HMO Rehab and Alcohol Detox Coverage
Not all insurance programs are alike, especially when it comes to covering services like alcohol rehabilitation. A detoxification program gets you through the potentially life-threatening withdrawal and rehabilitation puts you on the path to sobriety. Both of these options may be covered by your health insurance company depending on the benefits of the plan.
HMO plans are especially tricky when it comes to addiction recovery and rehabilitation. It is important to do your research before picking a facility to get the most out of your HMO alcohol rehab coverage.
What You Need to Know about HMOs
A health maintenance organization, or HMO, is a common policy option with many insurance providers. The National Conference of State Legislatures reports that over the last 15 years, HMOs have become the predominant health care model in the country.
An HMO plan allows the insurance community to control the escalating health care costs by managing the services provided by physicians. HMOs do save money, but have limitations.
HMO Alcohol Rehab Coverage
There is a good possibility you can get assistance from your HMO insurance plan for alcohol addiction. The insurance provider will ask you to meet specific criteria before agreeing to pay all or even part of the treatment cost. For example:
- HMO alcohol rehab coverage might limit the facilities you can use for rehabilitation.
- They may limit your inpatient treatment options to detox only and require outpatient care for rehabilitation.
- They may cap the amount of time you can spend getting treatment.
They will most likely require HMO alcohol rehab coverage to be medically necessary. In other words, your primary care physician must consider the treatment to be a necessity in order for the facility to get paid. The insurance provider will need to verify your need, as well, and may require you to get a consult with a counselor before approving treatment.
If the HMO denies your treatment, you will be required to pay for it on your own. Most HMOs have an appeals process that allows you to challenge the denial, but it will take time.
Verifying Your Coverage
Your best option when seeking HMO alcohol rehab coverage is to talk to your primary care physician. The staff will know who to contact to verify your coverage. If your insurance provider partners with a rehab facility, they probably will approve treatment as long as your primary care physician recommends it.