Rehab Centers That Accept PPO Insurance

Approximately 17% of the U.S. population struggles with some form of drug or alcohol addiction, and access to rehab is vital for treating these diseases and working through the stigmas surrounding them. Having flexible rehab insurance plans and understanding what they cover can help you or your loved ones get the care you need. Preferred Provider Organization (PPO) plans are offered by many health insurance companies and assist patients when seeking in-network and out-of-network addiction treatment.

PPO rehab coverage can ease recovery with payment toward vital services at many treatment centers, placing you one step forward in treating a substance use disorder (SUD). Rehab centers that accept PPO can be found more easily than those that accept some other insurance types, and these plans have flexibility in multiple factors.

Keep reading to learn more about PPO insurance for addiction treatment and what drug rehab with a PPO policy might look like in your unique case.

Preferred Provider Organization (PPO) insurance policies highlight specific facilities, doctors, and specialists considered in-network. If you have a PPO, your insurance plan will pay more toward services these select entities give than if you are treated elsewhere. However, treatment out-of-network can still be eligible for reduced coverage, giving you more choices in where you seek care.

Most treatments shouldn’t require a referral with PPO network healthcare, but you should review your explanation of benefits (EOB) or contact your insurance company to make sure. While PPO addiction treatment coverage can be more expensive than a Health Maintenance Organization (HMO) plan, the network of providers is usually larger.

PPO substance abuse rehab coverage tends to be a wider range of options, and the same goes for any mental health PPO plan. When deciding which type of plan works the best for you, consider what you can afford upfront, any later out-of-pocket costs, and whether the providers you want are included in your insurance network.

When considering PPO vs. HMO rehab coverage, there are some key factors you should know. Comparing rehab insurance can help you choose the best policy for your needs and budget.

With most HMO policies, any treatment by a provider other than your primary care provider (PCP) may require a referral before insurance will pay for services. With a PPO plan, you can usually see in-network providers without a referral. Most out-of-network providers aren’t covered under HMO plans, but PPO policies allow for treatment, albeit at a lower reimbursement or coverage rate than if the provider were in-network.

Premiums and deductibles tend to be higher when paired with PPO flexibility, but your out-of-pocket costs at the time of treatment may be lower.

HMO Insurance:

• Flexibility: Referrals required for care not provided by PCP
• Provider Choice: Treatment must be in-network unless emergent
• Cost: Lower premiums and deductibles

PPO Insurance:

• Flexibility: No referrals needed for providers
• Provider Choice: Treatment can be in-network or out-of-network
• Cost: Higher premiums and deductibles

Which insurance options for rehab are best for you will be based on what treatment you need, your location, and your budget. If you frequently travel outside of your coverage area, for example, a PPO plan will allow you to be partially covered no matter where you’re treated. If you need specialized care or think a specific treatment center is best, a PPO policy can help you reduce your costs in receiving addiction treatment.

PPO rehab flexibility in choice is one of the main advantages of choosing this type of policy. If the premiums are affordable for you, and you can meet the deductibles, it gives you the ability to seek the treatment you prefer or what your medical providers recommend. Otherwise, you may have to stick with options for care that are less than ideal for your situation but are available in your insurance coverage area with an HMO.

The benefits of PPO rehab are greater for those who need more specialized or high-end rehab programs that aren’t traditionally covered under an HMO due to higher costs. For example, a PPO plan rehab treatment may pay part or all of holistic or luxury treatment options. These can include massage, animal therapy, art therapy, and other care, sometimes considered not medically necessary, but that patients may find helpful in the recovery process.

Private rehab with PPO is also possible, depending on your plan coverage and where you’re being treated. You may need to use PPO out-of-network benefits to receive care at the facility you want, but what matters most is that you get the help you need.

What you’re addicted to and how severely factors into what treatment services you’ll require. The extent of covered PPO rehab services can differ with individual plan types, but most should cover some level of standard services.

Health insurance plans like a PPO that are purchased through the Health Insurance Marketplace must include coverage for the ten essential health benefits defined under the Affordable Care Act (ACA). These benefits include mental healthcare services and requirements that each policy must cover these services at the same level as it offers for any covered injury. All Medicare, Medicaid, and Tricare plans currently include these benefits.

PPO drug addiction coverage generally extends to: 

• Medical detox programs with fewer restrictions than HMO policies.
• Inpatient residential treatment that provides medical supervision 24/7. 
• Outpatient treatment services can act as step-down care or for less severe addictions.
• Dual diagnosis rehab that treats co-occurring disorders.
• Medication assisted treatment (MAT) programs for specific addiction types.

