum is the maximum amount you will be expected to pay for services. Once this cap has been reached, your PPO will cover any further costs.
Addiction and Mental Health Services Benefits
According to Healthcare.gov, the Affordable Care Act has included substance abuse and mental health care services as essential healthcare benefits. This means they must be covered like any other medical service according to your specific plan’s guidelines.
If the care is deemed medically necessary, most PPOs have specific coverage limitations per calendar year, such as 30 days for inpatient care and 30 outpatient rehab visits.
- Substance abuse services typically include the following:
- Medical detoxification
- Inpatient treatment
- Residential rehabilitation programs
- Outpatient care programs
How to Get Coverage for Our Program
Your specific insurance company may have its own list of requirements before it will provide coverage, but in general, there are things you can do to make getting coverage easier.
- Start With Your Physician – Your primary care physician will be able to give you a referral for our facility, which makes dealing with your insurance company less of a hassle.
- Review Your Coverage – We accept most major PPOs, but you should make sure that we are on your in-network provider list first so that there are no surprise out-of-network costs. If we are not considered in-network by your insurer, there is a good chance that you can still get partial coverage. We are happy to help you calculate what your out-of-pocket costs may be if necessary.
- Speak With Customer Service – It can sometimes be confusing to determine what is and is not covered simply by reviewing your paperwork. If this happens, don’t hesitate to call your insurance company and ask as many questions as you need to.