Trusted Content

Out-Of-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

If you’re having trouble finding a rehab center in your insurance network, don’t feel as if all hope is lost. Out-of-network insurance coverage is still an excellent option, especially if it’s the difference between getting the help you need and having to continue the struggle on your own.

For individuals entering rehab for alcohol or drug addiction, finding the funds for treatment can be a confusing, overwhelming process. Getting your health insurance to cover visits to some specialists, like a dermatologist or urologist, may feel like a walk in the park. Asking your insurance company to cover rehab, on the other hand, may feel like unfamiliar—and downright intimidating—territory.

Can I Get Out-of-Network Coverage?

One question to address is how exactly one gets out-of-network coverage in the first place. Most health insurance companies divide their plan options into two basic categories, Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Most HMO plans will not cover a stay in a rehab center that is out of the HMOs network of contracted care providers. PPO plans, on the other hand, do regularly offer coverage for out-of-network rehab treatment.

Go Outside The Network To Find The Perfect Fit For You

Of course, if you have an HMO, the trade off is that you pay a lower annual premium. With a PPO, however, you get a much wider range of rehab centers to choose from. While the coverage amount for out-of-network choices tends to be less generous than for those that are in the network, some coverage is still better than no coverage at all. This is especially true if the reason you’re going outside your network is to find the right facility for you, rather than settling for an option that’s in your network but not quite the right one for you.

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An Uplifting Example

To take just one example, a leading rehab facility in the Napa Valley has said that for patients who have insurance through Anthem Blue Cross (the main company with whom this rehab center is partnered), the amount the insurance company pays is usually between 60-100 percent of treatment costs. A good deal, to be sure.

At the same time, however, this same rehab center has said that for patients who have out-of-network insurance through a different company, United Healthcare (with whom the rehab center is not partnered), it’s not uncommon to see that insurance company still offering up to 60 percent coverage—depending, of course, on the specifics of the patient’s plan.

The Price Tag Of Addiction

Don’t let the absence of a good in-network option for drug or alcohol rehab keep you from starting your path toward recovery. Having to pay slightly more for rehab pales in comparison to the costs—both monetary and otherwise—that come with a life of addiction. If you have a PPO insurance plan, contact us today at—we will be able to find the perfect out-of-network option for you.

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