Comparing In-Network and Out-Of-Network Providers for Rehab
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Last Updated - 12/8/2020View our editorial policy
Rehab costs vary, but the best way to keep your costs down is to find a facility that is covered in your insurance provider’s network.
Most insurance providers offer coverage for addiction rehabilitation and treatment. However, certain rehab centers may or may not be in your insurance network. Choose an out-of-network center may mean you are responsible for more out-of-pocket costs. The biggest differences between in-network and out-of-network coverage are:
- In-network coverage means that your insurance provider receives a discounted rate from certain rehab facilities. With in-network care, you are responsible for fewer out-of-pocket costs.
- Out-of-network coverage means that your insurance provider does not have a discounted rate for certain facilities. You could potentially pay the full bill for treatment when going to an out-of-network facility.
Your insurance coverage also affects out-of-pocket expenses you’ll be subject to, such as coinsurance and deductible limits. To find the most cost-effective plan, it pays to do some research on facilities you may prefer. If you go without preparing, you may find yourself burdened with avoidable medical bills.
At an in-network facility, your biggest out-of-pocket expense will be your deductible. This is the amount you must pay before your insurance begins to help pay for health care costs. Depending on your insurance plan, you may also be responsible for costs such as copays and coinsurance.
At an out-of-network facility, you will typically be taking on most or all of the costs involved with treatment unless you have a certain type of insurance. If there are deductibles, they will likely be higher than those of in-network programs.
For some insurance plans, you must pay coinsurance after your deductible. Coinsurance is a percentage you pay of your medical costs up to a certain out-of-pocket amount, and the rest is paid by your insurance provider.
For example, if you reach your $2,000 deductible and then have 20% coinsurance, you’d begin paying only 20% of your medical costs. If your out-of-pocket limit is $5,000, you’d need to pay $3,000 in coinsurance (which would account for $15,000 in total medical costs) before insurance would take over completely.
Types of Managed Care Plans
Most health insurance plans are either health maintenance organization (HMO) plans or preferred provider organization (PPO) plans. Each type has its own unique features and differences that may affect your choice of a rehab facility.
An HMO is made up of a network of health care providers. The network has health professionals who provide lower rates to people with specific insurance plans. People with this plan will need to use a primary care doctor for most services. If specialists are needed, the doctor will have to refer them. If you go to a provider who is not in this network, you will likely pay some or all of the provider’s costs. In addition, most visits require a copay, but there is typically no deductible.
People with a PPO health plan do not need referrals from a doctor to see a specialist. In addition, they do not need a primary care doctor in the first place. PPOs generally give people more freedom in choosing their health care, and this type of health plan has fewer restrictions on out-of-network providers. However, these plans typically have deductibles and higher premiums than HMOs.
Other Payment Options
If a person has high out-of-pocket costs, there are many rehab payment options available. Many facilities provide payment plans to help you pay them back over time, or can help you identify other ways to cover treatment. Some states have free or low-cost rehab clinics available to the public, though they may have a waiting period for being admitted to treatment. There are also rehab scholarships you can apply to that will help you reduce your out-of-pocket costs.
We are here when you are ready.
Speak with a Recovery Advocate today to talk about your treatment options.
How to Find an In-Network Rehab Center
Even if your out-of-pocket costs are high, rehab is still much cheaper than the cost of a substance use disorder. Whether you have insurance or not, treatment can help you save money and begin a healthier life.
If you are looking for an in-network provider but don’t know where to start, The Recovery Village Palm Beach at Baptist Health can help. Contact us today or verification your coverage to find out whether your insurance covers treatment.
HealthCare. “Coinsurance.” Accessed September 20, 2019.