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When it comes to paying for a drug or alcohol treatment program, understanding your insurance policy can be daunting. Questions like, “What does my insurance policy cover when it comes to treatment?” and, “Why do they cover some items and not others?” can cause you or your loved one to second guess the decision to get help. We have experience negotiating with insurance providers, so there’s no need to face the confusing details of coverage on your own.
Our team of professional admissions coordinators works with providers every day to ensure that patients get all the benefits available from their policies. We can speak to your insurance company on your behalf and convey all the important information to you. Our coordinators will give you a free, confidential assessment and determine your benefits for coverage at no cost to you.
Demystifying Common Insurance Terms
Getting to know often-used insurance terms you’re likely to hear from admissions coordinators can help you feel confident when calling our facility. The following are some of the most common:
Premium: A premium is the amount people pay at regular intervals to their insurance companies. This is the individual’s contribution to his or her policy. For those who have insurance through an employer, the premium is automatically deducted from each paycheck. Employers may also contribute to this premium. Premiums are determined by what kind of coverage a person has, such as an HMO or PPO plan.
Deductible: This annual cost is the amount you must pay before insurance will begin to cover your expenses. If you have a high-deductible plan, you accept higher overall costs in order to lower your monthly premiums. If you have a low deductible plan, your premium will be higher each month. Once the deductible is met, your insurance policy will cover all or a majority percentage of your health costs.
Co-pay: A co-pay is a regular fixed cost that you pay for certain services. For example, you may pay a small co-pay for regular doctor’s visits. This contributes to your overall plan and is part of your cost agreement with the insurance company. Some insurance plans do not require a co-pay.
In-network coverage: When a treatment provider is in-network with your insurance company, it means the rates for treatment are discounted and predetermined. This is cost-effective for all involved parties, but it also means that the choice of providers may be limited.
Out-of-network coverage: This applies to a treatment provider that does not have a predetermined contract or cost agreement with the insurance company, but people can still receive treatment with this provider. The rates won’t be discounted to the same extent they are for in-network providers, but finding a specialized facility may be worth the out-of-network rates.
Out-of-pocket expenses: Your out-of-pocket cost is any amount not covered by insurance that you are responsible for. These costs are usually due at the time treatment begins, but you may also be able to set up a payment plan. Out-of-pocket expenses include deductibles, co-pays and co-insurance.
Some of the insurance providers we work with:
- Exclusive Care
- Priority Health
Find Out What Your Policy Covers
The Parity Act has helped to make strides in getting greater insurance coverage for substance abuse treatment. Contact us (855-317-8377) to find out what your insurance policy covers when it comes to addiction programs. We will work with your insurance company at each stage of the treatment process to get as much coverage for you as your policy dictates.