Our private drug rehab programs are currently in-network with most healthcare plans following the changes from the Affordable Care Act. The Parody Law changed how insurance payers respond to mental health and substance abuse treatment and were are at the forefront of merging the quality care often found at private pay facilities with the ability to utilize your healthcare plan.
We continue to offer private pay programs for clients that do not hold insurance coverage or choose to pursue private pay for a variety of reasons. We are the most cost-effective program in St. Louis and Kansas City. Our programs cost less and provide noticeably more than the industry standard.
The difference between “accepting” and “in-network” with insurance?
There is a confusing array of insurance arrangements when seeking treatment at a private alcohol and drug rehab. Many programs accept health insurance plans. Accepting insurance coverage is different than contracting (becoming in-network) with insurance plans as these providers are typically out-of-network. There are two significant considerations for those entering treatment. First, out-of-network benefits typically have significantly greater deductible and coinsurance responsibilities for patients. This can double and triple the cost from comparable in-network programs. Secondly, the contracted rates for in-network coverage are significantly less than that of out-of-network rates. This mean far less cost for patients who have not met their deductible yet. Also consider other health care you receive. Generally, families utilize in-network providers so they are continually paying towards their deductible and out-of-pocket maximums. Using an out-of-network provider can mean starting at zero and accumulating significant patient responsibility.
The first thing you should do is contact our office and we will verify your benefits. We check your coverage carefully. We determine if you have mental health benefits, substance abuse benefits, how many sessions per the calendar year your plan covers, your deductible, and other pertinent information. Our private alcohol and drug rehab is considered in-network with most major plans and out-of-network with others; though we are able to obtain one-time agreements with out-of-network plans so you receive in-network benefits. This is dependent on your plan and may vary. MIA has chosen to reject some in-network contracts to enable our program to continue to provide the highest quality of care while still utilizing your healthcare plan.
How are we in-network while still providing a costly private model?
Simply put, we have smaller margins than our competitors. However, our clients receive the most effective care, top notch service, flexible scheduling, and a financial cost that most families can manage. In scenarios where even our low financial cost is difficult, we finance past treatment to make quality treatment obtainable.
Because MIA has chosen to contract with insurance plans and maintain a private-pay model we have the ability to be much more affordable than other addiction rehab centers while still providing flexible and unlimited quality services. Our addiction rehab staff are available at times when other facilities are closed. Our alcohol and drug rehab is accessible early, late, and on the weekends because we work around our client’s schedule and not our own. Furthermore, when considering the frequency with which services in this speciality occur affordability is a major factor in engagement in treatment, remaining in treatment, and ultimately the outcomes obtained.
What In-Network means to you?
Your plan will pay for all services once you have met your deductible. You will be responsible for you plans copay and no liability exists for the patient once they meet their out-of-pocket maximums.
How it works
You are responsible for your deductible and coinsurance. For example, if you have a $500.00 deductible and 10% co-insurance, you would be liable for $500.00 plus 10% of billed charges. However, for your benefit, MIA offers options for those who are not financially capable of paying our billed charges. Clients can apply for long-term financing when in-network and MIA provides monthly protective maximums and long-term financing for out-of-network and self-pay clients.
Here are some examples that might better illustrate this process. (Please note these are examples and actual insurance rates of pay may vary. While this can be somewhat confusing, MIA believes that transparency is vital to our clinical environment and we are glad to provide further information to clarify your specific situation.)
- John has a $500 deductible and 10% co-insurance. He has not paid on his deductible this year. John will pay a deposit of $500 to MIA to start treatment. Over a period of six months in our GOP program, John attends services that total $6000 at the published rates. Johns insurance pays 10% of the allowable amount. The allowable amount for these services is $5500. At 10% co-insurance and after John is held accountable for his $500 deductible, the insurance pays $4450. The total paid on John’s account is $4950. John already paid a $500 deposit which is applied to the amount owed. John pays the remaining $50 and has a zero balance.
- Now take the same situation but imagine the insurance plan has a $1000 deductible and 50% co-insurance. John pays $1000 and his insurance provider pays $2750 for a total of $3750 paid on the account. John requests a payment plan for the $1750 owed over a period of 12 months and it is approved. John is now able to budget what is owed that will work with his monthly obligations.
In the St. Louis and Kansas City areas most private rehabs cost $6500.00 to $8500.00 for similar care and that is 100% patient responsibility. Our program merges the private pay and healthcare payer sectors to create a program that provides the flexibility and quality of the private rehab with the financial feasibility of insurance programs.
Is outpatient alcohol rehab tax deductible?
Yes, there are ways to claim the cost of alcohol and drug rehab on your tax return – as long as you itemize your deductions on Schedule A. In fact, any medical and dental cost is deductible in the same way, as long as it exceeds more than 7.5% of your adjusted gross income for the year. Check with your accountant or tax professional regarding your situation.