HMO Addiction Treatment

Whether you are addicted to a controlled substance or a particular activity, overcoming your condition can be a struggle. To give yourself the best chance of a full recovery, professional treatment is typically the best option. However, many people suffering with addiction are hesitant to enter treatment because they know it will be expensive. Fortunately, if you have health insurance through an HMO, you may not pay as much for addiction treatment because of HMO addiction recovery benefits.

What is an HMO?

A Health Maintenance Organization, or HMO, is a type of managed-care insurance plan that encourages you to receive all of your treatment from providers within the organization. If you have an HMO, you will also be required to select a primary care physician who will be responsible for directing all of your care.

How Do I Receive Addiction Treatment as an HMO?

If you have an HMO insurance plan, you will need to get a referral from your primary care physician, or PCP, before you will be able to visit a specialist or begin a treatment program. After you get permission from the PCP, you will also need to choose a doctor and/or facility from within the HMO network. If you don't choose your providers from within this network, any expenses you incur during treatment will not be covered by HMO addiction recovery benefits.

In addition, some types of treatment may also require you to obtain precertification from the HMO itself in order to qualify for HMO addiction recovery benefits. To obtain precertification, you must contact the insurance company and get prior permission for the treatment you will receive.

Other Considerations

Some other factors may also affect your HMO addiction recovery benefits. Some of these issues include:

  • Deductible - Before your HMO addiction recovery benefits will begin, you will need to pay a certain amount out-of-pocket. This amount is known as a "deductible."
  • Coinsurance/Copay - After meeting your deductible, you may still be responsible for coinsurance, which is calculated as a set percentage of the expenses incurred after your deductible. Likewise, certain services may require you to pay a copay, which is a flat fee due at the time of service.
  • Out-of-pocket maximum - Your out-of-pocket maximum is the maximum amount you will be required to pay for your medical expenses during the year. Once you have reached this limit, you won't be responsible for any further covered costs.

For more information about your HMO addiction recovery benefits, consult your plan documents.

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