HMO Covered Addiction Treatment

Twin Town Treatment Centers is a preferred and contracted, in-network addiction treatment program working with the members of over fifty HMO, EPO, PPO, EAP and managed care plans.


Question: Do HMO’s and other managed health plans cover treatment for drug addiction and alcoholism?


Answer: Yes! There are two federal laws which require that alcohol and drug treatment is covered at the same rate and under the same terms as other medical conditions.


Question: Will insurance cover all of the services offered or provided in treatment?


Answer: Your treatment program, if they are in-network or contracted with your insurance company to provide treatment is responsible to gain authorization for the intensity and duration of treatment. If your program or provider recommends services or treatment duration which is not covered, they are responsible for giving you this information and getting your informed consent to provide and bill you for such services or extended stay.


Question: How do I find a treatment program which my insurance plan will cover?


Answer: Go to your health plan website or call the 800 number for “Behavioral Health” or “Mental Health” providers. Your health plan will list professional, independent providers such as doctors and therapists, and will also list “facilities” which will include treatment programs for substance use disorder or addiction.


Question: What is the advantages of finding a contracted, in-network provider rather than “going out of network”?


Answer: Your insurance plan maintains strict cost and quality controls over its contracted providers, who are contractually obligated to render services which are sanctioned by government and accreditation agencies. Treatment rendered by a contracted provider is also covered at a substantially higher rate, with lower out-of-pocket expense than those provided out of network.


Question: Why do most treatment programs remain out-of-network if they can’t provide treatment and get paid by HMO and EPO plans?


Answer: The payment from PPO for out-of-network services are based on a percentage. If the marked-up retail rate is high enough, the out-of-network provider can bring in a profit significantly higher than those earned by in-network providers. The out-of-network provider is also able to bill you for services and lengths of stay without your expressed and informed consent.