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Does Insurance Cover Drug Rehab – HMO, PPO, and POS Contracts

You may be wondering, “does insurance cover drug rehab?” With the rising costs of healthcare, this is a serious concern for addicts who need professional help. Fortunately, there are a variety of ways that insurance companies can help people pay for drug treatment. Addicts who are worried about their finances need to understand the various ways they can use HMOs, PPOs, and POS contracts to pay for drug rehab.

Understanding Provider Networks

HMOs, PPOs, and POS companies all use the network system of health insurance. They organize large groups of general physicians, specialists, hospitals, and clinics. When customers pay their monthly premiums, they are actually paying for access to these networks. These types of plan differ in the ways they allow their customers to access medical treatments – and in their coverage of care obtained outside their networks.

Health Management Organizations

HMOs generally offer the cheapest coverage in terms of average premiums, co-pays, and deductibles. However, they are also notoriously inflexible. HMO customers are required to designate primary care physicians – the doctors they see for their routine check-ups. In order to attend other treatments or consult with specialists, patients must first get referrals from these physicians.

HMOs also offer little to no coverage when customers seek treatments outside their networks. This is especially problematic for drug addicts, since some networks contain only a few options for rehab. Rehab patients with HMO insurance may need to pay extra for additional coverage, or they may incur large out-of-pocket costs. Ultimately, addicts may need to compromise to get the most affordable treatments.

Preferred Provider Organizations

Many addicts and non-addicts alike choose PPO insurance for the great flexibility it offers. Although these plans usually involve higher premiums and deductibles, their networks tend to be far larger and more diverse than those of HMOs. Most PPOs will also offer a great deal of coverage for treatments obtained outside their networks. In fact, many states place strict limits on the reductions in coverage that PPOs can place on extra-network medical care.

Overall, the variety of treatments these insurance plans offer can be perfect for addicts. Drug rehab is a specialized field of medicine, and access to a wide network of clinics can allow people to get the exact treatments they need. However, the high costs can be too much for some people to bear.

Point of Service Contracts

POS contracts combine elements of HMO and PPO insurance. Customers are required to designate primary care physicians, and they must pay out-of-pocket if they get treatment outside their networks. However, their physicians can refer to them to extra-network providers. In these cases, the companies will pay all or nearly all of the costs of treatment. Since so many people get their insurance through the workplace, POS plans are excellent for addicts whose employers’ headquarters are out-of-state.

Even if you’re worried whether or not your insurance covers drug rehab, you need to seek the best treatment you can get. Type the required information into the insurance verification form to the right of this page, and find out about the assistance payment programs available to you. Don’t let money prevent you from living your life on your own terms once again.

About The Contributor
The editorial staff of Recovery First is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed thousands... Read More