HMOs & Addiction Treatment: The Truth About Insurance & Patient Choice

HMOs & Addiction Treatment The Truth About Insurance & Patient Choice - TransformationCare

Pretty much everyone in America would probably agree that health insurance sucks, and HMOs tend to suck even more than other plans. If you’ve never had to think about it, you’re lucky; but if you’re struggling with a serious disease — and addiction is one of them — then insurance issues loom large. When you’re trying to get help without going bankrupt, HMOs give you more than a few hoops to jump through. Still, it’s possible to get addiction treatment under an HMO insurance plan. Let us explain.

What’s an HMO?

First up: What is an HMO and how do you know if you have one? HMO stands for health maintenance organization, which is a health insurance plan that is contracted with certain healthcare services. Choosing an HMO over a PPO or EPO may make your deductible cheaper each month, but there are a few trade-offs. First, you will have limitations around what healthcare services you can get. With an HMO plan, you have to see your primary care doctor first to get a referral before anyone else will see you. (At least, that’s if you want your insurance company to pay for your treatment.) Then, you have to see the healthcare provider that your referring doctor picks. You don’t get a choice. 

How Do I Know if I Have an HMO Insurance Plan?

If you have a health insurance card, it should say what type of insurance plan you have (ie. HMO or PPO). If you can’t find your card or don’t see this information listed, you can call the member services number for your insurance provider (also listed on the card). If you don’t have an insurance card or can’t find it, google your insurance company and look for the member services phone number. You can also give us, Transformations Carea call and we’ll help you figure out what you’re covered for.

If I Have an HMO Plan, Do I Have a Choice in an Addiction Treatment Program?

Once, you’ve figured out if you do have an HMO plan, how do you look for addiction treatment? We’ll be straight with you: HMO plans can be a pain in the @ss, because you’re extremely limited as to what rehab programs you’re covered for. Why are your options limited? Insurance providers have contracts with certain treatment facilities, so they want you to go to a rehab that’s in-network with them. (Surprise, surprise: They make more money this way.) 

Any treatment is better than none at all, but going to an addiction rehab facility just because it’s in-network doesn’t mean that the addiction treatment program is right for you. Yes, maybe they can get you clean, but it takes finding a facility with a solid addiction treatment program to keep you clean and sober for good. At Transformations Care, our approach treats both your addiction and any underlying mental health issues to help you find a better life once and for all.

What your HMO insurance plan doesn’t want you to know is that you still have options. You can choose the residential addiction treatment program that works best for you, no matter what they say. But how? 

At Transformations Care, we accept private pay, which means you have the freedom of choice and can pay for the cost of rehab with your own funds. Not all addiction treatment centers allow for private pay, but we’ll help you figure out a way to get the addiction treatment that you deserve. Give us a call at 424.339.0965 to learn more about your options outside of your HMO’s in-network programs and how we can make rehab affordable for you.

Getting Clean Sober at Home 2

GUIDE

Getting Clean & Sober at Home

Today, more than 75% of hospitals and healthcare providers offer access to telehealth treatment, with 29 states having gone so far as to enact telehealth parity laws, which force insurance companies to reimburse patients for telehealth at the same rates as they would for in-person treatment.
 
 If you’ve been thinking about getting clean and sober, or if you’ve been wanting to work on and strengthen the recovery you already have, it’s never been easier to do it through telehealth.