HMO Rehab and Heroin Detox Coverage
Medically supervised treatment offers those addicted to heroin hope for a problem responsible for tens of thousands of deaths each year. The Global Burden of Disease Study reports that 51,000 people died from heroin abuse in 2013. Withdrawal from any opiate is painful and difficult to tolerate, but not all health insurance plans pay for heroin detox. In you have an HMO plan, it is important to learn more about your coverage options when you or a loved one needs detox.
Will an HMO Pay for Detox?
HMO heroin detox coverage depends on your insurance provider, but some do offer it. A health maintenance organization, or HMO, provides managed care for consumers with this type of health insurance. HMO models have been gaining in popularity over the last few decades and, today, many mainstream insurance providers offer them.
With an HMO plan, you have the opportunity to build a long-term relationship with a primary care physician and usually pay less for office visits. The downside is there are limitations to what an HMO will cover, especially detox and addiction recovery.
What Does HMO Heroin Detox Coverage Pay?
The amount your insurance provider will pay under an HMO heroin detox coverage plan depends on many factors. The insurance company for one thing. One company may offer umbrella coverage under behavioral health while another may disallow medically supervised detox care.
One thing most HMOs have in common is the medical necessity criteria. In other words, they will not pay for any treatments unless your primary care physician deems them medically necessary. This would include HMO heroin detox coverage.
By definition HMOs require you to stay in-network with selecting a treatment facility, too. They may still agree to pay part of the cost if you go out of network, but it will mostly be less.
Will HMO Heroin Detox Coverage Pay for Inpatient Treatment?
This would also depend on the policy guidelines. Some may agree to pay for inpatient detox, but not rehabilitation while others will have a cap on the amount of time you spend in a residential treatment facility for both.
Your best source of information is your primary care physician. The staff can contact the insurance provider and find out exactly what they will and will not pay. You can also check with your employer’s human resource department or contact the insurance provider directly for information about HMO detox coverage.