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Paying for Drug Rehab with HMO Insurance

It is crucial for people who need drug rehab to understand the advantages and limitations of their health insurance plans. Most insurance companies do not explicitly cover addiction and substance abuse problems, and paying for specific treatments can become a difficult issue. Matters can get especially complicated for those with Health Management Organization coverage – a typically low-flexibility option. In order to afford the best addiction treatment possible, addicts with HMO coverage must understand how to take full advantage of the cost-saving benefits of their insurance plans.

Understanding Health Management Organizations

Health Management Organizations contract with various healthcare providers to form their “networks.” Customers then get access to the providers within these networks for typically-low co-pays. However, each customer must also select a primary care physician for regular checkups and referrals to specialist organizations – such as drug rehab clinics. If someone’s current doctor is not in their new HMO’s network, they will have to find a new one or pay extra money for each visit. Additionally, most HMOs offer little or no coverage for treatment administered outside their networks.

Greater Coverage

The greatest advantage of HMO insurance is that it usually offers lower premiums and co-pays than Preferred Provider Organizations (PPOs) and other types of plans. Some addicts undergo three or even six months of inpatient care, and bills can get extremely high. While addiction can afflict people of any socioeconomic status, many rehab patients also struggle financially – especially when they’ve spent years funding their drug habits. Overall, these low costs can be life-saving for addicts.

Reduced Flexibility

The tradeoff with HMO coverage is that it is typically the least flexible option. To keep costs down, insurers must incentivize their customers to stay within their networks. Most HMOs will not pay for treatment outside their networks, and co-pays tend to be extremely high when they do. This can be a problem for people seeking drug treatment, since rehab services are highly individual and specialized. Pregnant women, teens, elderly people, and other addicts may have unique concerns which are only addressed at certain clinics.

Working with Limitations

In some cases, addicts’ ideal clinics or treatments will not be available in their HMOs’ networks. The cheapest solution to this problem is to simply adapt to the closest alternatives that are available; getting some type of care is likely to be much better than receiving none at all. Another choice is to add coverage or change payment plans on existing policies. This option may be expensive, but it can still save addicts money in the long run. Finally, people with the means to pay for rehab themselves can always do so if their networks don’t provide them with the best coverage. Some rehab patients have needs that can only be met at certain facilities, and paying out-of-pocket may be the best decision.

When Addicts Don’t Have Insurance

Many addicts are too poor or have too many other expenses to afford health insurance. Others may be covered under HMOs whose networks don’t include any rehab clinics. Fortunately, there are a few ways for these people to pay for treatment. Some state and city governments provide funding for use at private rehabilitation centers, and almost all states contain public clinics which offer free or low-cost treatment for addicts. The standards of living and care may not be as high at these facilities, but they still provide proven therapies and helpful medications for detox and withdrawal.

No matter how desperate your situation is, there is hope for a better future. If you’re struggling with a drug problem, call the number at the top of your screen for a toll-free consultation with one of our dedicated addiction specialists. We will help you get started on a drug rehab program that will have you back on your feet in no time.

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