How to Find an In-Network Drug Rehab Center

search for treatmentWhen a provider of medical, mental health, or substance abuse services, like a drug rehab center, is considered to be “in-network” that means that they have an agreement with an insurance company to offer care for prearranged, and usually lower, rates than other providers.

It is an agreement between a particular rehab center and an insurance company that allows members with specific insurance pans to get discounted rates.

The alternative to in-network coverage is insurance providers or plans that are out-of-network, which can have higher out-of-pocket costs for individuals than using an in-network provider. Out-of-pocket fees refer to the costs individuals will pay for services themselves beyond monthly premiums and what insurance will cover. In-network drug rehab providers generally provide covered individuals with the lowest out-of-pocket costs for services.

Difference between Being In-Network and Out-of-Network

The difference in cost between in-network providers and those who are out-of-network may vary. For example, one insurance provider may cover 100 percent of the services at an in-network drug rehab center, while only covering 75 percent for a facility that is not considered to be in-network. Other times, insurance companies may not provide any coverage for facilities that are not in-network, and individuals may be expected to cover all costs at these drug rehab centers.
The difference in coverage type may depend on an individual’s plan as well. For instance, a Preferred Provider Organization (PPO) plan usually does not require a referral from a primary care provider for services; however, for the best rates, individuals need to receive care from an in-network provider, while those with a Health Maintenance Organization (HMO) generally require a referral and must remain in-network in order to receive coverage for care, U.S. News explains.

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Steps for Determining In-Network Coverage for Rehab

Over 20 million Americans (over the age of 11) struggled with a substance use disorder in 2014, according to the National Survey on Drug Use and Health (NSDUH). Drug abuse and addiction can be costly to individuals, families, and society, as the National Institute on Drug Abuse (NIDA) estimates that drug abuse costs the American people close to $200 billion every year in criminal justice costs, lost production in the workplace, and healthcare expenses. Drug rehab helps individuals to recover, and it is generally agreed that rehab costs less money in the long run than ongoing addiction.

Finding and using insurance to help pay for services can defray rehab costs. Below are some tips on how to find an in-network drug rehab center:

  • Check individual insurance plans, and any documents explaining them, as these should indicate what providers are considered to be in-network for that plan.
  • Go to the insurance company’s website or call the 24-hour hotline to check whether or not the chosen drug rehab center is considered in-network.
  • Check with the drug rehab center, as most providers will have professional staff members on hand who can answer questions about insurance providers and which ones are considered in-network.
  • Find out if the insurance plan requires a referral from a primary care physician before treatment can be provided in order to be covered by insurance.
  • Determine if there will be copays (small amounts individuals are expected to cover at time of service), and if a deductible is expected to be reached before coverage kicks in. A deductible is the amount an individual must personally pay before the insurance company’s coverage kicks in.

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