Use this form to quickly and easily verify private or company provided PPO health insurance plan benefits for addiction treatment services.
If you have a substance use disorder (SUD), entering an addiction treatment center is important for a successful recovery. A recent study shows that more than 20 million Americans had an SUD in 2019, and only 4% of them received addiction treatment. Cost of care is one of the biggest barriers to people entering rehab. You may be wondering if you can afford rehab and if there is addiction treatment insurance available for you.
Does Health Insurance Cover Addiction Treatment?
You will find that many types of insurance cover all or part of the cost of addiction treatment and rehab. In the past few years, the Affordable Care Act made it mandatory for insurance policies issued under state health exchanges and through Medicaid programs to provide coverage for addiction treatment.
Insurance plans often utilize co-pays and deductibles to help you pay for the healthcare you need. This is true for addiction treatment insurance as well. Your provider will let you know what your co-pay for treatment is and how much you will need to pay out of pocket before services are fully covered by the insurance company.
You can visit your insurance carrier’s website or call the phone number listed on the back of your insurance card to find out what services your policy covers. You can also call Dana Point Rehab directly to speak with someone who can verify your coverage and give more information on addiction treatment costs.
Types of Insurance Plans
There are three main types of insurance plans that can help pay for your addiction treatment.
HMO (Health Maintenance Organization) Plans
These types of insurance plans require you to choose a primary doctor who is covered by your plan. You must commit to seeing this doctor in order to be eligible for your co-pays and deductibles. If you need to see a specialist while on an HMO plan, you will need a referral from your primary doctor. These types of insurance plans usually have lower deductibles and monthly premiums, and they can be extremely helpful in covering some of the costs of addiction treatment.
PPO (Preferred Provider Organization) Plans
PPOs offer a bit more freedom than an HMO in that you don’t have to commit to a specific primary care doctor, but rather you are free to see any doctor who is in-network with your insurance provider. You also do not need referrals to see in-network physicians. These plans tend to be more expensive, but they sometimes cover more of your healthcare costs.
POS (Point of Sale) Plans
Point-of-sale plans are similar to HMO plans, but with some POS plans, you can see a doctor that is outside of your provider’s network. These rules are different for each plan, so you should always check with your provider to find out exactly what your insurance coverage looks like.
Understanding Your Insurance Plan
Insurance policies can be confusing and hard to understand. They often use jargon and terms that you may be unfamiliar with, making you wonder what your policy actually covers and what you will have to pay out of pocket. Dana Point Rehab has insurance specialists on staff that can support you in this process. They will verify your insurance coverage and help you understand what to expect in regards to paying for your addiction treatment.
Most insurance plans will pay a large portion of your expenses, but you will most likely still have to cover some costs yourself. Some of the out-of-pocket expenses you can expect will be:
- Monthly premiums that you pay to your insurance company for your plan
- Co-pays which are small fees associated with various doctors and services
- Deductibles that are set amounts you must reach in out-of-pocket costs before your insurance company starts to cover expenses
Your policy may also have annual or lifetime limitations that limit your coverage up to a certain amount. If that is the case, you will be responsible for all healthcare costs beyond that limit.
What Will Insurance Cover?
Each insurance plan is different in what your copays and deductibles will look like. Most insurance plans will cover a portion of rehab services, which include:
- Inpatient detox care
- Inpatient and outpatient therapy services
- Group therapy and peer support
- Medical staff that can prescribe appropriate medications for your condition
- Follow-up care for after you leave rehab
If you have co-occurring conditions like addiction and a mental health issue, insurance can help pay for a treatment plan that covers all areas needing help.
How to Use Insurance for Addiction Treatment
The first step in using insurance for your addiction treatment is to talk with a rehab center and get an assessment that can outline your treatment needs. Once you’ve received a recommendation for your care, you can speak with the rehab center directly or with your insurance company to find out what parts of the treatment plan will be covered and what you will need to pay.
Even if your insurance does not cover all of your costs, most rehab centers will work with you on how to pay for treatment.
Dana Point Rehab is a highly effective treatment center that works with most insurance providers to get you the help you need. Currently, DPR does not accept Medicaid or any other state-funded insurance providers, but don’t let that keep you from seeking treatment.
If you or a loved one is struggling with an addiction, call Dana Point Rehab to learn more about your treatment and payment options.