Insurance and Rehab: What’s Covered?

Substance misuse is becoming more and more recognized as a serious disorder that deserves the same care and treatment as any other physical ailment. Not only this, but you’re much more likely to succumb to other illnesses or injuries while suffering from substance use disorder.

Additionally, the Affordable Care Act requires most insurance plans to cover certain essential health benefits, which include treatments for substance use disorder. For these reasons, insurance companies are inclined to cover at least some aspects of drug rehab. 

How much of your substance misuse treatment is covered will depend on your insurance company, as well as your particular insurance plan. To find out exactly what’s covered for you, contact your insurance company directly.

That being said, most insurance companies will cover anywhere from 30 to 90 percent of your treatment costs. Basic plans will often cover only certain types of treatment, while premium plans tend to give you more options. Copays and deductibles will also vary based on your insurance plan.

Treatments for Substance Use Disorder

Searching for in-network drug and alcohol rehabs in Massachusetts helps to know what kind of treatment you’re looking for. There are two main types of substance misuse treatments: intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs). Deciding which treatment is best for you can narrow your search and make the process of finding the right rehab much easier.

Intensive Outpatient Programs

Intensive outpatient programs are ideal for those who need their treatment to have a certain degree of flexibility. Opting for an IOP method of treatment allows you to live at home while visiting the rehab center according to a predetermined schedule.

IOPs are a great treatment choice for you if you have an inflexible schedule, are surrounded by a reliable support group at home, and have not previously relapsed. If you need a higher level of care but can thrive in your home environment, and IOP is likely the best form of treatment for you.

Partial Hospitalization Programs

Partial hospitalization programs are great for those who need intensive treatment for their substance use disorder but need something more than residential care.

In many cases, patients struggle to be at home once their scheduled treatments have ended for the day—particularly if they don’t have a solid support group to come home to. PHPs dive even deeper into your treatment and give you the strength to withstand being in your home environment.

Northstar Recovery Center: Start Your Journey to Recovery Today

Northstar Recovery Center is dedicated to providing residents of the Southborough, Massachusetts, area with the care they need to overcome substance misuse. Fill out an insurance verification form today to find out if you can get in-network coverage, and take the first step toward recovery today.

What is an Addiction Treatment Continuum of Care

People with serious SUDs need at least a year of addiction treatment in Massachusetts, beginning with inpatient addiction treatment and ending with outpatient addiction treatment in Massachusetts. After that, there’s a shift to continuous 12-step group attendance. The care continuum offers appropriate interventions depending on where you are in your recovery journey. Without the right level of care, relapse becomes more likely. 

For example, if you’ve just been through a medically managed withdrawal program, you need more support than if you’ve been sober for a year. Research shows that intensive outpatient programs in MA or PHP day treatment (level 2) in Massachusetts can be excellent alternatives to a round-the-clock residential rehab (level 3 or 4 treatment), especially when beds are hard to come by after a detox. IOPs and PHPs are also the next step after live-in rehab when you transition back to ‘normal life’ but still need significant aid. Regular outpatient services are a step-down level 1 treatment. 

What is an Intensive Outpatient Program in Massachusetts?

IOPs are a powerful form of addiction treatment in MA if you have a mild to moderate SUD. For adults, intensive outpatient programs involve at least nine hours of therapy per week, and adolescents require at least six hours weekly. The hours can be spread over two to five days, and this schedule applies for a few months. Evening, after-school, and weekend sessions are offered for those with work, college, or family commitments. If the patient improves, they can move to Level 1 outpatient treatment with sessions once or twice a month. 

What is a Partial Hospitalization Program?

It’s not 24-hour care—partial hospitalization services entail about 20 hours of tailored day treatment weekly. Individuals in PHPs are at a vulnerable stage of recovery and must do the necessary mental work to make sobriety stick—this takes time and effort. PHPs offer interdisciplinary care, daily management and monitoring for better long-term outcomes, and emergency services. They’re particularly effective for individuals with dual diagnoses or co-occurring psychiatric or medical conditions. The structured programming in PHPs isn’t too different from what you’d find in an inpatient context. This structure is critical to keep lapses at bay.

