Cost for Rehab – Know Your HMO

Medically reviewed by

Dr. Anna Pickering

April 3, 2019

Cost for Rehab with HMO Coverage

A health maintenance organization, or HMO, is an organization set up to procure managed care for a variety of entities in conjunction with health care providers on a prepaid basis. Under an HMO, health care professionals enter into a contractual agreement to offer treatment in strict accordance with certain specifications and restrictions. The advantage for doctors and other professionals is that, following the HMO rules, they will be assured of a steady flow of clients.

All of this is just a fancy way of saying that there will be limitations with an HMO, which is not so much the case with traditional insurance coverage. (The word “managed” gives it away.) So you need to know exactly which services and what level of treatment your HMO covers with respect to drug/alcohol rehab.

So what is the cost for rehab with an HMO? Well, it’s hard to say until all the variables have been factored in.

Cost for Rehab and Variables in HMO Coverage

Using an HMO to cover the cost for rehab will guarantee coverage for at least part of the treatment. There is, however, a wide range of HMOs and their extent of coverage, so research and willingness to adapt may be needed on your part. You also need to be aware that your insurance provider will likely be involved in determining the level and extent of care you get.

Selecting a treatment plan will mean balancing the care you need with the coverage your HMO provides. This can sometimes involve a necessary trade-off or compromise. Depending on your unique treatment needs, you may be able to request less care at one level in order to get more at another.

Suppose, for example, you have determined that outpatient treatment will be more beneficial to you than inpatient treatment. In this case, you could work with your HMO insurance provider to exchange coverage of residential treatment for several more days of outpatient treatment.

Knowledge of Treatment Options in the Cost for Rehab

Knowing something about the various treatment options available will help you through this thorny HMO tangle. Consider, for example, outpatient and inpatient treatment.

• Outpatient treatment – This shorter-term option usually involves patients seeing therapists and psychiatrists as well as engaging in group therapy. The costs here consist in the concentrated intensity of treatment.
• Inpatient treatment – This treatment option lasts much longer, sometimes up to several weeks, and patients often live at the facility during the treatment period. The length of inpatient care and the fact that patients live for an extended period in a hospital or other facility accounts for the higher costs.

If you are seeking care, first be aware of the various treatment options available to you and what they entail with respect to costs. Second, you need to be ready to adapt your treatment so that it works with the stipulations and limitations of your HMO coverage.

When you’re considering addiction treatment, you don’t want to have to worry about coverage of costs on top of everything else. Contact us today for free information about HMO coverage and possible treatment.