Treatments Covered

In Georgia, there are a few different insurance providers available. The services within the city include balanced care, essential care, and secure care. Balanced care is insurance that provides a balance between deductibles/out of pocket expense and premiums. These plans are broken into levels from one to twenty. The availability of these plans depends on the income of the individual in comparison to the Federal poverty level. Depending on what plan one chooses there are different levels of coverage for substance abuse treatment. Some coverage may require co-pays, coinsurance, and/or a deductible to be met prior to receiving coverage. 

Essential care is another type of insurance offered. This typically has the highest deductibles and out of pocket expenses. However, the premiums are lower. The plan is broken down into levels between one and twenty and the availability depends on the individual’s income in comparison to the Federal poverty level. All levels of this type of insurance may offer coverage for substance abuse. However, co-pays, coinsurance, and/or a deductible may need to be met prior to coverage. 

Lastly, there is secure care. This type of insurance has the lowest deductible and out of pocket expenses. However, there may be higher premiums. The plan is broken into levels from one to twenty. Once again the availability depends on an individual’s income level in comparison to the Federal poverty level. All levels may offer coverage for substance abuse treatment. All levels may offer coverage, however, there may be co-pays, coinsurance, and/or a deductible that needs to be met. What each person is looking for in terms of coverage depends on the individual. It is important to thoroughly look at each plan and talk with an advisor about your individual needs. 

HMO versus PPO

When it comes to HMO versus PPO there are certain things to be aware of. HMO stands for health maintenance organization. This type of insurance has its own network of doctors, hospitals, and other healthcare providers. Those in this network have agreed to accept payment at a certain level for any services that are provided. This type of insurance is provided for a monthly or annual fee. These plans typically have lower monthly premiums and there is usually less out of pocket pay. With the majority of HMO plans healthcare services are coordinated by your primary care provider. When going to see a specialist you must first go through your primary care provider and then they will refer you to an in-network specialist. If a provider is out-of-network there will not be any coverage. However, in the case of a true medical emergency, coverage will be provided even if it is out-of-network. The insurance provider in an HMO plan pays the provider directly so you never have to file a claim.

PPO, on the other hand, stands for the preferred provider organization. With this type of insurance plan, an individual gets maximum benefits when visiting an in-network provider. However, if a provider is out-of-network there is still some coverage. The monthly premiums tend to be higher due to the flexibility of being able to go in and out of the provider network. There may also be a higher out-of-pocket cost for services. With this type of plan, no referrals are needed for any services. If an individual chooses an out-of-network provider, however, there may be a higher fee and a separate deductible. In some cases with this type of plan, an individual may have to pay a doctor for services and then file a claim to get reimbursed. This is more likely to happen with out-of-network providers. When it comes to insurance it is important to get a plan that reflects your needs and what you are financially comfortable with.

Medicare and Medicaid

Medicare and Medicaid are accepted in most major cities. That means within Georgia there are treatment centers in cities that accept both. Medicare covers substance abuse treatment when it is reasonable and necessary. However, there is no distinct Medicare benefit category that exists. Outpatient and inpatient treatment are both covered. When it comes to Georgia Medicaid covers substance abuse treatment for adults with alcohol or drug dependency. Outpatient and residential services are included in the coverage. When looking for substance abuse coverage on insurance company websites look under the behavioral and mental health sections for more information. For more specific inquiries always check the insurance company’s website or speak with an insurance agent. For those concerned about the financial cost of treatment many centers in Georgia offer payment assistance and/or sliding fee scale cost for treatment. Treatment is key to addiction recovery. It is important that individuals are able to get the financial support they need. Regardless of one’s financial situation, everyone should be able to get treatment. For more information on your options talk with your insurance representative today or get in touch with experts at the treatment center.