IOPs and Medication-Assisted Treatment (MAT)

When you combine behavioral interventions with medication to assist with, for example, alcohol and opioid disorders, it’s known as MAT. Level 2 treatment can include post-detox MAT, and patients are assessed case-by-case to see if they’d be a good fit. Medications can have side effects or misuse and overdose potential, but they can also be transformative when used correctly. They take hazardous street drugs out of the picture, reduce cravings, and keep people engaged in treatment. With therapy and meds, your daily life can start feeling less chaotic, and you can lay the groundwork for a positive future. Doses drop over time; eventually, you won’t need maintenance drugs except for medical conditions, if relevant, and abstinence will be manageable.

Who can get the most out of an IOP?

If you’re looking for addiction treatment in MA, IOPs are more affordable than inpatient rehabs and are more readily covered by insurance carriers. For most patients, intensive day programs also have comparable outcomes to their 24/7 counterparts. They allow you to get help without leaving home for weeks, a considerable barrier to treatment for those with kids or other obligations. With access to stable housing and a living situation conducive to recovery, you’re halfway to being a strong candidate for intensive day treatment. A solid social support network is a plus; motivation to work on recovery is essential because IOPs don’t offer constant supervision. IOPs are suitable for people who aren’t a danger to themselves or others and don’t currently require detoxes.

Virtual Addiction Treatment

One of the advantages of day treatment is you can do it from anywhere that has internet. Telehealth services allow people who live far away from rehabs to access the same experts via secure and private online channels. Virtual IOPs foster a similar sense of community and give you the tools you need to kick destructive habits.

Northstar Recovery Center Is Here For You

If you or someone you care about needs to break out of the cycle of addiction, our team of qualified professionals in Southborough, MA, can assist. Contact us for more information about addiction treatment, telehealth services, and insurance coverage through MassHealth or another provider. There’s reason to hope, whether you’re struggling with benzos, stimulants, opioids, or drinking, but you have to take that first step.

In-Network Insurance vs. Out-of-Network Insurance

In-network facilities and providers essentially mean receiving a discounted insurance rate on your final costs. These are contracted doctors or facilities that have an agreement with an insurance company. They may have to meet certain credentials or criteria. 

Ultimately, seeing a physician or attending a facility specializing in addiction treatment in MA in-network could save you thousands. Out-of-network providers and facilities are not contracted with your insurance company. They can charge full price for their services. 

Since rates are higher, you are responsible for paying the difference between what your plan is willing to pay. For example, if your insurance company has an agreement to only pay a specific amount for a service, you may not accrue any costs. On the other hand, if your plan will still only cover a specific amount but does not have an agreement with an out-of-network provider, you are responsible for the difference. 

Does Insurance Cover Addiction Treatment?

The answer is more complex than a simple yes or no. It primarily depends on your insurance provider and how much of your deductible you have met. Also, you will want to check with the rehab facility on which insurance providers they have a contract with. 

Medicare is often the gold-standard insurance provider that many private insurances follow. Medicare will cover substance use treatment with the following criteria:

• Your physician has deemed it medically necessary
• If the center is Medicare-approved

Additionally, private insurances might have different contracts with facilities. It is essential you speak to an admissions specialist about your insurance beforehand. 

So, how much can you expect Medicare to pay?

Inpatient rehab falls under different criteria than outpatient. If you require a residential stay, it is usually covered by your hospital portion. Medicare Part B or other insurances focusing on outpatient treatment will cover additional stays, such as an intensive outpatient program. 

You will have to meet your deductible and coinsurance. For Medicare Part A, this could total $1,408 for a deductible. Yet, each insurance may have different deductibles dependent on traditional or high deductible plans. 

