HMO Addiction Treatment | Treatment for Addiction
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HMO Addiction Treatment

HMO Addiction Treatment

If you have HMO insurance, you might be wondering if they even cover addiction treatment facilities. Nothing is straightforward when it comes to managed care programs, so the answer for many will be maybe. Whether or not the company pays for HMO addiction recovery will depend on a number of factors including who provides the insurance. Before shopping for a facility, it is critical that you understand how HMO addiction recovery works..

What You Need to Know About HMOs

When considering HMO addiction recovery options, it is important to understand how managed care works. A health maintenance organization, or HMO, is a liaison for doctors and medical facilities. They work on a prepaid basis, so providers are considered partners with the company.

Services like what you get from addiction treatment centers are not always covered. Some HMOs offer a behavioral health benefit that will most certainly include HMO addiction recovery. The ones that don’t specify behavioral health may also agree to pay all or part of your HMO addiction treatment if it meets the criteria.

How Much of the Bill Does HMO Addiction Recovery Cover?

That will depend on the type policy and the insurance provider. Some may agree to cover inpatient detox and outpatient recovery while others offer full residential care. In some cases, the company may pay a portion after out-of-pocket expenses are met. The policy may include full payment if you get help at an approved addiction treatment facility and pay less if you go out of network.

One advantage to having HMO insurance is the relationship with a primary care physician. HMOs rely heavily on the recommendations from the primary care doctor. In order to qualify for HMO addiction treatment, the company may require the primary care doctor to deem it medically necessary. They may also ask you to see a counselor to get a second opinion on whether time in one of the addiction treatment centers is warranted.

Your primary care physician is a good resource for information about HMO addiction recovery, too. The staff can pinpoint exactly what your insurance covers and help you find the right facility for treatment. You can also contact your employer’s benefit administrator or human resource department or call your insurance provider directly for information about your coverage. Many HMOs have online membership portals that will offer resources to find an in-network treatment facility, as well.