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PPO Insurance Coverage for Drug and Alcohol Addiction Treatment

  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Modified:
  • Reading Time: 8 minutes
  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Last Update:
  • Reading Time: 8 minutes

Learn about PPO insurance coverage for drug and alcohol rehab treatment, highlighting benefits and important coverage terms.

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Addiction patients with a Preferred Provider Organization may go to any rehab or therapist they choose, regardless of whether they are in their network.

Most of us worry about how we’ll be able to pay the hefty expense of rehabilitation. When considering different options for paying for rehabilitation, one such plan that may come in handy is a PPO plan.

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Navigating the Flexibility of PPO Plans

What is a PPO?

Also known as out-of-network providers, PPO plans include doctors’ offices, hospitals, and other medical institutions agreeing with insurance carriers to treat their policyholders at discounted costs.

PPO plans generally allow enrollees a broader pool of doctors and hospitals from which to choose. In addition, when PPO plan participants visit a provider (therapist, rehab, etc.) who is part of the plan’s provider network, the insurance company pays the provider the entire agreed-upon rate, and the patient is responsible for any applicable copayments or deductibles.

Care received from an “out-of-network” provider results in a claim being paid, but not at the agreed-upon cost. This results in increased out-of-pocket expenses for you.

When enrolling in a PPO, you are often given the option to choose from the preferred provider list. However, you don’t utilize a provider on the insurance plan’s list of recommended specialists. In that case, you may be responsible for paying the entire cost of care and whatever your copayment is under the plan.

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Ensuring Rehab Coverage with PPO Plans

PPO Coverage for Alcohol and Drug Rehab Treatment

PPO plans, made possible by the ACA, ensure that rehab programs may be as all-encompassing as any other medical program. For example, mental illness and substance abuse treatment must be equally important as physical illness; a credible in-network facility will ensure this.

In addition, because a PPO clinic is aware that the Affordable Care Act specifies that addiction is not a pre-existing condition, health insurance providers cannot refuse to treat patients because of their addiction.

What To Know About Your PPO Insurance

Our Admissions Experts Will Help You Navigate This Difficult Information.
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Co-Insurance

Typically, co-insurance percentage range from 20% to 40%, and the insurance company clears the rest.

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Deductibles

The amount you pay out-of-pocket for treatment before the health plan starts helping with payments.

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Copayment

Co-pay is a fixed amount you must clear (usually when you receive treatment) for covered treatment services.

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Addiction Treatment Coverage Through PPO

Drug and Alcohol Addiction Treatment Services Covered by PPO Insurance Plans

Addiction may be fatal, a sobering reality that no one wants to face. The greatest chance for long-term sobriety is to receive addiction treatment at a reputable drug rehab facility like Rolling Hills Recovery Center.

Our individualized care plans include many forms of therapy that impart knowledge and facilitate the development of coping mechanisms vital to avoiding repeat relapse. The only thing needed to reap these rewards is a dedication to the treatment program.

If you are a member of a PPO network, you may rest easy knowing that your insurance will cover some or all of the cost of addiction treatment. In addition, our therapists and counselors are here to help you become sober. Substance addiction is a battle that no person can win without professional help.

The following are examples of coverage that may be expected from a PPO plan:

  • Interventions (for example, by social workers).

  • Evaluations for alcohol and drug use.

  • Inpatient and outpatient rehab services.

  • MAT (medication-assisted treatment).

  • Psychological help for families, for example, through family therapy.

  • Behavioral therapies include CBT, DBT, and individual and group therapies.

  • Clinic visits.

  • Home care services.

In addition, a PPO plan may facilitate enrolling patients facing hazardous and incapacitating withdrawal symptoms into medical detox programs. Moreover, several states provide their healthcare coverage. That implies people may choose from the state’s or the federal government’s health care options.

Who is eligible for Medicaid and Medicare PPOs is determined by age, income, and the number of people living in the family, and these factors differ from state to state. In addition, individuals who do not qualify for federal health care programs like Medicaid and Medicare may shop for a PPO plan via the ACA’s online marketplace.

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Key Insurance Terms for Rehab Coverage

PPO Insurance Coverage Terms That Are Very Important to Keep in Mind

It would be best if you understood the terminology used by health insurers to comprehend how to use your policy to aid in the payment of rehabilitation services.

Deductible

Before your insurance provider starts paying anything, you will be responsible for paying a deductible out of your pocket. This sum must be paid in addition to your standard premium; your average premium will not be subtracted from the amount due.

In most policies, after you have satisfied your annual deductible, your insurer will start paying a certain proportion of the covered costs.

Premiums

You must make this recurring payment to keep your insurance policy active. Your premium won’t impact your deductibles; however, a PPO plan’s premium can be a little more expensive than other types of coverage.

Copayment

A copayment, sometimes known as a “copay,” is a small, upfront payment required at the time of service. For example, the visit cost might be as little as $5 or as much as $75, depending on the kind of treatment you want and the type of health insurance you have.

Your annual deductible will not be reduced in any way by this payment, just as your premium will not reduce it.

Co-Insurance

Your insurance provider will pay this amount after you’ve reached your deductible. Some policies may pay for a patient’s medical bills, while others may pay for just a specific proportion and require the patient to pay the remaining balance out of their pocket.

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In Conclusion

Verify the Coverage of Your PPO Insurance

If you or a loved one is currently receiving treatment, knowing the specifics of what your PPO insurance covers in terms of drug and alcohol treatment will help you feel more at ease. Concerns over one’s financial situation should not hamper the pursuit of sobriety and recovery from addiction.

If you need further information on PPO insurance plans or want to check what your plan covers, you may call the number on the back of your insurance card. Another option is for you to contact Rolling Hills Recovery Center at the following number: 855-559-8550 to speak with one of our admissions navigators. They will be able to guide you through the process of assessing whether or not you are covered and will respond to any questions or concerns that you may have.

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Written By:

Geoffrey Andaria

Geoffrey Andaria mental health writer at rolling hills recovery center
Rolling Hills Recovery Center

Mental Health Writer

About Author:

Geoffrey Andaria is an experienced mental health content writer and editor. With a B.A. in English and Journalism, Geoffrey is highly educated in freelance articles and research. Having taken courses on social work, Geoffrey is adamant about providing valuable and educational information to individuals affected by mental health and the disease of addiction.

Medically Reviewed By:

Dr. Carl Williams Ph.D., LCADC

Carl Williams, medical content reviewer at rolling hills recovery center
Rolling Hills Recovery Center

Expert Contributor

About Reviewer:

Dr. Williams presently serves on the board of Directors for two non-profit service organizations. He holds a Master’s degree in Human Services from Lincoln University, Philadelphia, Pa, and a Ph.D. with a concentration in Clinical Psychology from Union Institute and University. In Cincinnati, Ohio. He is licensed to practice addictions counseling in both New Jersey and Connecticut and has a pending application as a practicing Psychologist in New Jersey.

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