Using PPO Insurance Coverage for Treatment at Our Facilities
At South Shores, we know that alcohol and drug addictions can completely take over your life. From limiting your career to destroying relationships to long-term health concerns, there are a lot of reasons to seek help for your substance use disorder. Unfortunately, many don’t.
In 2022, nearly 50 million Americans were suffering from a substance abuse disorder, but only 13% actually received treatment. In addition to not believing they needed help, financial concerns were another significant limiting factor in seeking help.
Once you’ve made the brave decision to get help, your next step is figuring out where you’ll go for rehab. If your insurance provider covers a PPO drug rehab, you can attend a high-quality addiction treatment center like South Shores Detox and Recovery without worrying whether they’re in your insurance network or not.
South Shores is your complete drug addiction treatment center in Orange County, California. Their relaxing facility provides a peaceful environment where you can focus on your recovery with the help of their expert team and a custom-tailored treatment plan that works for you.
South Shores works with a wide range of insurance providers so you can get the best care possible instead of settling for an in-network facility. Keep reading to learn more about PPO health insurance coverage and why South Shores should be your #1 destination of choice!
What is a PPO Insurance Plan?
Preferred provider organization (PPO) insurance is a type of health coverage that gives you more control over your healthcare. Like health maintenance organizations (HMOs), a PPO works with each healthcare provider to negotiate lower rates for your medical treatment while providing varying cost-sharing levels to lower your personal expenses and out-of-pocket costs.
While one option isn’t definitively better than the other, knowing the benefits of your insurance plan and how to make the most of it will help you keep costs down while receiving the level of care you need.
What are the Pros of PPO Insurance?
The primary benefit of using a PPO insurance plan is the flexibility to choose where you receive treatment for your substance use disorder. HMOs generally only offer coverage for in-network providers, which means you’ll have to pay 100% of the costs of your treatment if you attend a PPO drug rehab in Orange County.
A PPO plan offers coverage for both in-network and out-of-network care providers. You’ll have specific coverage, deductibles, coinsurance, and limits for each type of treatment, but you generally won’t pay 100% of the cost for any care you receive outside your network.
As a result, you can choose which addiction treatment center you want to attend based on their treatment programs and level of service instead of being limited to a specific directory of options. PPOs also make it easier to travel for treatment because they aren’t regional like many HMOs.
Outside of giving you more addiction treatment centers to choose from, PPO insurance plans also give you greater flexibility for ongoing care. Once you return home, you’ll be able to attend the same drug rehab for intensive outpatient (IOP) or outpatient care or choose your own local care team without restrictions if you travel to receive treatment.
Cons Include the Cost of PPO Insurance
As a general rule, the downside of PPO plans is the higher out-of-pocket costs. Your monthly premiums are usually higher than an HMO plan because of the flexibility they provide. Your deductible, the amount you need to pay before your insurance provider begins to cover services, is also often higher.
It should be noted, however, that the Affordable Care Act (ACA) Marketplace offers a range of PPO insurance providers that can help you or a loved one find health insurance plan, often at a lower cost than you might expect!
Important Factors to Consider When Seeking Addiction Treatment
The process of choosing your addiction treatment center can be complicated. If you don’t know what to look for and consider, your choices can easily become overwhelming and make you second-guess your decision to get help. Fortunately, once you know how to compare your options, making a choice is much easier.
The Terms Regarding Insurance Coverage for Rehab
The most important thing to look for when choosing your rehab is your insurance coverage for treatment. If you have a PPO, you likely have rehab coverage for your preferred destination, but the amount of coverage will vary for an in-network and out-of-network provider. If you have an HMO, you must choose one of their healthcare providers to use coverage.
The Cost of Substance Abuse Treatment
Treatment costs vary depending on the facility you choose and the treatment program you attend. Costs for inpatient programs can exceed $10,000 per month, so check your choice’s pricing alongside your coverage.
Your Insurance Deductibles for Healthcare Providers’
Your deductible determines when your insurance coverage begins. You’ll be responsible for any costs accrued before you meet the deductible, so you’ll have to consider costs more carefully if you haven’t met your yearly deductible yet.
Coinsurance Rate or Co-Pay Amount
Coinsurance rates are the percentage of the bill you’re responsible for, while your insurance company covers the rest. These rates can range from 0% to 100%, but you’ll generally find most in-network coinsurance rates around 20%, while out-of-network rates are higher.
What is the Maximum Out-Of-Pocket Cost?
Most health insurance plans have a limit to the amount of money that you will have to pay in a calendar year for healthcare, known as your out-of-pocket maximum. Your premiums aren’t included in this figure, but any amount that you pay for covered services you receive is.
PPOs will usually have a limit for in-network services and one for both networks together, but once you reach it, your covered care is 100% paid for.
Travel Costs and Related Expenses
One thing to consider when traveling for rehab is the travel costs. You will have to pay to get to the facility as well as any housing associated with non-inpatient services, plus your return trip, which isn’t covered by insurance.
Does PPO Insurance Cover Rehab?
Addiction treatment comes in many forms, so having comprehensive coverage for your PPO drug rehab is essential for minimizing your expenses. Fortunately, thanks to the Affordable Care Act, essential health benefits, including mental and behavioral health benefits, must be covered under most private health insurance plans.
