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Using A Health Maintenance Organization To Access Drug Rehab Care

Statistics show that around 31 percent of Americans belong to a Health Maintenance Organization (HMO). These operate by using managed care contracts and they deal directly with a selected network or hospitals, doctors and other health care professionals. They do this so that they are able to provide a network of healthcare which their members can make use of.

How Does It Work?

When you join an HMO you will be assigned a primary care doctor or physician, this doctor will be responsible for providing most of your care using the specific doctors and services available in the HMO network. This helps to keep the costs low however you do have to sign a co-pay agreement which makes you responsible for paying a certain percentage of the cost of treatments, in addition to this you will also pay a deductible. Still, it works out to be a lot less expensive than paying everything out of pocket.


There are some negatives to choosing an HMO instead of a regular insurance provider, there are limitations to the care that can be accessed, particularly out of network, a primary care physician will need to be convinced that you are in need of drug rehabilitation therapy and then even if they believe that you are in need the decision will need to be reviewed by HMO admin who will be quite within their rights to refuse this treatment. You can appeal against this decision if they do refuse it and then if they refuse the appeal there are other avenues you can go down but it is a lot of hassle.

Out Of Network Care

Even if your request for drug rehabilitation treatment is approved you are still limited by the care which is available in your network. If treatment is not available within the selected network supplied by your HMO then you will either be refused the treatment or have to find other ways and means. Fee’s outside of the network are going to be much higher and there is a chance that your HMO will refuse to pay and you will be left to fund it all out of your own pocket. If they do agree to pay then you can expect your co-payment to be much higher than you would pay for care inside of the selected network.


There are also several advantages to choosing to use an HMO for your healthcare, not the least of which is having a primary physician in charge of your care. This enables you to build up a professional relationship of trust and understanding, they can get to know you and your family fully and so will know exactly what is normal and what maybe isn’t so normal for you health wise. They can fight your corner if they believe you are in need of treatment and are being wrongly denied it. It can be highly beneficial to have this sort of relationship with a physician, many people would love that opportunity rather than seeing different doctors and medical professionals all the time.

HMO Rehab

When it comes to rehabilitation treatment under a health maintenance organization you first have to be accepted onto a treatment program. If you are successful with this you will find that the HMO admins will be working in conjunction with specialists to determine the exact level of care that you will be needing. This will include detoxification periods along with counseling, inpatient and outpatient treatments and any medications that may be needed. However, it is important to note that there are often limits to the amount of treatment that will be covered and the costs that can be spared. You may find that after a certain number of days your coverage is maxed out so you may want to ask your HMO if you can exchange one level of care for another.

On Your Behalf

The journey of drug or alcohol abuse or addiction and the recovery from this is not going to be an easy one and it is common for individuals who are undergoing this treatment to feel completely overwhelmed and confused by the process. Most HMO’s will allow you to appoint someone else to act on your behalf, they will be able to handle all of the financial side, arranging for payments to be made and paper work to be filled in. They will not be able to dictate what type of treatment you should receive as this will always be the decision of yourself and the medical practitioners who are coordinating for you. It can be extremely helpful to name someone who they can talk to on your behalf so that if there comes a point where you can’t handle it, this is one less stress and worry to weigh on your mind.

HMO vs. Alternative Health Insurance

If you really want to know whether using a health maintenance organization is the best way for you to receive the correct rehabilitation treatment then you will need to sit down and compare what they offer compared with what some alternative health insurance companies offer. There are positives and negatives to both and an HMO can be a good thing for those who are maybe struggling a little bit financially due to the lower costs, however you will need to weigh up the limitations in care that can be received due to the strict networks which are used.

Whichever route you choose to access your drug rehabilitation treatment it is important to take a moment to be proud of yourself. It takes a lot of courage to admit you need help and then actively seek it so if you find yourself searching for this treatment you can rest assured in the knowledge that you have taken the first step of the journey. Recovery is not quick and it is not easy but there is a light at the end of the tunnel and when you come out on the other side you can look back on all that you have achieved. I bet you will be extremely grateful for the services provided by the HMO.