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Introduction To Open Access/POS Insurance Policies For Rehab

When it comes to health care, finding the right kind of provider is probably the most important decision one can make. Choosing the right kind of insurance coverage can make a difference between getting hit with major medical bills or making sure that your health care is in good hands with the right kinds of professionals. No one wants to be in a position where they are forced to decide between medical care and their wallet.

This is especially true when it comes to finding the right coverage for a substance abuse problem. Choosing to take the step to get treatment for a substance abuse can be an emotional and difficult decision all on its own so one would want to make sure that they have no problems that can throw a patient off track because they weren’t fully aware of what to expect from the insurance carrier.

For the most part, nearly every insurance carrier offers some form of coverage for substance abuse but there may be some major differences in what exactly is covered and how to go about getting the services you need. For that reason you need to understand your policy and what you can realistically expect from the carrier you have.

What Is An Open Access Plan?

Once an addict has agreed to go into a substance abuse treatment plan it is extremely important that they begin right away. A delay of any kind could end up with the patient changing his mind or getting more deeply involved in his habit. Still, even with the urgency of the situation it is important that you understand what your Open Access Plan will provide.

When you have an Open Access Plan, as a member you are allowed to receive any in-network covered services and benefits provided at the level of plan that you have chosen. This type of product is a blend of the traditional HMO and indemnity plan. Unlike the HMO however members are not required to obtain a referral before they seek the help they need.

While the carrier may have an approved list of treatment options and professionals that can take care of your substance abuse problem it is not a requirement for you to use that particular service. You do have the option of seeking non-approved professionals for your treatment if you are comfortable with other programs.

What Is A Point-Of-Service (POS) Plan?

With most plans, whenever you need services outside of a particular network or outside of the basic services offered you’re required to get a referral from your primary care physician. However, with a point-of-service (POS) plan a member has the option to receive coverage without getting prior authorization from the member carrier.

These may be classified as out-of-network services even when they are offered within the same list of approved professionals. When that happens you may find that you are subjected to a higher copay over and above what is the standard. Whether the outside services are for a specialist for a unique kind of rehab or you’re in need of emergency care it would be wise to be prepared to pay for that higher copay.

Cost Containment

Most people will choose HMOs or similar insurance programs because they have the assurance that when medical issues arise, there are some concerns that everyone should consider when deciding to go off the approved list to get the treatment you prefer.

While the insurance carrier may be willing to pay for the services you choose regardless of where you get your treatment they may require you to pay a higher copayment or coinsurance as a result. This could present a major obstacle if you’ve chosen your carrier because of the low copay. Some carriers may view the outside provider as a “specialist,” which will bring a higher cost than those that are approved on their list.

Watch Out For Limitations

There are other concerns you may want to double check before choosing a treatment facility for drug rehabilitation. Some Open Access/POS plans may have a number of limitations on the type or length of plan you may choose. Always check for the number of days allowable for a plan before you’ll have to start picking up the tab yourself.

For example, with inpatient care, a patient may be expected to do 30, 60, 90 days or more before they are considered clean and have completed the program. Make sure that your policy will cover all of the needed days. Some policies may have a limit of 60 days for each year. If the plan you choose calls for a longer amount of time you may have to pay the difference and that amount could be quite substantial.

The same is true for outpatient services as well. Some plans may authorize payment for as little as 5 days in one year while others could give you as much as 30 outpatient visits.

The best way to find out if your policy has these types of limitations would be to refer to your Evidence of Coverage Booklet or your Benefit Summary page for specific details about the limitations that may be imposed on your treatment plan.

People choose their insurance plan for a number of different reasons. Some choose because they like a particular medical professional and they are contracted with the plan they’ve chosen while others choose because of the lower cost of a plan they need. Whatever your reason for choosing your insurance carrier it is important that you make yourself familiar with your Benefits Summary page of your policy. This page is designed to give you a synopsis of your plan at a glance detailing what services are approved and what payments you need to make.

It is always wise that you familiarize yourself with the specific details of your policy before you’re in need of the services that may be offered. This way you can protect yourself from any additional surprises that could come your way.

When it comes to getting substance abuse treatment the matter can be very sensitive and often there are many concerns to deal with not only physically but emotionally, socially, and mentally as well. You don’t want to be dealing with financial or legal issues at such a difficult time. Always check and double check your coverage before you start with any type of rehab so that you are better equipped to deal with the real problem at hand and that is taking care of the health of your family.