PPO Insurance Rehab

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PPO Insurance Rehab

Preferred Provider Organization (PPO) forms of insurance is widely recognized as a superior alternative to health maintenance organization (HMO) and exclusive provider organization (EPO) plans.

In most cases, a referral from your primary care physician is not necessary when using a PPO health insurance plan to see a specialist. In other words, if you have PPO insurance, you can go to whatever doctor or “PPO insurance rehab” you like as long as they accept your plan.

Read on to learn why it’s important to take advantage of your PPO policy’s coverage for addiction treatment and how to do it in a way that protects your privacy and your health.

Will PPO Insurance Cover Substance Abuse Treatment?

PPO insurance plans, like those from most other carriers, often include coverage for a variety of drug and alcohol rehab centers. The reason for this is the Mental Health Parity and Addiction Equity Act of 2006.

As a result of this legislation, mental health and substance abuse services are required to be included in health insurance plans. In most cases, your health insurance will cover a wide range of alcohol and drug rehab programs and levels of care. This includes medically-assisted detox, inpatient residential treatment, outpatient treatment programs, and partial hospitalization programs.

Although PPO plans may not provide complete coverage for an extensive rehabilitation stay, they can still help you save money and provide you more flexibility in choosing your healthcare providers and the course of treatment you want to follow.

Why Is PPO Coverage So Efficient for Substance Abuse Coverage?

Substance Abuse

People with substance abuse problems benefit greatly from the 24-hour supervision and rigorous program structure offered by inpatient and residential drug and alcohol rehabilitation centers.

By entering inpatient treatment, patients are shielded from the stresses and temptations of the outside world, which may otherwise threaten their sobriety. They will have a much lower chance of relapsing and will have an easier time recovering if this choice is made.

This level of drug and alcohol treatment will likely also include different behavioral treatments and holistic recovery services for people battling an underlying mental health challenge, as well as give a holistic approach to therapy for clients who wish to participate in a more natural option.

Many insurance companies, including a Preferred Provider Organization that yields PPO plans, will provide less coverage for inpatient treatment in light of these supplementary benefits. This implies that if you want to rehabilitate in a residential treatment center, you may have to pay more money out of pocket.

Does PPO Cover Outpatient Treatment?

A lot of people who are trying to overcome their addiction prefer to do it through outpatient programs. While less intensive and organized than inpatient treatments, PPO coverage expands with outpatient care, reducing the client’s out-of-pocket costs.

In addition, as you won’t have to relocate to attend treatment, you’ll be able to keep up with your obligations at home, work, and school while still getting the help you need for your substance abuse issue.

Group therapy, recovery support groups, and skill-building programs are common components of outpatient treatment plans. Care at this level may still need some out-of-pocket expenses, but it will be far more cost-effective than hospitalization.

How Long of a Stay Do PPO Plans Cover During Rehab?

PPO Plans

How long someone stays in rehab for substance abuse depends on several variables. Possible factors that may impede a person’s ability to recover from addiction include the severity of their condition, the nature of the treatment program, and any barriers they face on a personal level.

Many people lack the resources (both time and money) to get the help they need for their drug use disorder, which places them in a position where they cannot recover fully from their addiction. This might discourage people from getting help from professionals to solve their substance misuse problems.

Inpatient care typically lasts between 30 and 105 days, whereas outpatient programs often last around 120 days. Some patients, in their search for the most appropriate degree of care, go to both inpatient and outpatient rehabilitation centers.

If the healthcare practitioner providing the therapy is not part of the insurance company’s network, the patient’s out-of-pocket expenses will likely exceed the maximum amount that the insurance company would pay. Insurance companies that operate on a PPO model may be more accommodating when it comes to covering addiction treatment.

In some cases, PPO insurance carriers will pay for detox, inpatient, and outpatient services from non-network treatment facilities, even if the patient’s private insurance company would not.

The client may be responsible for paying any additional fees that aren’t covered by insurance. Still, this will be far less expensive than providing healthcare with less adaptable insurance or no healthcare financing at all.

Dual Diagnosis Treatment Coverage with a PPO Plan

Dual diagnosis therapy, or the combination of several behavioral and holistic treatments, is a crucial part of addiction treatment, as stated by the Substance Abuse and Mental Health Services Administration (SAMSHA).

This paves the way for healthcare practitioners to adopt a holistic view of their drug and alcohol addiction therapy, treating not just the addiction but also the factors that led to it.

Essential health benefits, such as dual diagnosis services and access to select deluxe treatments, may be included with these suppliers under a PPO insurance plan. These facilities will, of course, charge more than average for rehabilitation services.

