In Network Drug Rehab Center

When a medical provider such as a addiction treatment center, is “in-network” that means that the addiction rehab facility and the insurance company have agreed to a rate for treatment of their health insurance members. This is normally at a lower cost than they would pay at an out-of-network center.

It is an agreement between a selected rehab centers and the insurance companies that provides members with a discounted rate for treatment.  Most of the time, this lower cost is absorbed by the insurance company, less any deductibles.

The other way someone can find treatment is through going out-of-network. Most HMO policies do not cover out of network centers.  This requires the policy holder to have a PPO policy, which allows for out of network services.  Although the insurance company will cover some treatment, the policy holder is required to cover their deductible, and any out of pocket expenses not covered by insurance. As a 30 day stay in treatment can cost between $12,000 and $35,000, this out of pocket can become very expensive.

Difference between Being In-Network and Out-of-Network

The major difference between the two options is cost. For example, one insurance provider may cover 30 days of treatment, including detox at 100 percent if the treatment center is in-network with the insurance company. While out of network coverage may only cover 50% of the total bill.  Leaving you, the policy holder, responsible for the other 50%.

In another example, an insurance company may not cover any treatment center which is out of network and would require you to stay in network for your addiction treatment. These policies are called HMO policies.  They restrict the policy holder to staying in network, most of the time, in the same state the policy is written on.