Medical detoxification programs covered by PPO can be part of a larger treatment plan, and they are usually the first stop in addiction recovery care. These can address a range of withdrawal symptoms and medical issues, but the most important thing is to seek help rather than doing it on your own. 

Inpatient rehab with PPO insurance is care for patients with severe addictions and those who may not be able to live at home while starting recovery. Having support around the clock can ensure your chances of relapsing are lower. 

Outpatient PPO addiction treatment covers a range of programs. Partial hospitalization programs (PHPs) provide treatment 5-7 days a week, with some care requiring short hospital stays. Intensive outpatient programs (IOPs) drop treatment days to 3-5 days a week, though it may still take several hours of the day to complete services. Other outpatient rehab programs can generally be done while living completely at home and allowing you to handle any number of daily tasks. You’ll still be in recovery and need different therapy and counseling sessions to maintain sober living. 

Dual diagnosis PPO coverage is care when you are diagnosed with co-occurring disorders like a SUD and another mental health disorder. Coverage benefits may fall under multiple parts of your policy, including medical and mental health treatment services. 

MAT program components of PPO policies take care of situations where you need prescription drugs on a temporary or ongoing basis in recovery. This mainly applies to acamprosate, disulfiram, and naltrexone for alcohol addiction. Opioid addictions may be treated with methadone, buprenorphine, and naltrexone. When used in conjunction with behavioral health therapy and other interventions, MAT is shown to improve success rates and reduce relapses in recovery.

The PPO insurance process is a tool in your arsenal to give you an advantage in recovery. Reducing stress is one of many factors that contribute to lifestyle improvement, and knowing you have the right insurance plan to fit your needs can be a weight off your shoulders.

To get the most out of using PPO for rehab, review your policy for mental health and substance abuse benefits. If you have questions about whether a facility will be covered, contact your PPO provider. They can answer your concerns and confirm which choices are in-network and out-of-network.

When you’ve spoken to your insurance provider, it’s also important to contact the facility for rehab insurance verification of your PPO plan. While it’s unusual, it is possible to have your insurer cover a provider that won’t accept that insurance. Getting confirmation from both providers can save you from future issues.

While speaking to the insurance company and rehab facility, be sure to go over the costs of treatment and what portions you’ll be expected to pay. Check whether your deductible has been met, what copayments and coinsurance you can expect, and your out-of-pocket maximums. Having these numbers can help you prepare your budget for any additional expenses under your specific plan.

Searching for something like “PPO-accepting rehabs near me” will generally net you a good list to work from. You can also include the zip code you’re in or where you’re seeking treatment to ensure the best results. Insurance providers usually have a PPO directory for rehab on their websites, though you may need to log into your account to use it.

However, finding PPO rehab centers can be a hassle if your insurer’s database is outdated. You can try calling them or reaching out to local rehab facilities to see if they accept your PPO insurance. Unfortunately, challenges with chatting or tracking down a helpful representative can be a roadblock for those needing help.

There is hope when you feel these issues are obstructing your path to needed care. RehabNet offers tools to make the process easier, including:

• A directory of rehab centers that accept PPO insurance (and it’s searchable)
• A free service that verifies insurance coverage and acceptance
• A helpline that matches you with personalized treatment placement 24/7

Know that addiction treatment with a PPO plan is possible, and help is accessible. Evidence-based levels of care covered by your insurance benefits can be easily verified, putting you on the way to recovery quickly.

PPO-accepted rehab quality tends to include a wider range of program options, such as specialty and holistic. Coverage also increases the likelihood that you will get partial reimbursement for out-of-network PPO rehab. When compared with HMO plans, PPO plans have fewer coverage limitations and often shorter wait times before your treatment begins. HMO policyholders frequently end up on waitlists because facility options are limited and fill up quickly.

Access to higher-end or luxury PPO rehab experiences can improve the quality of your care and relapse prevention outcomes. Being able to seek drug or alcohol rehab at the PPO treatment facility that best meets your needs, rather than what your insurance coverage dictates, is one of many advantages.

When you’ve decided to seek substance abuse treatment support using your PPO, it’s best to start immediately. Delaying any disorder treatment can increase relapses and negatively impact mental health conditions. Using a PPO rehab locator can help you get the addiction care you need and jumpstart your path to recovery.

RehabNet PPO help is available 24/7 with:

• Support online and via phone
• Connections to licensed counselors who can guide you through the process
• Free, no-obligation insurance verification
• A database that lists all treatment centers in the U.S. that accept PPO insurance

Treatment works best when you begin ASAP. Let RehabNet simplify things for you. We can verify your PPO insurance for rehab and help you find the best rehab facility options for drug and alcohol addiction treatment programs.