Dealing with substance abuse can be a trying circumstance for anyone. It puts stress on friends, family members, and coworkers alike when someone is dealing with an addictive habit. Whether the individual has chosen to go into rehab of his own accord or he’s going as a result of an intervention of some kind it is important that that person gets the treatment as soon as possible. While this fact is true there are some things that the policyholder will need to be absolutely sure of before he or she begins to enroll the patient in a particular program.
There are many different types of insurance plans for each individual to choose but your decision must not stop there. Even within a particular insurance plan there may be a number of variations. Often health insurance policies can be very detailed and no one policy will cover every possible health condition that may come up so it is extremely important that you understand what is included in any given plan you may have.
Substance abuse programs can be quite detailed and usually take a long time to complete making this type of treatment very expensive. To avoid getting hit with unexpected expenses you will need to take extra care when deciding on a substance abuse program to make sure that it fits within the parameters of your specific policy. Here are a few things that you’ll need to verify.
What Is A PPO Insurance Plan?
The Preferred Provider Organization (PPO) works within a specified network of healthcare professionals and preapproved centers to deliver substance abuse treatments. The professionals listed within this network have already entered into a contract with your provider for the services that you will receive.
Many people prefer this type of plan because it is a means of controlling medical costs by giving you a fixed dollar amount to pay for any services you’ll receive. The amount you or the patient will pay can be predetermined before any treatment begins; there are no surprises.
A rehab patient may begin treatment with any amount of cash they may have on hand and the insurance carrier would cover the balance remaining. Depending on the specific details of the policy the amount paid out of pocket may or may not be reimbursed but in most cases the patient will not have to pay any additional payment for the treatment he or she receives.
PPOs are often the preferred choice for drug or alcohol rehabilitation programs since they usually have a wider range of services to take advantage of. Often you will be able to receive treatment from any drug and alcohol rehab program listed within your plan.
Private companies usually have a more detailed list of options and facilities to choose from than public insurance carriers. In the US today, there are more than 10,000 detox and rehab centers that private insurance carriers will cover while with other public insurance carriers you could be limited to only as many as they have listed in their benefits package.
Another feature you may want to look at when you have PPO is the cost savings for treatment. Most private carriers offer a higher amount of coverage than public plans. However, caution must be exercised in this regard. One may believe that they are getting a higher level of coverage but that savings could easily be absorbed by a higher deductible as well. While you may have fewer out of pocket expenses, you may be surprised by the amount of money you’ll have to pay up front to cover your deductible.
Possible Treatment Options
Inpatient programs: More PPOs are willing to cover the costs of inpatient services, which will take the patient and completely remove him from the negative environment. By removing the patient from the negative environment he has enough time to recover and clear his system completely without interference. During the time he is away from his home environment he is counseled on how to deal with the negative triggers that may be causing him to use. In many cases the longer a patient is removed from the problem the stronger he may become.
Most PPOs will cover this type of treatment but you need to make sure that you know the number of days they will authorize and stay within those limits. Anything over that amount and you may find yourself having to pay out of pocket.
Luxury Rehab: Another possible option that PPOs will often cover that other public plans won’t, may be the luxury rehab centers. This type of treatment center affords patients with a higher-class environment while they are going through their detox treatments and counseling sessions. Rather than being put into a communal setting with shared quarters a patient may be provided with a private room, restaurant quality meals (rather than cafeteria style), personal instructors, and other luxury accommodations.
These types of facilities could be very costly if paid for on their own but with a PPO you may find that you can get that added level of dignity without having to shell out the extra cash.
Holistic Programs: Not all centers hold to the Western style health practices. Some may prefer a more organic approach through nontraditional methods. Centers that employ practices such as yoga, meditation, acupuncture, hypnosis and other less invasive medicines can often be rejected by public policies but with a PPO you’ll have more freedom to choose the type of plan that you feel would work best for you.
There are many different types of PPO plans that you may have. It is important that you verify with your provider before you enroll in any addiction recovery plans to make sure that these types of plans are provided. While the majority of PPOs will cover such a plan there are a number of variations that you need to know about. If you discover that your plan does not cover the amount of treatment you need, you should discuss with your carrier about changing your policy to cover the services you need.