Payment & Insurance

An HMO is a health maintenance organization, and a PPO is a preferred provider organization. The difference between the two lies in the policy holder’s ability to freely seek treatment from a specialist. An HMO typically requires a referral from a primary care physician while a PPO does not. The flexibility can be more costly. PPOs have higher deductibles and copays, though the network is larger and policy holders have more freedom. HMOs tend to have smaller networks and lower copays and deductibles.

Insurance companies typically create a network of doctors, hospitals, and treatment centers that are under contract with the company. These health care providers offer lower group rates, and in return, insurance companies incentivize policy holders to use those in-network providers by offering lower copays and more coverage. On the other hand, health care providers that are out-of-network can be more expensive because they are not under contract with the insurance company.

A deductible is the annual dollar threshold that you’re required to pay out-of-pocket before the insurance will cover your costs. Copays and monthly premiums do not count toward this amount. For example, if you have a $1000 hospital deductible and your hospital bill was $12,000, you must pay the initial $1000 and the insurance company pays the agreed upon percentage for health care services after that amount.

Coinsurance refers to the percentage of services you’re responsible for paying after your deductible is met. For example, if your coinsurance is 80/20, then the insurance company pays for 80% of the remainder of the cost after your deductible is met and you pay for the other 20%. It may also be 90/10 or 70/30.

A copay is a fixed sum that you’re required to pay to use a certain service. For instance, if you have a $50 copay for visits to your primary care doctor, that’s what you would pay regardless of the cost of your visit. Your insurance would cover the rest.

If you’re a client paying fully out-of-pocket, either because you don’t have insurance or your insurance won’t cover rehab, you can work with our finance specialists to establish a payment plan. If you’re using health insurance to pay for rehab, you may only be responsible for a copay or deductible, and the insurance company will be billed for the remaining costs.

Yes, you’re not required to have insurance to attend rehab. It is also available for self-payers. In some cases, Medicaid or Medicare along with other state or federal plans may cover rehab costs.

The cost of essential treatment does not incur added costs. However, if you’re interested in luxury options at your rehab center, those may be available for an additional fee.

Most insurance companies cover some form of addiction treatment, including popular companies such as Blue Cross Blue Shield, Humana, United Healthcare, and Aetna. However, your individual policy determines the type of treatment and the amount covered.

Retirement account withdrawals can be used to cover medical expenses including rehab. You can borrow up to $50,000 or half your account balance. However, keep in mind that when you borrow from a 401(k) or other type of retirement plan, you’ll have to repay the amount with interest.