Insurance Options for WAVE

In- vs. Out-of-network
Insurance Coverage

When it comes to health insurance coverage, insurance companies have lists of physicians, clinics, hospitals, or other health care providers that have contracts with them. These lists, or provider networks, also include specific services that the insurance companies are willing to pay for— like rehab.

So, any coverage that pays for services in a provider network is "in-network coverage."

Now, if your insurance company doesn't cover something, it's usually because the service or provider is not part of the provider network. However, your insurance company might still help pay for outside services through "out-of-network coverage."

For example, suppose you go to a doctor’s office that does not accept your insurance plan. This means that either that particular office or the service you need is not in your insurance’s provider network. Even so, your policy may allow you to use insurance to cover part of the cost of the visit.

Services vs. Providers

It’s important to note that the out-of-network services your insurance will cover depend entirely on your plan. It’s also worth noting that out-of-network coverage refers specifically to services outside of the insurer’s network— not providers themselves. In other words, even if the provider is within your insurer’s network, some of their specific services may not be covered by your insurance plan.

 Out-of-pocket Expenses and Balance Billing

When you use out-of-network coverage to pay for medical services, balance billing is almost always part of the process. Balance billing is when you receive a bill for the remaining balance after insurance has paid the allowed amount. Using the previous example, if the doctor’s office visit totals $100, and your insurance covers $70, you’d pay $30 out-of-pocket.

Generally speaking, balance billing only applies to out-of-network coverage. This is because out-of-network service providers (hospitals, clinics, etc.) do not have contracts with insurance companies. To be part of a provider network, service providers have to agree to the terms of the insurance company’s in-network benefits, like discounted service rates. However, since out-of-network service providers have not agreed to such terms, they are not obligated to accept insurance coverage as payment in full. Still, most out-of-network insurance plans keep out-of-pocket expenses as low as possible. 

Out-of-network Insurance Coverage at WAVE

Since almost all insurance companies cover addiction treatment, most of them will offer some degree of out-of-network coverage. Of course, it all depends on the insurer, the insurance policy, and what the health provider is willing to accept. The types of ACA-compliant insurance policies that cover addiction care services typically include:

-Government-funded health insurance
-State-financed health insurance
-Employment health insurance
-Military health insurance
-Private health insurance

At WAVE, we accept out-of-network coverage from most major insurance plans. To find out if your insurance provider will cover out-of-network rehab services, you can review your insurance policy or ask a representative for help.