In-Network vs. Out-of-Network Rehab Insurance

By admin on January 5, 2019 | Treatment Programs
A woman using in-network insurance for rehab sits during a group therapy session.
In-network health insurance for rehab can often be the most cost-effective route, but it’s not your only option. Learn about in-network vs. out-of-network rehab insurance & the life-changing support that’s available.

Treating any disease can be a costly undertaking. The typical expenses associated with hospital care and clinical interventions can make a person’s head spin. That is why receiving comprehensive health care coverage is so coveted: it ensures that the medical care you need will always be readily available and that if or when a major medical expenditure is required, you will not be stuck footing the entire bill for treatment.

The same logic can be applied toward rehabilitation coverage for a substance use disorder. Whether you are looking into an outpatient form of therapy (a program primarily based in the community) or an inpatient option (a program initiated in a residential setting), making sure that your insurance coverage is in place prior to beginning treatment can have a dramatic impact on the costs associated with your experience.

Imagine wanting to receive the necessary care and treatment for your addiction but being so overwhelmed with the costs associated with care that you forgo therapy altogether. Or, that you begin your rehabilitation stay at a clinically sound treatment facility without having the insurance or necessary funds to cover the costs associated with the program.

In both cases, the progress that could be made in therapy is clouded and potentially washed out by the stress associated with the cost of care you are receiving. This is no way to begin your recovery journey and can negatively impact your overall therapeutic experience and potential progress to be made in treatment.

Taking the time to better understand in-network coverage vs. out-of-network coverage can better prepare you to make an informed decision regarding which treatment facility best suits your needs as well as your pocketbook.

What Does In-Network Mean?

As the term states, in-network refers to the treatment options that are within your particular network of care. The terminology itself is used to indicate when a clinician or treatment facility accepts your health insurance and is considered a participating provider through your insurance company.

Additionally, in-network refers to providers or health care facilities that are part of a health plan’s network of clinicians and facilities with which it has negotiated a discounted rate. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts.

The provider’s contract with the insurer requires the insurer to accept the insurer’s payment (plus the patient’s cost-sharing, such as the deductible or copay) as payment in full. This ensures that the person receiving the treatment and therapeutic services will not be forced to pay the entirety of their medical expenses.

What Does Out-of-Network Mean?

The term out-of-network refers to clinicians, treatment facilities and other health care providers who do not participate in an insurer’s provider network. This means that the provider has not signed a contract agreeing to accept the insurer’s negotiated prices.

Depending on which insurance plan an individual has, expenses incurred for treatment services provided by out-of-plan health professionals may not be covered, or may only be partially covered by their insurance company.

Policies that cover out-of-network care are less common than they once were, but they are still available in some areas. They generally impose a higher deductible and out-of-pocket limit when patients obtain care from an out-of-network provider.

This means that rehabilitation services obtained through an out-of-network provider will typically carry considerably more out-of-pocket expenses.

Why In-Network Health Insurance for Rehab Isn’t the Only Route to Paying for a Top
Rated Rehab Program

While the benefits of sticking with an in-network provider are evident, there are definitely times when stepping outside of those designated treatment options is a viable alternative.

In particular, if you are struggling with a specific addiction and everything you read and hear points you to a certain rehabilitation facility that is outside of your network, it is worth the effort of researching alternative payment options.

Many facilities will work with clients to set up payment schedules and tapered payment opportunities in order to facilitate their assimilation into the rehabilitative program.

At Covenant Hills, every effort is made to treat each and every client like the individual that they are, discussing their specific needs and working directly with each incoming participant in order to ensure that their transition into the facility is as simple and expeditious as possible.

Facilities that are committed to their clientele exemplify the rehabilitative process and welcome any and all questions and concerns regarding their intake procedure. This includes how they can individualize the process for you and what efforts they can make to adjust the cost of treatment in order to benefit your specific scenario.

At Covenant Hills, we believe that hope facilitates change and change requires adaptation. We are constantly adapting to our client’s needs in order to provide them the hope and change they deserve along their recovery journey.

Faith-Based Addiction Treatment and Relapse Prevention at Covenant Hills

Our highly-credentialed treatment team has helped thousands regain their lives, and we are ready to help you now. To start the process toward a new life in sobriety, contact us directly.

Our dedicated admission experts help prospective patients navigate confusing insurance plans and talk them through affordability options.

Every call is completely confidential, and after a quick and free assessment, we will be able to better understand your situation, describe what a treatment program can look like for you or a loved one, and help you uncover viable ways to pay for treatment.

At Covenant Hills, it is our upmost mission to meet you wherever you are in your religious and addiction journey and walk with you every step of the way until you reach complete recovery.

We take a Whole Person Approach to drug and alcohol rehab and mental health disorders. We work with every aspect of you to ensure complete care and healing. Above all, we offer a safe place to surrender and connect with God.

Learn about our gender-specific, faith-based addiction treatment programs, or contact us for a free and confidential assessment. We are available 24/7.

We're Here to Help

32236 Paseo Adelanto Suite G.
San Juan Capistrano, CA 92675


We're Here to Help

32236 Paseo Adelanto Suite G.
San Juan Capistrano, CA 92675

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