Rehab Program Options

There are several programs you can choose from at Northstar Recovery Center. Some of the more popular ones include:

• Partial hospitalization program (PHP)
• Intensive outpatient program (IOP)

There are two primary reasons you may enroll in a PHP or IOP. First, you could be transitioning from detox or a residential program. It is often recommended to continue intensive therapy when moving from 24/7 facilities back home. 

Next, you may have a mild substance use disorder. In these situations, you might not pose a threat to yourself or others and/or not require a medical detox. How can you decide between them?

PHP is more time-intensive, requiring upward of six hours daily for five days. In an IOP, this is largely cut in half. You can plan on around two to four hours daily for up to three days a week. 

Both programs do not require overnight stays. The benefit of these programs is it provides a safe environment for you to continue working on skill development and coping mechanisms. You can participate in individual-specific therapies and group therapy. 

You will also have access to highly skilled professionals with vast experience. They will help you develop a plan of care that works for your lifestyle and facilitate improved health and wellness. 

Find Coverage for Your Rehab

In-network insurance providers can cut your costs substantially when you enroll in rehab. Many people with substance use disorders are worried about the costs and inability to work. And rightfully so!

Rehab can be expensive, but it can also save your life. Enrolling in a program that has a contract with your insurance provider, such as Northstar Recovery Center, provides you with access to a skilled addiction treatment center at a fraction of the cost of others. 

Are you ready to get started? Contact us today and find out how you can enroll!

What Is an Intensive Outpatient Program?

An intensive outpatient program or IOP is a type of substance use disorder treatment. It is less time-intensive than a partial hospitalization (PHP) or residential program. 

Yet, it still requires more time commitment than your standard outpatient programs. These programs also average a longer duration than traditional outpatient therapies. With more time spent on the recovery process, you have a reduced risk of relapse.

At the end of the day, you can still return home. On average, IOPs require five hours daily for three to five days per week. The exact timeframes and intensity of the sessions can be customized to your situation and need. 

Who Benefits From an IOP?

Addiction treatment in MA has several types of programs, stemming from detox centers to outpatient centers. Substance use disorders also vary in intensity. 

A mild substance use disorder case may only require a PHP or IOP to start. More severe cases could transition from a detox center or residential center to a PHP or IOP. 

Ultimately, IOPs are ideal for patients who need the flexibility of keeping up with responsibilities at home while continuing the rehab process. It also costs less than traditional or inpatient rehab facilities. 

Suppose you have transitioned from a higher level of care. In that case, IOPs are more useful than traditional outpatient programs since they require more accountability while still allowing you to practice life skills at home. Lastly, IOPs have greater flexibility than PHPs, making them ideal for those holding part-time or full-time jobs. 

Evening IOPs

Evening IOPs help union workers in Massachusetts hold a job and continue their rehab journey. In 2021, Massachusetts employed around 402,000 union members.

Being a union member and a worker has several benefits, including advocating for workplace and health safety. Part of that includes seeking help for your substance use disorder. 

Treating substance addictions requires flexibility with your work schedule. For many who work traditional hours (e.g., 9-5 or 8-5), an evening program is ideal. 

At Northstar Recovery Center, we offer flexible IOPs, including virtual and evening sessions. Evening IOP is ideal for workers with strict schedules and individuals in school. 

It entails all the same benefits as a traditional IOP. This includes working with highly skilled professionals.

If you have mild to moderate substance use disorder symptoms with a busy work schedule, this could be the best option for you. In conjunction with group and individual therapy, therapists may also use other evidence-based practices like cognitive behavioral therapy (CBT).  

Benefits of Evening IOPs

IOPs are equally as effective as inpatient programs, based on recent studies. Here are some of the benefits of participating in an IOP:

• Reducing the risk of requiring 24/7 care
• Reducing the risk of mental health disorders
• Smoother transition to a lower level of care
• Manage early-stage relapse risks
• Develop coping strategies

It can also help individuals who deal with emotional or psychological distress. IOPs can be combined with family therapy to bridge relationships and facilitate a healthy home environment. Patients who excel at an evening or traditional IOP are those who are self-motivated and do not need acute detox services. 

