Whether it’s you or a loved one who needs help with an addiction, it doesn’t take long before the question, ‘Will this be covered by insurance?’ comes up. Each and every person we treat at the New England Recovery Center (NERC) has unique circumstances, and the topic of insurance can quickly become confusing and overwhelming. That’s why we’ve provided you with some answers to the most frequently asked questions, below.
- Will my insurance policy cover inpatient addiction treatment?
The majority of insurance policies do cover inpatient addiction treatment, though the amount of coverage varies. NERC employees will work with you to determine your level of coverage right away, and create an appropriate treatment plan for your individual needs and means.
- What will the out-of-pocket costs be?
Out-of-pocket costs are all policy specific. Based on the specific insurance policy, NERC works with individuals and families to identify client costs and strategize payment options. In some cases, we offer partial scholarships to help defray the cost to our clients. In every case, we ensure that persons struggling with a substance use disorder receive some level of care.
- How long will my insurance pay for me to stay?
The length of treatment covered by insurance is based upon the individual’s medical and clinical needs. On average, insurance tends to cover between one and four weeks, depending upon medical/clinical needs as determined by the insurance company.
- What is the difference between co-pays and deductibles?
A co-pay is a fixed dollar amount that an insured person is responsible for paying at the time services are rendered. It’s a portion of the total cost of treatment.A deductible is a fixed dollar amount that applies during a benefit period (typically one year). The insured person is responsible to pay this amount in medical bills before the insurance company will begin to make payments. Because the deductible applies to most medical services that a person has received in the designated time period, some people find that their deductibles have already been met prior to coming in to NERC.
- What is the difference between an HMO and a PPO, and how will it affect my care?
PPO plans offer more flexibility for selecting treatment facilities. NERC is typically able to work with all PPO plans.HMO plans give members access to specific treatment facilities within the insurance network. NERC is currently considered “in-network” with the following insurances, and thus able to accept clients with these HMO’s:
– BCBS of MA
– Beacon: Fallon, NHP, BMC, GIC (Commerical and QHP plans)
– Tufts Commerical
– Mass Laborers
– Modern Assistance Program
– Minute Man Health
To find out if your plan is PPO or HMO, check your insurance card – it should state which plan you’re on. If it doesn’t, call your provider. Your provider can also help you find approved facilities in your network, if you do have an HMO.
Please note that this FAQ is specific to private-pay, commercially insured inpatient treatment at The New England Recovery Center. Our parent company, Spectrum Health Systems, has numerous inpatient and outpatient treatment options for lower levels of coverage.
What is most important to understand is that help is available for everybody –Spectrum Health Systems and The New England Recovery Center will meet you where you’re at and ensure you receive treatment, regardless of your coverage.
Have more questions? Please reach out to us anytime at (844) 233-6372.