If you’re looking at substance abuse treatment centers, you likely won’t be surprised to know that insurance coverage is one of the biggest treatment worries. Many panic at the high costs of treatment centers, and worry that their insurance provider will not cover the costs.  However, the cost of treatment should never deter you from seeking addiction treatment services. Whether you are new to insurance or have specific questions, here is a comprehensive guide to understand your health insurance plans and rehab insurance coverage. 

Understanding Key Insurance Terms

When reviewing your insurance plan, you may be confused at all of the terms and specifics. However, here are some of the most important terms to pay attention to when selecting an insurance plan and checking on the coverage options. 

By understanding these key terms, you can ensure that you pick the right plan to fit your finances and needs. 

Important Insurance Terms

Deductible

This is a crucial part of insurance. A deductible is the amount of money of out of pocket expenses you will have to pay before your insurance begins to cover costs. 

For example, your insurance may have a $4,000 deductible. This means that you will have to pay the first $4,000 of medical costs yourself before insurance will cover the rest. Generally, these deductibles reset at the beginning of the year, but your insurance provider will specify this. 

Copayment

Also referred to as the co-pay, this is often a set amount of money you will have to pay for a specific treatment. 

For example, a doctor’s office visit may have a $30 co-pay, meaning each time you visit that doctor’s office, you will pay $30 while insurance covers the remainder.

Premium

A premium is the monthly cost of keeping your health insurance plan. This will be a predetermined cost based upon the coverage level you’ve chosen. 

Usually, the higher the monthly premium, the lower the deductible and out-of-pocket costs will be.

Coinsurance

This is the portion of money that you’ll pay out of pocket depending on your insurance plan. Usually, these numbers fall under 60/40, 70/30, 80/20, and 90/10 percentages. 

If your coinsurance is 40%, that means you’ll pay 40% of the costs while your provider covers the other 60%. 

Insurance Provider Common Plans

Your insurance may offer specially-named plans, or they may be common plan names, like EPO, HMO, POS, and PPO. If you are struggling to understand the difference between the plan names and the specifics, here is a quick explanation of each plan.

Common Insurance Plan Names

Exclusive Provider Organization

This plan is also called an EPO plan. In this tier, you are only covered if you visit doctors, centers, and specialists within your insurance’s covered provider network. Sometimes, in the case of emergencies or special treatments, your insurance company will allow you to use out-of-network providers. 

Health Maintenance Organization

This plan is also called an HMO plan. This plan usually only covers care for doctors and centers that are contracted through that insurance organization. This plan may also require you to live within a certain county of your state to maximize your coverage. Much of an HMO plan focuses on preventative wellness.

Point of Service

This plan is also called a POS plan. This tier allows you to see providers outside of your network. However, you will pay less and get more coverage if you use providers that are in-network. You will also be required to get a referral from a PCP if you need to see a specialist. 

Preferred Provider Organization

This plan is also called a PPO plan. In this tier, you will pay less for doctors in-network. However, you will still be able to use providers out-of-network. The main difference between a PPO and POS plan is that with a PPO plan, you are not required to get referrals from a primary care physician. 

Does Insurance Cover Addiction Treatment?

Understanding Rehab Insurance Coverage

Now that you understand the basics of your plan, you may be wondering whether or not insurance will cover your stay in an addiction treatment center. 

Due to the passing of the Affordable Care Act in 2014, insurance companies can no longer deny coverage or charge extra premiums for pre-existing conditions. Based on the extensive mental health and substance abuse services required for addiction treatment, substance use is considered a pre-existing condition. 

Am I Covered? 

Harmony Outpatient works with a variety of insurance providers to ensure that the addiction treatment you need is within your reach. Our treatment services team is available to answer any questions you may have regarding financial assistance and insurance. You can also verify your insurance policy through our online form here.

Additional Substance Abuse Insurance Resources

Depending on your health insurance carrier and specific insurance coverage, you may be eligible for additional benefits. Often these benefits are given by insurance providers as free resources for substance abuse treatment.

Some resources provided may include crisis text and call lines, free community counseling services, support groups, and networking and outreach events. You will need to check in with your insurance provider to see what resources are available to you. 

Treatment with Harmony Healing Center’s Outpatient Program

Drug and alcohol addiction can be debilitating, but Harmony Outpatient offers a way for you to break free of substance abuse. 

We offer partial hospitalization programs, intensive outpatient treatment, and a standard outpatient track.

Our treatment providers can work with you to find the best treatment options and create individualized recovery treatment plans. Treatment costs should not deter you from the drug and alcohol rehab services you deserve!

Substance addiction treatment is within your reach! Contact us today at Harmony Healing Center to learn about your rehab insurance coverage.