Using In-Network Insurance for Addiction Rehab

What is In-Network Insurance Coverage?

When a provider of medical, mental health, or substance use services, such as 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 pay for services themselves beyond monthly premiums and what insurance covers. In-network drug rehab providers generally provide covered individuals with the lowest out-of-pocket costs for services.

Types of In-Network Insurance Plans

There are several types of in-network insurance plans, all of which can help with the cost of rehab. These include:

• Healthy Maintenance Organizations (HMOs): HMOs offer lower premiums but have a more restricted network of providers. You usually need to choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists, including addiction treatment centers. Treatment is typically covered at a higher rate when you stay within the HMO’s network.
• Preferred Provider Organizations (PPOs): PPOs offer more flexibility than HMOs. You have a wider network of providers to choose from and generally don’t need a referral to see a specialist. You’ll have lower out-of-pocket costs when using in-network providers. Additionally, PPOs usually provide some coverage for out-of-network treatment, but you’ll pay a higher percentage of the cost.
• Point of Service (POS) Plans: POS plans are a hybrid of HMOs and PPOs. You have a PCP who coordinates your care, but you may have the option to go out-of-network for certain services. Similar to HMOs, you’ll have better coverage when staying in-network.
• Exclusive Provider Organizations (EPOs): EPOs are similar to HMOs in that they have a network of providers you must use, but you may not need a referral to see a specialist. Treatment at in-network facilities is covered.

It’s important to note that the specific details of your coverage will depend on your individual insurance plan. Always check your policy documents or contact your insurance provider to understand your benefits for addiction treatment.

In-Network vs. Out-of-Network: What’s the Difference?

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.

Steps for Determining In-Network Coverage for Rehab

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 your insurance plan, by calling the number on your insurance card or login into your insurance provider’s website.
• Check with the drug rehab center, at AAC we can verify your insurance to see your insurance is in-network with us.
• 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 pays for coverage.

Cigna In-Network Drug Rehab

United Healthcare In-Network Drug Rehab

Blue Cross Blue Shield In-Network Drug Rehab

Anthem In-Network Drug Rehab

Checking for In-Network Coverage Online

American Addiction Centers (AAC) is in-network with many insurance companies. Depending on your provider and policy your addiction treatment could be partially or fully covered by insurance.

To find out if your specific plan is in-network, call us at or complete our online verification form below.

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