Trusted Content

In-Network Insurance Coverage Alcohol And Drug Rehabs

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

April 9, 2019

Thanks to the increasingly common view of drug and alcohol addiction as a medically treatable disease, more and more drug, and alcohol rehab centers are finding themselves in a position to partner up with health insurance companies and become in-network care providers. By contracting with insurance companies, many of these rehab facilities are able to offer substance abuse treatment at discounted rates to patients with participating insurance plans.

If your health insurance company has moved to include rehab centers in its network of care providers, you may be one of these lucky patients that can have access to affordable rehab. What follows are a few pieces of advice to aid you in your search for in-network addiction treatment coverage.

HMO In-Network Coverage For Rehab

One important factor to consider when looking for in-network coverage for rehab is whether your insurance plan is classified as a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). Most HMOs require that you first consult with your primary care physician and obtain an official referral from them before any sort of coverage for rehab is approved.

Usually, if rehab is truly necessary, your primary physician will not only approve you for your treatment but will work closely with you to find a trusted rehab center in your network, as HMOs usually do not cover out-of-network rehab stays. The takeaway? If you have an HMO, be sure to check with your primary care physician to see just how many rehab centers are in your HMO network to begin with.

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PPO In-Network Coverage For Rehab

Is your health insurance plan a PPO? If so, you probably know that PPOs differ from HMO plans in that tend to charge a higher annual premium, but on the flip side, you don’t need a referral from a primary care physician to get coverage for specialized treatment. In most cases, this policy applies to treatment involving drug or alcohol rehab. Indeed, with many PPOs, the insurance company will even cover a portion of the cost for the out-of-network rehab treatment, although it will almost certainly cost you more than admission into an in-network rehab facility.

Be On The Lookout For “Phantom Networks”

Another thing to remember when searching for in-network insurance coverage for rehab is to avoid what is sometimes called “phantom networks.” Imagine finally finding a rehab center within your HMO’s network, and then discovering later that the center no longer exists or is no longer accepting new patients—this is the so-called “phantom network” problem. It’s a problem that’s mostly found in the field of mental health and substance abuse treatment, so be sure to do your research when looking through your insurance plan’s list of partnered rehab care providers.

We’ll Get You Answers

Recently passed laws such as the Affordable Care Act and Mental Health Parity and Addiction Equity Act have dramatically expanded the range of substance abuse treatment services that health insurance companies are required to cover. If you have questions regarding the possibility of in-network coverage for a potential stay in rehab, contact us at, and we’ll get you the answers you are looking for.

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