Find an Evening IOP Near You

An evening IOP is ideal for union workers and those with more rigorous work or school schedules. It provides all the benefits of an IOP, including access to professional counselors, therapists, and group therapy sessions. 

However, it is all performed in the evening, requiring no overnight stays. This allows you to receive much-needed assistance for your substance use disorder around your work schedule. 

Northstar Recovery Center has several rehab options that fit your unique symptoms and situation. Contact us today and find out more information on how you can get enrolled!

Compared to other facilities that don’t have a contract with Cigna Insurance, you could accrue hefty bills. Limitations on drug and alcohol rehab program options can also make it challenging.

Are you still interested? Keep reading on and learn more about Northstar Recovery Center’s rehab programs and how in-network providers help you through the process!

What Is Addiction Treatment in MA?

Treatment for addiction includes institutions focused on helping individuals with their substance use disorder. A substance use disorder is a mental health condition.

Patients use drugs or alcohol despite ongoing problems. These issues could be related to your relationships, job, physical, or mental health.

Often, quitting is virtually impossible. This is from neurological changes in the brain and your reward centers.

Ongoing use can place you at risk for higher tolerance and overdose. There are several types of addiction treatment programs.

Typically, the first step is a detox center. With severe substance use disorders, a medical detox helps a person safely withdraw from a substance.

It also reduces the risk of medical complications or relapse. Residential treatments are a continuum of care, often needed for individuals with high relapse risk.

These two intensive programs are also useful for individuals with suicidal tendencies. However, if you have a mild to moderate substance use disorder or have recently completed a residential stint, where do you turn to? There are three primary treatment centers at this point:

• Partial hospitalization program (PHP) in MA
• Intensive outpatient program (IOP) in MA
• Evening IOP in MA
• Virtual IOP in MA
• Outpatient therapy in MA

Traditional outpatient therapy is usually the last step. A PHP or IOP is ideal for those who need intensive therapy without overnight stays.

Partial Hospitalization Program vs. Intensive Outpatient Program

Both programs are more affordable than residential treatments. They emphasize similar addiction therapy treatments, such as:

• Individual therapy
• Group therapy
• Trauma therapy
• Cognitive-behavioral therapy (CBT)
• And more

It allows for interaction between skilled counselors and therapists while allowing you to engage with group members. The primary difference is time.

PHPs are slightly more time-intensive. They require upwards of seven hours daily, and you can plan on it taking the majority of your week. IOPs fall between PHPs and traditional outpatient programs.

They may require half the weekly therapy, depending on your treatment plan. Many people choose IOPs because it allows greater flexibility for working full-time. At Northstar Recovery Center, we specialize in several types of IOPs.

These include evening or virtual IOPs that can fit many different schedules. Additionally, you can continue earning money to save on costs.

How Much Does Addiction Treatment Cost?

Treatment costs fluctuate based on location and level of care needed. High-end or private institutions with 24/7 stays can cost around $17,000 per month. That doesn’t include celebrity-style resorts, which can add up to $100,000 per month!

Most individuals don’t have the financial means for residential treatment. A PHP or IOP is one way you can save money while still receiving care.

They are often much less expensive than 24/7 facilities. Choosing a facility that is in-network with your insurance provider could save you even more.

More insurances are starting to cover addiction treatment. Before the Affordable Care Act, many insurance providers lacked sufficient rehab coverage.

However, even with expanded coverage, many patients don’t know whether their plan covers treatment. In recent studies, only 13.4% of participants with insurance coverage sought treatment.

Finding Treatment for Addiction

Now that Northstar Recovery Center is in-network with Cigna Insurance, you have more opportunities for your rehab journey. Whether you decide intensive outpatient programs are ideal for your work schedule or not, insurance coverage can save you significant sums. 

How can you get started? First, if you want to double-check coverage, fill out our insurance verification form. We will have one of our qualified staff members follow up. And for more questions, contact us to speak directly with a representative!