However, your coverage will vary based on your plan, insurance provider, and treatment program.
Medical Detox in a Safe Setting
A medical detox is a physician-supervised discontinuation of the substances you’re addicted to. You’ll wean off of the drug or stop it entirely, experiencing withdrawal in the care of a qualified health team who will help you deal with any dangerous or uncomfortable symptoms so that you can have a fresh start when you enter rehab.
Medical detox is an especially essential step for alcohol and opioid addictions due to the risk of dangerous and potentially fatal side effects. Here, you’ll receive medication-assisted treatment that prevents serious complications
Inpatient Rehab and Residential Addiction Treatment Services
Inpatient rehab usually follows a medical detox but can also be the beginning of your treatment program, depending on your level of drug abuse. During inpatient rehab, you’ll live at the addiction treatment center of your choice. This includes all meals, sleeping, therapy, and other activities as part of your treatment plan, providing you with the environment, structure, and support you need to overcome your addiction.
Inpatient rehab is usually the most expensive and longest-lasting type of treatment, which can lead to higher out-of-pocket expenses and may cause issues with your health insurance coverage, depending on the length of your stay.
Outpatient Rehab
Outpatient rehab offers a longer-term treatment program for ongoing care as you live with sobriety. You aren’t required to attend treatments for a specific amount of time or on specific days, and you’ll go home after each treatment. Usually, these treatments will include therapy, psychiatry and medication management, and group therapy to aid in your recovery.
Outpatient rehabilitation treatments will often only incur a copay for the appointment, which keeps your expenses lower. However, out-of-network treatment may still apply a coinsurance rate.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs are usually the next step after an inpatient treatment program is completed. IOP at South Shores requires you to attend the facility for treatments 10-20 hours per week, usually for 3-5 days. Unlike inpatient programs, you’ll go home after treatment. But, you have to stick to the schedule they set to remain in the program, so it’s more intensive than outpatient rehab.
IOP is covered by most health insurance plans and doesn’t usually have a time limit imposed on your treatment, so you can continue to attend without worrying about losing coverage.
Should You Go To An In-Network or Out-Of-Network Addiction Center?
While there is no clear-cut winner when it comes to in-network versus out-of-network treatment centers, the best option for you will depend on what you value most in your treatment: value or choice.
Differences In Health Insurance Coverage Rates
Having PPO rehab coverage means that you can choose any treatment center or healthcare provider. However, there are still benefits to staying in-network for your treatment.
PPOs provide coverage for doctors and facilities outside of your network, but the coinsurance rates are likely to be different than in-network providers. For example, you might pay 20% of your treatment costs within your health insurance’s network, but out-of-network coverage requires you to pay 40% of the costs because they don’t have established rates with those healthcare providers to keep costs down.
Rehab Facilities and Getting Options at South Shores
Addiction treatment is a very personal and emotional process that can be mentally draining. An addiction program that doesn’t work for you or a facility that doesn’t give you peace of mind can derail your path to recovery. In many cases, your options are limited by your location and the nearby in-network PPO rehabs you have available.
Fortunately, your PPO plan gives you the freedom to attend any rehab center that you want to, providing you more control over your care and allowing you to set yourself up in the environment that’s most likely to aid in your recovery. If your in-network options don’t feel right, you can handpick your facility without paying the full cost of substance abuse treatment.
Your Next Steps for Seeking Addiction Treatment Coverage
Reaching out for help is difficult, but fortunately, a PPO insurance plan makes it easier to begin your path to sobriety.
You don’t need a referral from your primary care doctor to attend rehab with a PPO, so you can receive a diagnosis and referral at the treatment center to minimize the amount of time you spend waiting for help.
Your next step is to pick your substance abuse treatment center. The drug rehab that you choose can make or break your treatment, so spend time finding one that fits your needs. At South Shores, we are ready and waiting to answer any questions about treatment and make sure we are the right fit for you or your loved one.
Once you’ve chosen where you’ll attend rehab, it’s a good idea to call us directly so you can verify your health insurance coverage, get an idea of your costs, if any, and learn more about our facility and what to expect when you arrive.
South Shores Recovery: Your Premier PPO Drug Rehab
If you or a loved one are struggling with substance abuse, getting the right treatment is essential. Fortunately, if you have a PPO, you can get effective treatment from a drug rehab like South Shores Recovery no matter where you are.
South Shores is a comprehensive addiction treatment center that works to simplify the process of getting help with your addiction. We work with a wide range of health insurance providers to make sure you can access our holistic treatment programs, serene facility, and custom-tailored treatment plans to start the path to recovery off on the right foot.
If you’re looking to take advantage of your flexible insurance plan, look no further than South Shores in Orange County. Contact us today to begin your journey to sobriety!
Resources
- https://www.samhsa.gov/newsroom/press-announcements/20231113/hhs-samhsa-release-2022-nsduh-data
- https://nida.nih.gov/about-nida/noras-blog/2022/01/making-addiction-treatment-more-realistic-pragmatic-perfect-should-not-be-enemy-good
- https://www.hhs.gov/answers/health-insurance-reform/does-the-aca-cover-individuals-with-mental-health-problems/index.html