This is because they will provide extra luxuries that may not be available through other treatment programs, such as diverse sporting services and facilities, equestrian therapy, art therapy, aromatherapy, and spa services.

While obviously more tempting and pleasant than other treatment centers may seem, luxury rehab facilities are not a necessary level of care for addiction recovery. Those without the financial means to pay for these luxuries can get by just fine with the basic levels of care.

Paying for Services Not Covered by PPO Insurance

Services Not Covered by PPO Insurance

Sadly, many alcoholics and addicts won’t get assistance because they can’t afford it. For this reason, a solid health insurance plan might be crucial to a person’s chances of beating their addiction for good.

However, it’s possible that some people won’t ever be able to afford dependable insurance. Fortunately, there are a number of options for covering the cost of professional substance misuse treatment that do not involve insurance or supplement what insurance does not cover.

Installment arrangements are by far the most common. These allow those in recovery to spread out the cost of their therapy over time, rather than having to come up with the full amount at once. This may be a huge relief to many people’s wallets as they attempt to pay for rehabilitation.

Another option is to ask close friends, relatives, or other loved ones to help out financially. A tight network of people who care about the individual’s well-being can lessen the financial burden of necessary medical care.

Having confidence in your ability to afford expert help to overcome drug and alcohol dependence by knowing what kinds of addiction treatment services are covered by your PPO insurance plan and how much coverage you will actually be able to obtain is crucial.

Getting Started With Insurance Coverage for Rehab

While each insurance provider has its own set of rules that must be met before they can issue a policy, there are certain things you can do to increase your chances of being accepted.

If you do not yet have a PPO policy, the Affordable Care Act and the ACA Marketplace can be a good starting place for your search. When searching, remember that PPO insurance coverage is generally the best option for both in-network rehab options as well as an out of network provider.

Consult Your Physician

You can avoid unnecessary bother with your insurance provider by requesting a reference from your primary care physician to the institution of your choice.

Check Your Insurance

Although most rehabilitation centers take all major PPO plans, you should double-check that the facility you’re considering is indeed an in-network provider with your insurance company to avoid any unwanted out-of-network charges.

Even if rehab is not in your insurance network, you may still be eligible for some financial assistance. Your out-of-pocket costs can be determined with the aid of customer support.

Contact the Help Desk

Reviewing your documents alone may not always help you understand what is and is not covered. In this situation, feel free to call your insurance provider and ask any questions you may have, and remind them you would like to attend Pathfinders and find out any associated costs.

Our Admissions team is also always happy to assist with questions about your PPO insurance coverage and can let you know out-of-pocket costs within minutes.

Important PPO Insurance Coverage Terms to Remember

You should be able to grasp the language used by insurance companies in order to understand how to use your insurance to assist pay for rehabilitation treatments.

To help you better understand discussions regarding insurance, we’ve included definitions of several often used phrases below.

Deductible

You will have to pay this amount out of pocket before your insurance company begins paying anything. Payment of this amount is required in addition to your regular premium; your regular premium will not be deducted from this total.

In most plans, once you’ve met your yearly deductible, your insurance will begin paying a certain percentage of covered expenses.

Premium

This is the regular payment you make to keep your insurance in force. No, it won’t affect your deductible at all, as we’ve already established, but a PPO plan premium can tend to be a bit higher than other sorts of coverage.

Copay

A copayment, or “copay,” is a modest, predetermined sum of money that is due at the time of service. Depending on your insurance and the service you’ve requested for your visit, the fee might be anywhere from $5 to $75.

As with your premium, this contribution will not be applied to your yearly deductible.

Co-insurance

After your deductible is met, your insurance company will reimburse this amount. While some plans cover all of a patient’s expenses, others may only pay for a certain percentage, leaving the patient to foot the bill for the rest.

In-network

PPO Insurance Coverage Terms to Remember

Providers who are “in-network” with your insurance plan have bargained for lower fees on your behalf. In most cases, you may save the most money on medical treatment by sticking with providers that are part of your insurance network.

Out-of-pocket

You will frequently hear this as either “out-of-pocket expenses” or “out-of-pocket maximum.”

The term “out-of-pocket expenditures” describes the amount of money you will have to spend out of cash for medical treatment.

The greatest amount you’ll have to spend out of cash for medical care is known as the “out-of-pocket maximum.” After this limit is met, your PPO will pay 100% of the covered expenses.

An Addiction Treatment Center Made for Your Lasting Recovery

At Pathfinders Recovery Center, our program is covered by most major PPO providers. In addition, we also take a large range of different insurance plans, so we’re likely to cover the cost of your treatment.

For more information regarding coverage of your stay or to speak with our admissions team, contact Pathfinders Recovery today!