PPO Insurance Coverage for Alcohol and Drug Rehab

If you have PPO health insurance, you have mandated coverage for drug and alcohol rehab.

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A preferred provider organization is more commonly referred to as “PPO”. It sets itself apart from medical insurance companies by not requiring you to get a referral before you can see a specialist. As long as you visit a medical expert, doctor or physician who is within their network, you will be covered.

Under a PPO plan, you usually have to pay a deductible for every visit to the doctor. Additionally, coverage will generally only start after you have paid a specific amount yourself. Not every PPO plan offers coverage for drug and alcohol treatment and those that do will usually require you to pay a significant deductible. If you are dealing with a substance abuse problem, then it is very important that you look into this properly so that you know what to expect.

PPO Insurance Coverage for Alcohol and Drug Rehab

Becoming free from an addiction to drugs or alcohol always starts with a period of detox, which should always be medically supervised, but unfortunately, not every PPO plan will cover detox. This is quite unique because, since the implementation of the Affordable Care Act, substance abuse treatment must be covered in the same manner as mental health treatment. This would suggest, therefore, that some PPO plans do not cover any mental health treatment either.

Recovery is more than just detox, though. Once your body has been cleansed from the harmful toxins, you still have to work through your psychological addiction and significant emotional trauma. Under the Mental Health Parity and Addiction Equity Act of 2008, all insurance companies now have to offer substance abuse coverage as part of their plan. Exactly how insurance companies offer this can vary greatly. As such, your PPO may not cover a stay in rehab at all. If any of the plans do offer any limits on substance abuse treatment, it must place those same limits on mental health treatments.

Quick Stats:

Nearly 40% of stimulant abusers first began using before the age of 18.

How Long Will PPO Insurance Cover You for Drug and Alcohol Treatment?

The Substance Abuse and Mental Health Services Administration has stated that the average stay in residential rehab is between 30 and 105 days. Those who undergo an outpatient rehab program, by contrast, usually take at least 120 days. By going to a residential inpatient facility people can receive slightly more confidential and discreet services, because they can literally withdraw from the world and not be seen entering or exiting a facility by anyone. How long you can stay in rehab, whether for an inpatient or outpatient treatment program, will vary depending on the terms and conditions of your policy.

Quick Stats:

About 72% of all cases reported to poison centers for substance use were calls from people’s homes.

PPO Insurance Coverage for Specialty Drug and Alcohol Treatment

PPO plans are often managed by employers, and they will generally choose different providers based on past experiences, rather than enabling employees to name their own preferred providers. As a result, if you have a PPO plan, you may not be able to choose where you want to go. That being said, the coverage will be the same across the board, meaning that you will have the same access to the same physicians and professionals as the CEO of your company. In some cases, this also means that you can have access to some very luxurious and executive services, including private rehab facilities. These facilities cater specifically to the needs of executives and VIP’s who need to be able to fully remove themselves from the world, while at the same time being able to maintain business contacts. Some of the amenities you can expect at these facilities include swimming pools, aromatherapy, horseback riding, tennis courts, massages and more. It is unlikely that your PPO will cover 100 percent of your stay, but you may just find that your personal out of pocket expenses are surprisingly low, particularly when you consider that few other insurance companies would provide any cover for luxury or executive treatment facilities.

Quick Stats:

The United States produces on average 300 tons of barbiturates per year.

PPO Insurance Coverage for Inpatient and Outpatient Treatment

As previously mentioned, rehab treatment is offered either on an inpatient or an outpatient basis. What brings the two together is that they both focus on teaching those abusing or addicted to substances the skills they need to live a sober, healthy and happy life. Which treatment plan you are assigned to will vary tremendously.

In many cases, inpatient residential treatment is the only suitable option if someone is to get and stay sober. However, before you choose one to go to, you should make sure that you check with your PPO on whether they will provide coverage at all. Outpatient facilities tend to be a lot less expensive, because you will not be receiving 24/7 care in an environment surrounded by medical professionals. If you do have your heart set on a certain inpatient facility, you could ask that center to perform an insurance check for you so that you can find out whether or not you will be covered. This check is 100 percent confidential, discreet, free and no obligation, so you have nothing to lose.

How to Pay Your Out of Pocket Expenses

The first thing to understand is that, no matter what your out of pocket expenses are going to be, treatment will be worth it. You cannot put a price on lifelong sobriety, health, and happiness, after all. Plus, continuing to use substances is also incredibly expensive. Nevertheless,just because the costs are justifiable, it does not necessarily mean that you have the means to pay for them. Luckily, some methods exist to help you with the cost of rehab, including:

  • Applying for a scholarship or sponsorship through the treatment center itself
  • Applying for a grant through the SAMHSA, which are usually open all year
  • Taking out a bank loan
  • Selling your vehicle and other assets
  • Asking friends and family members if they would be willing to donate some of the money

As you can see, there are plenty of options available for you. If you are ready to seek help, you may feel like your finances are one of the greatest obstacles in your way. While finances certainly do not make things easy, there are ways to work around them, thereby making sure you get the help that you need.