People who have health insurance and are considering addiction treatment may seek help from providers that are in-network or out-of-network with their insurance. Treatment from an in-network provider will often cost less, but there are benefits to choosing out-of-network care at times.
In-Network Vs. Out-Of-Network Addiction Treatment Providers
Health insurance plans have specific pricing for in-network and out-of-network addiction treatment centers. In-network rehab centers, also known as participating providers, are typically more affordable than out-of-network rehab centers. In-network providers are doctors, clinics, hospitals, and other facilities and professionals that share a contractual agreement with an insurance provider. The agreement allows these providers to offer pre-negotiated, fixed rates for their services to people with that insurance. The amount plan-holders pay for services is determined by their plan type, which outlines their deductible, coinsurance, and copays. For example, if a primary care physician charges $150 for a visit and the doctor is in-network with Best Insurance, then people with Best Insurance may only have to pay $30 for the visit.
Out-of-network services may be covered somewhat by your insurance company, but not to the same extent as in-network care. Using the previous example, a person whose insurance plan is not in network with the physician may have to pay $120 for the same visit.
Why Would Someone Choose An Out-Of-Network Rehab Center?
For many people, cost is a determining factor when choosing a treatment center. Selecting from a list of in-network providers can help save thousands of dollars, especially for inpatient care. However, for those who have already met their out-of-network maximum or deductible, have more leeway with cost in general, or are seeking comprehensive and/or specific services, an out-of-network rehab center may at times be the better choice.
Choosing an out-of-network rehab center can also provide the individual with more control over their treatment plan. In-network providers typically have set agreements with the insurance company that define how long treatment is covered and what services someone is eligible for, among other factors. For example, if an in-network rehab center offers 30-day inpatient treatment, then the person may have to leave immediately after the 30 days is complete, regardless of whether they feel comfortable and/or prepared enough to do so. Going to an out-of-network rehab center allows the flexibility to prolong treatment and incorporate other services if needed.
People may also consider going to an out-of-network addiction treatment center for the following reasons:
- to receive treatment at a center that incorporates cultural, religious, and lifestyle needs into its programs
- to ensure privacy and confidentiality
- to receive treatment in a different area or region of the country
- to access specialized treatment programs, such as those for parents of young children or LGBTQIA+ people
- to experience shorter waitlists, or no wait
- to receive personalized treatment and enhanced one-on-one care
- to participate in therapies that specifically appeal to the individual, such as adventure therapy, equine therapy, experiential therapy, nature therapy, and holistic approaches to treatment
What Happens If I Choose An Out-Of-Network Provider?
If you decide to go to an out-of-network addiction treatment center, then you’ll want to be aware of several factors to avoid surprise fees. The most important component is to understand the out-of-network coverage offered through your insurance provider and chosen plan. You’ll want to take note of the percentage of care fees covered by your insurance company for out-of-network providers. You’ll also want to know what the out-of-pocket maximum is, which is the most you’ll be expected to pay annually for the deductible, coinsurance, and copays to see out-of-network providers. For example, if your out-of-pocket maximum is $14,000 and you meet this figure, then 100% of any additional fees are covered. Because inpatient rehab can be expensive, it may be possible to reach the maximum of your plan.
When planning to pay for treatment, or any healthcare fees, knowing about your insurance provider’s billing practices for out-of-network providers can help. While some providers cover their percentage of fees upfront, others send full bills in the mail and/or via email and require plan holders to submit a claim to recover the costs. If the latter is the case, it’s important to periodically check your mail and/or email so as not to accidentally overlook any of the bills.
Some insurance providers do not pay for treatment at an out-of-network provider unless a referral is received. A referral is a communication written by a primary care physician or other doctor indicating that seeing a specialist is warranted for a specific health concern. Knowing whether your insurance provider requires a referral for out-of-network rehab can determine if they cover a portion of the care costs.
How Much More Will Out-Of-Network Rehab Cost?
Treatment at an out-of-network rehab center can cost significantly more than it will at an in-network rehab center. Again, the total cost will be determined by a number of criteria.
The cost of treatment at an out-of-network rehab center is influenced by factors such as:
- the amount of your out-of-pocket deductible that’s been met so far
- your insurance provider and plan type
- whether your insurance company denies rehab coverage
It’s important to remember that despite the above-mentioned variables, the costs associated with out-of-network addiction treatment will usually be significantly higher than in-network treatment.
How Can I Find Out If A Facility Is Out Of Network?
If you’re curious about whether a facility is in network or out of network, you can contact the treatment center directly or your insurance provider. Every treatment center that accepts any type of insurance has a list of the accepted insurance providers. Likewise, a customer service representative for an insurance provider will be able to find out whether a specific facility is within its range of in-network coverage.
Find Freedom From Addiction
If you are dealing with an addiction to drugs or alcohol, you don’t have to attempt recovery alone. Help is available whenever you’re ready. Call Bedrock Recovery Center for more information today, including fast, free health insurance verification.
