In-Network vs Out-of-Network

When you call to verify insurance for addiction treatment, one of the first questions is whether the clinic is "in-network" or "out-of-network" with your plan. The distinction has significant implications for cost and access. This page explains what each means, when out-of-network is sometimes the right call, and how to know what you are dealing with.

What "in-network" means

An in-network provider has a contract with your insurance carrier. The contract typically includes:

For most clients, in-network treatment is significantly less expensive out-of-pocket than out-of-network treatment.

• An agreed-upon rate the carrier pays for each service
• Streamlined billing (the clinic bills the carrier directly)
• The provider's services count toward your deductible and out-of-pocket maximum at the in-network rate
• Lower copays and coinsurance than out-of-network
• Pre-negotiated terms for prior authorization and utilization review

What "out-of-network" means

An out-of-network provider has no contract with your carrier. The carrier still may pay for some portion of the services, depending on your plan:

For SUD treatment, plans that pay out-of-network benefits usually do so at a meaningfully lower rate than in-network, and the client's deductible and out-of-pocket maximum may be different (often higher) for out-of-network services.

• Some plans have out-of-network benefits at a lower rate of coverage
• Some plans pay nothing for out-of-network care
• Some plans pay out-of-network only in specific circumstances (no in-network option available, emergency, etc.)
• The client is responsible for the difference between the provider's billed rate and what the carrier pays (this is "balance billing," limited in some contexts by federal and state law)

When out-of-network might be worth it

In some situations:

Most clients in most situations are better served by in-network treatment.

• No in-network provider is available within a reasonable distance or with timely capacity (the carrier may then process the out-of-network claim at in-network rates, sometimes called a "network gap exception")
• The clinical fit with a specific out-of-network provider is significantly better than available in-network options
• The plan has strong out-of-network benefits that make the cost difference small
• The client has the financial means to absorb the difference

The Archangel Centers and insurance

The Archangel Centers works with most major commercial insurance plans and verifies benefits free of charge before treatment begins. Plans the admissions team commonly verifies include:

If your specific plan is not on this list, the admissions team can still verify whether benefits apply and what the cost picture would look like. Out-of-network benefits are available on many commercial plans and can substantially offset cost.

• Aetna
• Cigna
• BlueCross BlueShield (specifics vary by state plan)
• Tricare

How to verify

Call (888) 464-2144 or use verify your insurance. The team contacts your carrier and confirms:

Verification is free and does not commit you to anything.

• In-network or out-of-network status with The Archangel Centers
• Coverage rates for in-network and out-of-network services
• Deductible status (in-network deductible may be different from out-of-network)
• Copay or coinsurance for in-network and out-of-network
• Any prior authorization requirements

When the carrier's network is inadequate

Federal mental health parity law and some state laws address network adequacy: the requirement that the carrier maintain enough in-network providers that members can actually access timely care. If a carrier does not have an adequate network for SUD treatment, an out-of-network provider may sometimes be authorized at in-network rates ("network gap exception" or "transition of care" provisions). The Archangel admissions team can pursue this when applicable.

Out-of-network billing protections

The federal No Surprises Act, effective 2022, provides some protections against unexpected out-of-network billing in specific contexts (emergency services, services at in-network facilities by out-of-network providers). For SUD treatment, the application is partial; the planning and verification process is the main protection against surprise costs.