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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.

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