If you’re struggling with addiction and are seeking treatment, you are making the right first step by looking into insurance coverage for rehab. The road to recovery begins with acknowledging the problem and working towards improving your health.
Scottsdale rehab centers are a crucial resource to those suffering from addiction, guiding you through the process from detox through to post-addiction recovery. Due to how crucial of a role your rehab center plays, choosing the right provider is vital to your treatment and recovery progress.
Once you begin considering treatment, your first decision is likely going to be picking a care facility to go to. Your insurance will most likely push you one way towards an in-network rehab, while research and recommendations may lead you to an out-of-network rehab. But which should you choose?
Considering the Role of Your Health Insurance Plan
In many cases, your insurance plan will play a significant role in choosing your facility because they determine how much treatment will cost you. While you shouldn’t let the price of treatment control your decision, having the right insurance plan may allow you to choose a higher-quality treatment center without changing the price.
HMO vs PPO Coverage for Rehab
There are 2 primary forms of insurance plans: HMOs and PPOs. A HMO plan is a plan that focuses on lower monthly premiums and more coverage, but will only cover treatment at facilities they approve within their network. Many HMO plans will not cover any out-of-network treatment.
Alternatively, a PPO will cover a specific amount of your costs at just about any facility – in-network or out-of-network – but costs will vary between in and out-of-network rehabs.
If you have a PPO plan, the decision to choose your facility based on your research and go out-of-network is a no brainer. If you have a HMO and want to go out-of-network, the decision may be harder financially, but when it comes to your health and ultimately your life, there is more to consider than the dollar sign.
Do What’s Best for Your Recovery – Not Just Your Wallet
Depending on your insurance provider, you will likely have a variety of rehabs that are “in-network”, meaning that they have pre-arranged deals with your insurance company for specific treatments at specific rates.
Be warned, that in many cases, in-network providers do have to sacrifice the quality of care in order to stay in business at the rates that insurance companies set.
The following scenario is completely fictional in terms of the monetary figures used, but it can be helpful to illustrate how insurance companies work to make money:
When any healthcare provider becomes an in-network provider with an insurance company, they have to agree to a set price for every service. When an item or service price is set, it comes from the insurance companies – not the provider.
This means that even though it may cost $1,000 for something, the insurance company may determine they are only going to pay $300 for that same service.
The provider (the rehab, in this case) will then only be able to collect $300. So what happens to the other $700? The rehab has to write off the remaining $700.
In order to stay in business, many in-network rehabs will instead offer a lesser option of the service.
While health insurance helps to save many lives, it’s important to remember that insurance companies are for profit businesses.
These insurance companies like to save money where they can and pushing you towards one of their in-network rehabs allows for just that. In many cases, these facilities will be cheaper and appear to have more coverage from your plan but may not be able to provide the same level of care as an out-of-network rehab, in addition to other differences.
Ultimately, it’s important that you consider more than just the cost of treatment as a determining factor when choosing a rehab facility. The effectiveness of your treatment depends on a variety of factors, including their specific approach (12-step programs or other programs), your comfort level with the facility and staff, and your willingness to improve. Price should fall far behind choosing the best environment for you to improve your mental and physical health.
In-Network Rehab vs Out-of-Network Rehab
There are some general differences between the two types of rehab facilities that will help you to decide which will work best for you. These differences may not apply to all care providers, so be sure to research any facilities that you consider extensively.
In-Network Rehabs Give Less Control Over Treatment
As part of being in a network, these facilities are often limited in the treatments they can provide you. This can be due to insurance agreements that stipulate what treatments are covered as well as when a patient is “rehabilitated enough” to no longer need treatment in the insurance company’s eyes. It also depends on the allowed dollar amount that the insurance company determines (as stated in the scenario above.)
This can lead to less than adequate care, requiring additional authorizations for treatment, fighting with the insurance company for coverage, and potentially more uncovered costs. All of this is time spent dealing with the insurance company rather than doing what is best for the patient’s recovery. Even worse – it could mean being discharged before you are ready to leave.
Out-Of-Network Facilities Have More Resources Available
Private rehabilitation facilities have the luxury of being unrestricted by deals or limits to care with insurance providers.
Many in-network rehabs that are in-network with insurance policies practice a quantity over quality approach to treatment. This allows for less of an investment into their facility and care, potentially leading to worse results for their patients. Instead, out-of-network rehabs often have a smaller waitlist and are less crowded due to a lack of insurance-required patients coming in, making them more private, personal, and even more relaxing. When it comes to recovery, your environment is one of the most important factors!
In addition to having a more peaceful environment, the quality of services that an out-of-network rehab is able to provide is much higher. This doesn’t mean that it automatically has a higher price tag – it just means that they are able to continue with the best evidence based treatments instead of whatever they can do to stay under the dollar amount set arbitrarily by the insurance company.
Should I Go To An In-Network Or Out-Of-Network Rehab?
Overall, choosing your own rehab facility without worrying about price is the best course of action for your recovery. In many cases, out-of-network treatment providers will have the ability to provide better services to you because they are unrestricted by in-network billing procedures and coverage guidelines.
If you have a PPO insurance plan, your costs will likely end up being similar for most choices, allowing you to go with your best choice rather than whoever fits your insurance coverage. Even if you have a HMO, be sure to consider all options – after all, your health and sobriety is worth more than anything.
Scottsdale Recovery Center is a rehab facility that specializes in providing effective and affordable care regardless of your financial situation or insurance coverage. We offer inpatient and outpatient substance abuse rehabilitation services to Scottsdale and the surrounding areas.
If you would like to verify your insurance plan benefits for addiction treatment services, you can use our online form or give us a call today.
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Talk to Someone Who’s Been There. Talk to Someone Who Can Help. Scottsdale Recovery Center holds the highest accreditation (Joint Commission) and is Arizona’s premier rehab facility since 2007. Call 602-346-9142.