While dealing with insurance companies isn’t exactly anyone’s idea of a good time, it’s often necessary for various needs. This is often the case for those involved in addiction treatment and recovery programs, and it can be helpful to understand some basic insurance terms or concepts if you or someone close to you is in this situation.
At Moonlight Mountain Recovery, we’re proud to offer the best addiction treatment center available for patients around Boise, Pocatello and nearby parts of Idaho, including alcohol rehab, drug rehab and more. Here are some of the most important terms and concepts to know when it comes to insurance coverage for any kind of addiction recovery program, ensuring you aren’t in the dark when handling this important area.
Kinds of Insurance Policies
There are several kinds of health insurance policies that you or a loved one may hold, including:
- HMO: Short for Health Maintenance Organization, this kind of insurance plan restricts patients to specific doctors or hospitals within the HMO network. There are lower out-of-pocket costs with HMO plans, but they do not cover out-of-network care.
- PPO: Short for Preferred Provider Organization, these plans allow for more flexibility in choosing doctors and hospitals outside of the network. However, there may be higher out-of-pocket costs associated with PPO plans.
- EPO: Short for Exclusive Provider Organization, these plans offer a mix of benefits from both HMO and PPO plans – patients can see any provider within the network without referrals, but out-of-network care is typically not covered.
- POS: Short for Point of Service, these plans also offer a mix of HMO and PPO benefits. Patients must choose a primary care physician within the network, but can see specialists outside of the network with referrals from their PCP.
- HSA: Short for Health Savings Account, this is a tax-advantaged savings account that can be used to pay for medical expenses. These accounts are usually paired with high-deductible health plans.
Coverage Levels
When it comes to addiction treatment and recovery programs, there are often different levels of coverage offered by insurance policies:
- Inpatient: This level of care involves staying at a residential facility full-time for a set amount of time during treatment.
- Outpatient: This level of care allows patients to return home after treatment each day, rather than staying in the facility overnight.
- Partial Hospitalization (PHP): This level of care falls between inpatient and outpatient – patients attend therapy or other treatments during the day, but return home at night.
- Intensive Outpatient (IOP): Similar to PHP, IOP allows patients to live at home while attending treatment during the day. This level of care is often used as a step-down from inpatient or PHP programs.
Verifying Coverage
Before beginning any addiction treatment program, it’s important to verify what kind of coverage your insurance policy offers and for what levels of care. Here are some tips for verifying insurance coverage:
- Contact your insurance company directly: Call the number on the back of your insurance card and speak with a representative about your specific policy and its coverage for addiction treatment.
- Request a breakdown of benefits: Ask for a written document that outlines the specifics of your coverage for addiction treatment, including any limitations or exclusions.
- Verify in-network providers: If you have a specific addiction treatment center in mind, make sure they are an in-network provider with your insurance company to avoid higher out-of-pocket costs.
- Consider pre-authorization: Some insurance policies require pre-authorization before beginning any addiction treatment program – be sure to follow these steps if necessary to ensure coverage.
Alternative Payment Options
If you or a loved one do not have health insurance that covers addiction treatment, there may be alternative payment options available:
- Payment plans: Many addiction treatment centers offer payment plans that allow patients to spread out the cost of treatment over time.
- Sliding scale fees: Some facilities may offer a sliding scale fee based on income for those in need of financial assistance.
- Scholarships or grants: There are organizations that offer scholarships or grants for addiction treatment – do some research to see if you or your loved one qualify.
At Moonlight Mountain Recovery, we understand the importance of insurance coverage and alternative payment options when it comes to addiction treatment. Our team is dedicated to helping patients and their families navigate this aspect of recovery, ensuring that everyone has access to the care they need. Contact us today to learn more about our programs and how we can help with insurance verification, whether you’re in Boise, Pocatello or any nearby part of Idaho.
