Attending Out-of-Network Rehab in Florida: All You Need To Know

Understanding Out-of-Network Rehab Services

The term “out-of-network rehab services” refers to any rehab treatments, including inpatient, outpatient, detox, medication-assisted treatment programs, or any other sobriety support that is not in-network with an insurance company. In short, the provider has not signed an agreement with the insurance company to agree to provide discounted rates to people with insurance. There are many reasons why a treatment provider might be out-of-network. In many cases, it’s simply because of their location, or because the rehab center doesn’t agree with the insurance terms.

This means that as a person seeking treatment, you may have to pay more out-of-pocket if you choose an out-of-network rehab than if you were going to go to one that’s in your list of participating in-network providers. Sometimes your insurance plan will still cover a percentage of out-of-network treatment, but it will be much less than what they would cover for in-network care. 

The Pros and Cons of Choosing Out-of-Network Rehab

There are pros and cons to choosing out-of-network rehab treatment, and weighing out the benefits vs. the costs will help you decide where you choose to go for your substance use disorder treatment. 

With out-of-network rehab, you can get specialized care and holistic or alternative treatments that may not be covered by your insurance plan. If you think you’d benefit from a specific rehab program or prefer a particular therapist who you already know, or if you’re looking for a personalized treatment plan that is not in-network, you can go where you please, with the caveat that it may cost you more. Some other pros of out-of-network rehab include:

• Specialized treatment will often be out-of-network
• You may need treatment while traveling or out of town, or your preferred treatment center is in another city, especially if you live in a rural or remote area
• Your in-network doctor might recommend an out-of-network service if they believe it will be a better fit for your needs
• You aren’t constrained to the limited pool of in-network providers, which can make your treatment time faster and more convenient
• Providers can freely prescribe treatments they know will better help you, rather than constraining their care to what insurance will pay for
• Out-of-network center workers are fairly compensated for their time, so they aren’t forced to rush appointments or cram in too many new patients to make ends meet

The biggest con to using out-of-network treatment is the out-of-pocket cost. You may pay extra for care at your preferred substance use treatment center if they’re not in-network with your insurance provider. 

You will also have to do your homework to determine how credible and trustworthy the treatment center is. In-network rehabs are all accredited and licensed for addiction care, but not all out-of-network programs are. Look for accreditation by SAMHSA or the Joint Commission, along with credentials from your state’s health and safety commission, and ensure the center uses evidence-based, peer-reviewed treatment methods before choosing a specific treatment center. 

How Out-of-Network Coverage Works with Insurance

In most cases, insurance companies will cover at least some of the costs of detox, inpatient rehab, outpatient rehab, medication-assisted treatment (MAT), dual diagnosis treatment with mental health services, partial hospitalization programs, and aftercare services.

Each insurance plan is different, and depending on your policy your benefits may or may not cover out-of-network rehab. If you’re not sure, you can check what is and what is not covered within your plan’s documents. Log in to the insurance company’s web portal, or call the phone number on the back of your health plan card to find out more about your specific plan. Even if you think you know the answer, it’s a good idea to check before committing to a program, as insurance networks and rules can change over time. 

You can also call us at WhiteSands, and we can help you by going over the type of insurance plan you have in plain language with you, or by contacting the insurance company on your behalf (with your permission). 

Assessing the Costs of Out-of-Network Rehab

The costs of out-of-network rehab are higher because you are paying the full price (or most of it), and the health insurance company cannot determine how much a provider charges for their services. 

You won’t get the health plan discount, your coinsurance, and deductible amounts will likely be higher, and the treatment center may also be able to “balance bill” you, or charge you the full amount after your health plan pays its part. Some other financial considerations are:

• Your out-of-pocket maximum amount will be higher, or cease to exist, meaning medical costs like copays and deductibles can be limitless
• Out-of-network rehab and treatments may not count toward paying down your annual deductible amount
• You may be billed directly for services, which means you have to pay first, and then submit your receipts to the insurance company for reimbursement

You’ll have to determine for yourself whether the benefits outweigh the cost. Many times, it is still worthwhile to consider out-of-network care, especially for tailored, comprehensive treatment. 

Navigating Insurance Claims for Out-of-Network Rehab

Some insurance plans will cover some or all of the cost of out-of-network treatments, but this is becoming less common. To ensure your out-of-network treatment will be partially covered by insurance, you can request prior authorization, which may also be called pre-authorization, predetermination, or prior approval depending on your insurance company. This means that you are requesting approval before getting treatment, ensuring you won’t have any nasty financial surprises once you’ve gone to rehab. If denied, you may be able to file a formal appeal to have their services covered as an out-of-network provider. These processes can take some time, so it’s best to start right away. 

At WhiteSands, we are happy to work with you and your insurance company to maximize your insurance coverage, while providing you with appropriate treatments and care that suit your physical and mental health needs. If you have questions about how rehab works with your insurance plan, you can always give us a call. We can help you figure this out. 

Quality of Care in Out-of-Network Rehab Centers

Out-of-network rehabs will often have lower wait times, better quality of care, and more personalized treatments than in-patient centers, as they are unconstrained by the low prices and rules of insurance companies. They are better able to accommodate long-term stays, provide relaxing environments, and offer alternative and holistic treatments alongside traditional evidence-based care. 

Finding the Right Out-of-Network Rehab Facility in Florida

There are, unfortunately, places that offer spa-like retreats that call themselves rehabilitation centers, but these types of treatments won’t help heal the underlying causes of addiction. Aside from financial concerns, this is one of the biggest issues you may find when looking for quality out-of-network rehab. Some of the most important qualities of a substance abuse treatment center are:

• Accreditation and certification, to ensure the programs are effective, the treatments are safe, and the staff is qualified. Look for accreditation from the Joint Commission, CARF, HIPAA, SAMHSA, and the National Association for Behavioral Health Care, as well as state-run health and safety associations
• Comprehensive, tailored treatment options with multiple levels of care, so they can meet you where you are on your recovery journey, and create a plan that will work for your unique needs
• Safe, medical detox programs and medication-assisted treatment plans, followed by multiple levels of customized care tailored to suit each patient’s unique needs and aid in providing continuity of care, long-term
• A safe, protective environment where healing can take place, with a focus on quality of life in a person-centered approach to care

WhiteSands Treatment’s Approach to Out-of-Network Care

At WhiteSands, we accept out-of-network insurance, and although your health and wellness are our number one priority, we are willing to work around the limitations of your coverage to maximize your insurance. 

We are a fully accredited, luxury treatment center offering evidence-based care and holistic healing to give our patients the best chance at achieving long-term recovery. This includes behavioral treatments, psychotherapy, group therapy, dual diagnosis programs, medical care, medication management services, relapse prevention programs, healthy living programs, and much more, to give all patients the tools and resources they need to live their best lives. 

To find out more about rehab at WhiteSands, or to learn what your health insurance will cover with us, please phone us at 877-855-3470. You can speak confidentially to a counselor today, and take one step closer to making your recovery a reality. 

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.