How Does In-Network Insurance Work With Drug Rehabs?

How Does In-Network Insurance Work With Drug Rehabs?

Insurance can feel like a puzzle, a maze and, to be honest, a total enigma at times.

The knowledge to understand the esoteric jargon in the pages and pages and pages of a typical policy are enough to give you an aneurysm and trying to explain it all would take far too long.

The big thing to know is that plenty of private health insurance plans do cover drug rehabs. If not in total, at least in part. Moreover, all plans through the Affordable Care Act Marketplace cover mental health and substance abuse services, in fact, they’re considered essential health benefits.

That said, the majority of Americans are covered through private insurance by their employer and the main item to pay attention to is whether the rehab you’re considering for yourself or a loved one is in or out of your network. Why? Because it can significantly affect the costs.

In-Network Insurance Explained

In-network insurance just means that your rehab of choice has an agreement and contract with your health insurance provider to deliver addiction treatment services at a pre-negotiated – discounted – price. Your insurance provider works by creating a network of these doctors, facilities, rehabs, pharmacies, etc. that meet certain requirements and that’s what constitutes the available services, treatments, etc. of your particular plan.

Out-of-network is, of course, the opposite. These rehabs have not agreed to any discounted rates and that ultimately means you’ll be paying more, often significantly more, for drug rehab or any other service not covered in the network. In other words, health care providers across the board set prices however they please and going out-of-network means you’re paying the difference between the portion your insurance covers and the actual full price of service.

Confused? Don’t worry. Here’s and an example from Anthem Insurance:

Suppose you visit a doctor and his or her fee for services is $250. Here’s how your costs may break down, depending on whether the doctor was in your plan or not.

If the doctor is in your plan, you and your insurer would pay your portions of your doctor’s negotiated rate. If that rate was, for example, $175 and your copay was $35, you’d pay $35 and your plan would pay $140.

If the doctor was outside your plan, your plan would still pay the same $140, but you’d be responsible for your $35 copay, plus the additional $75. Instead of just $35, you’d pay $110.

An extremely important note: just because a rehab (or anyone else for that matter) accepts your insurance it does not mean they are in-network. What that looks like in practice is that they’ll accept payment from your insurance company and stick you with the difference between their list price for services and what the insurance paid them.

For something like a 60-day inpatient rehab stay, for example, you can imagine that difference can add up quickly.

Can I Use In-Network Insurance to Pay for Rehab? 

Yes. Probably. Maybe. It depends. All the above.

The only way to truly know which rehabs and which addiction services are covered in-network on your insurance plan is to check and verify with your insurance company and provider. You’ll be able to find much of that info on their website but calling always adds a little more peace of mind.

On our website, prominently featured in the top left corner, is a button that reads “VERIFY INSURANCE BENEFITS”. We know it can be tough to wade through these waters when all you want to do is get on the road to recovery, so if Principles Recovery Center looks like the right place for you or your loved one, we make it as easy as possible to know if you’re covered and keep things similarly simple and transparent every step of the way.

Get in touch with us, we’re happy to discuss insurance, treatment options and more.

Get Help with Depression and Alcohol Abuse Today

Depression and Alcohol Abuse Today

Depression and alcohol abuse are two things that often go hand in hand with one another and serve to make the other worse. Depression can very well lead people to alcohol as a coping mechanism and in turn create a self-perpetuating cycle that leads to yet greater consumption of alcohol.

Let’s first define both depression and alcohol abuse, or alcohol use disorder (AUD), though.

Depression – Beyond just the standard blues or feeling sad, depression is a serious mood disorder and medical illness that negatively affects how you feel, think and act and affects everything from your sleep to your work. You can think of it as feeling down, low and hopeless for weeks at a time.

In 2017, 17.3 million American adults had at least one major depressive episode.

Alcohol Use Disorder – Not just simply problem drinking, AUD is a chronic relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

Roughly 15 million people in the United States have alcohol use disorder.

Can Depression and Alcohol Abuse Be Connected?

Broadly speaking, serious mental illness (SMI) and substance abuse disorder (SUD) co-occur with a disconcertingly high frequency with roughly 1 in 4 people with SMI also having a SUD.

Concerning depression and alcohol specifically, they very much can be connected, a recent study noted that “depressive disorders are the most common psychiatric disorders among people with AUD. The co-occurrence of these disorders is associated with greater severity and worse prognosis than either disorder alone, including a heightened risk for suicidal behavior”.

Adding to that were findings from previous research showed that the “prevalence of depression among alcohol-dependent persons is high (63.8%) with a significant association between depression and the mean AUDIT score (alcohol use disorders identification test). At posttest, depressed participants had a statistically significant craving for alcohol…Alcohol dependence is associated with major depression.”

People are using alcohol to quite literally drown their sorrows as the famous saying goes. To escape those feelings of sadness, if only temporarily, with the sedative effects of alcohol. The irony, as we’ve already covered, is that avoiding dealing with depression by consuming alcohol only serves to make it worse.

Can I Receive Treatment for My Depression and Alcohol Abuse at the Same Time? 

Not only can you receive treatment for depression and alcohol abuse simultaneously, but that’s also exactly what you should do. Having AUD and depression at the same time, or any addiction and mental illness/disorder for that matter, is known as a co-occurring disorder or a dual diagnosis

Dual diagnosis treatment is critically important because it’s designed to tackle the connection between mental illness and addiction rather than keeping them in totally separate and distinct silos. Look at it this way, if you were to focus on solely beating depression but left your alcoholism untouched, your drinking could be a conduit for the depression to come right back. And vice versa, working only on your alcohol abuse leaves the underlying depression, perhaps a big underlying reason for your drinking to begin with, unexamined.

Because both depression and alcohol abuse fall under the roof of mental illness, treating them both in an integrated fashion tends to produce more effective and lasting outcomes. The goal is not to just work on the addiction but rather you as a whole person and offering a much more holistic and complete treatment than would otherwise be possible.

Get Help With Depression and Alcohol Abuse at Principles Recovery Center

At Principles Recovery Center in South Florida, we well understand the interplay of alcohol abuse and depression, substance abuse and mental illness, and have years of experience honing our program to help people get back to sober and fulfilling lives.

If you or a loved one is dealing with alcoholism and depression or are simply unsure if you have co-occurring illnesses, get in touch with us today and let’s discuss it.