Insurance
Understanding Your Insurance Options for Addiction Treatment
PPO Insurance Coverage
A Preferred Provider Organization (PPO) allows flexibility in choosing providers while providing both in-network and partial out-of-network coverage. Policyholders pay less when using in-network doctors and facilities.
PPOs provide benefits for eligible substance abuse treatment, though policies vary. Deductibles, coinsurance or copays may apply depending on the services received. Many PPO plans don’t require referrals for specialists like addiction treatment centers. Check your policy or visit common PPO comparison sites for details on your specific plan.
Point-of-Service (POS) Plans
Point-of-Service plans function as a hybrid between HMOs and PPOs. Members select a primary care physician who coordinates referrals for specialty services. However, POS plans also offer some freedom to use out-of-network providers for a higher cost-share.
For addiction treatment coverage, you’ll need your main doctor’s approval. Some plans require precertification to verify medical necessity before receiving residential rehab services. Confirm our acceptance and policy guidelines before entering treatment to avoid surprises.
HMO Health Insurance
Health Maintenance Organizations provide exclusive care from contracted physicians and facilities for lower costs. You must choose a primary care doctor to manage referrals for specialists, including assessments and approvals for rehab.
HMO plans do not offer any out-of-network benefits coverage. All addiction services, including detox and residential treatment, need advance approval from your primary provider. Be sure to obtain proper referrals before starting treatment to maximize coverage.
Unsure About Your Benefits?
If you are unsure about your coverage options or benefit requirements, please contact one of our 5 Star Care facilitators. We are happy to help guide you through the insurance enrollment and prior authorization process.