When it comes to behavioral health treatment, the benefits of choosing an in-network rehab provider for addiction treatment far outweigh the benefits of choosing an out-of-network rehab provider.
Choosing an in-network rehab gives you a leg up in many areas. While completing a search for a rehab center, you may have heard the terms “in-network” or “out-of-network” in conversation, ads, and web content. Or, maybe you’ve heard these terms regarding while choosing a new healthcare plan or while seeking out treatment for an ailment that has arisen recently. However, what exactly do these terms mean for you and your wallet? Can you still receive medical benefits and financial reimbursements for treatment that is sought with an out-of-network provider?
There are many questions surrounding this topic, but we’re here to answer them for you.
When a physician or healthcare facility is out-of-network, it essentially means that the doctor or facility providing your care does not have a predetermined contract with your health insurance company on an agreed-upon reimbursement amount. More often than not, physicians and facilities will choose to not be in-network with certain insurance companies because of the cap on reimbursement that insurance companies tend to come with. Of course, insurance companies do this in order to make sure that (generally) fair market prices are charged by every different medical center.
An in-network provider also referred to as a “participating” provider, is a facility or physician that has a previously-set contract with your health insurance plan. When a healthcare provider decides to join the network of a health insurance company, what they are essentially doing is agreeing upon an established and fixed price for the specific services being provided. Most often, when referring to in-network care,
According to healthcare.gov, a Preferred Provider Organization, or PPO, health insurance plan is “A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.”
This leads us to our first (and possibly most enticing) reason for choosing an in-network provider:
Choosing an in-network behavioral health provider is usually more cost-effective and economically wise, and this isn’t a little-known notion. When you choose a behavioral health center that has an existing contract with your health insurance company or plan, you are often going to pay much less out-of-pocket expenses. You will still be responsible for any of your deductible or coinsurance fees, all of which vary in expenditure depending on the specific contract you agreed upon with your insurance company as well as your personal health insurance plan. However, because of the agreement between in-network institutions and your insurance company, costs are significantly reduced. On the explanation of benefits (EOB, for short) for each claim submitted to your insurance company by an in-network provider, you’ll be able to see a detailed summary of how much you saved by choosing a participating healthcare provider.
Choosing an out-of-network provider will definitely dig a hole in your wallet- and it’s not always clear how huge that hole may be.
When you choose an in-network rehab or behavioral health provider, the choice is made easier. More often than not, you are able to search for in-network providers through your personal portal on your health insurance’s website. Doing this allows you to find doctors, physicians, hospitals, treatment centers, amongst many other types of providers that are close to you and accept your insurance. What a breeze!
Having a choice helps you feel more in control of your treatment plan. Of course, when you feel like you have more of a choice you consequently feel a better sense of well-being.
Not only does choosing an in-network rehab or behavioral health provider give you access to personalized search portals to find great providers near you, but it is also much less time-consuming than choosing someone out-of-network. When you choose to go to an out-of-network provider when you have an insurance plan, you will most likely be asked to pay the fees of care upfront, and then submit claims to the insurance company yourself.
The process of submitting claims is a difficult process to navigate, and the process of getting claims paid adequately by insurance companies is even harder. Having a professional behavioral health or medical facility that has a specialized billing department designed to optimize the payments your insurance makes for your care will save you loads of cash… and time. Not only this, but your insurance company will pay less for out-of-network provider benefits than for services rendered by in-network institutions.
In-network rehabs and other institutions and physicians in the field of behavioral health, addiction medicine, and mental well-being belong to specifically what their name suggests – a network of institutions that are trusted in for the care that they provide their patients and clients. This trust is so strong between the insurance company and provider, and the in-network providers’ businesses are so fairly and ethically ran, that insurance companies choose to make mutually beneficial agreements with them.
Luckily, this doesn’t solely benefit the provider and the insurance company- it also benefits you. You can rest comfortably with the knowledge that the insurance company you choose to trust with the entirety of your health is also approving of the rehab that you choose for yourself or your loved one.
Yes, it’s true that in-network providers also often tend to sport credentials such as certain accreditations. These accreditations, whether national or international, are incredibly important as they showcase the credibility of the way that treatment centers (and other facilities) are operated. Accreditations, such as the Joint Commission International Accreditation, are certificates that many in-network treatment centers wear like badges of honor- as they should! These societies are sure to regularly audit the means of operations in businesses such as rehab centers in order to ensure that their businesses are being run ethically.
All in all, choosing an in-network facility is a wiser choice for the average policyholder. For the intent of economic ease and time consolidation, choosing an in-network rehab spares excess both excess time and energy.