When it comes to substance use disorder treatment, few things are as important as having the right insurance coverage for rehab. However, the medical system in the United States is more complex than having coverage or not having coverage. Indeed, insurance coverage for rehab comes in two types: In-network and out-of-network. The difference between the two can make a major difference: Finding an in-network treatment center can save you a lot on the rehab cost.
What Is In-Network Rehab Insurance Coverage?
A healthcare provider is considered “in-network” when it contracts with a specific insurance agency. If a provider is in-network, it has a contract with the insurance company to be reimbursed at a discounted rate.
There are many benefits for both the healthcare provider and the insurance company. From a provider perspective, certain agencies — like rehabilitation facilities — can have a steady stream of covered patients. This arrangement allows rehabilitation facilities to concentrate on providing care and expect predictable revenue flows.
From an insurance perspective, in-network contracts allow insurance providers to save money. They also allow insurance companies to set certain limits and gain access to some data metrics. In doing so, insurance companies can ensure that the quality of care provided by their in-network healthcare facilities meets appropriate standards.
Generally speaking, in-network coverage will let you access all services at a rehabilitation facility, including treatment for substance abuse or mental illnesses. However, in some instances, insurance companies may only cover specific services. It is always better to check with your insurance provider beforehand to find out what they do and don’t cover. Early communication allows you to make the best possible therapy decisions and avoid surprises.
What Is Out-of-Network Rehab Insurance Coverage?
Out-of-network coverage means your healthcare provider and insurance company don’t have a contractual relationship. The provider will thus bill the total price. Your insurance company will likely still pay the discounted rate, but you will have to pay the difference out of pocket. This cost is in addition to what you would otherwise pay for coinsurance or deductibles.
From a consumer perspective, it is almost always better to work with an in-network provider. Furthermore, insurance companies generally review providers before signing contracts, ensuring that the provider in question meets certain standards of care. While an out-of-network provider may be just as good—or even better—than an in-network provider, the care you get may not be checked by your insurance company.
How Much Extra Will Treatment at an Out-of-Network Facility Cost?
Unfortunately, this can be a tricky question to answer. Numerous factors influence the cost of a stay in a rehabilitation facility. This includes the length of stay, the intensity of the therapy, what your plan covers, and how many providers you see. How much your insurance company would have covered for an in-network plan can also impact how much you will ultimately have to pay.
The cost of inpatient stays can be substantial. Rehabilitation programs cost thousands of dollars, and multi-week stays in rehabilitation facilities can cost tens of thousands. An out-of-network provider will be partially covered but not completely. As such, if you stay with an out-of-network provider, you may be on the hook for thousands of dollars.
How Can I Find Out if Insurance Coverage Is In-Network?
Generally speaking, there are two ways of getting this information.
First, you can ask your insurance company for a list of in-network providers or ask if a specific facility is in-network.
Second, you can contact the facility itself. Most rehabilitation facilities allow you to contact them and find out what insurance companies they work with. At Transformations Treatment Center, we list our contracted insurance providers on our website such as Allied Trades for mental health treatment.
Even if a provider lists an insurance company on their website, you may want to consider calling the facility and confirming that the information is still accurate. Websites can be out of date, and insurance contracts constantly change. It is always better to confirm this information ahead of time.
Ready To Learn More?
If you know you are ready for rehab or have a loved one who can benefit from time with a recovery-oriented community, we’re here to help. Our mission is to provide high-quality, customized substance abuse and mental health treatment to individuals who are looking to beat their addiction, and we want to serve you. We offer various insurance coverage options for your rehab stay and are here to serve you.
Contact us today if you are ready to take your next steps.
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