Understanding your coverage

Health Plan Guides

Insurance terminology shouldn’t be a barrier to getting help. Plain-language explanations of plan types, common terms, and the verification process.

Call 24/7 (626) 635-3737

Plan types

Four common health-plan structures

The type of plan you have shapes how you access detox and how much you pay. The four most common in California:

PPO

Preferred Provider Organization

Most flexible · most popular

No referral needed. In- and out-of-network coverage. Higher premiums but more freedom. The easiest plan type for accessing detox quickly.

HMO

Health Maintenance Organization

Lower cost · referrals required

Lower premiums but you must get a referral from your primary-care doctor before seeing a specialist. No out-of-network coverage outside emergencies.

EPO

Exclusive Provider Organization

Middle ground

No referral needed (like a PPO), but coverage is in-network only (like an HMO). Premiums fall between the two.

POS

Point of Service

Hybrid

Like an HMO that lets you go out-of-network with a referral and higher cost-sharing. Less common but still found in employer plans.

Common terms

Insurance vocabulary — translated

Key terms to know

Deductible — the amount you pay out of pocket before your insurance starts covering costs.
Co-insurance — the percentage of costs you split with your plan after the deductible is met (e.g. you pay 20%, plan pays 80%).
Co-pay — a flat fee you pay at the time of a service.
Out-of-pocket maximum — the most you'll pay in a year. After this, your plan covers 100%.
In-network — providers your plan has a contract with. Lower costs.
Out-of-network — providers without a contract. Higher costs, but PPOs still cover a portion.
Pre-authorisation — your plan's approval before a procedure or admission. Required by many PPOs for inpatient detox.

Insurance + detox FAQ

What people ask most

Will my insurance cover medical detox?

Most insurance plans cover medically necessary detox, including PPO, HMO, EPO, POS, Medicare, and Medi-Cal in California. The exact coverage and your out-of-pocket cost depend on your specific plan. Our verification team confirms everything before you commit.

Does my employer find out?

No. HIPAA protects your medical privacy. Even though your insurance is provided through your employer, they receive no details about your care. Insurance carriers are legally barred from sharing this information with employers.

What if I don't have insurance?

We offer private-pay options for those without insurance. Call us to discuss rates, payment plans, and any sliding-scale assistance that may be available based on your situation.

How is "medical necessity" determined?

Medical necessity for detox is established through a clinical assessment based on DSM-5 criteria for substance use disorder, withdrawal-symptom severity, and risk factors. Our admissions team conducts this assessment as part of the verification process.

Can I use Medicare or Medi-Cal?

Medicare and Medi-Cal both cover medically necessary detox in California. Coverage details and required referrals depend on your specific plan. Our team verifies before admission.

Three steps

Verifying your benefits — what to expect

Step 1

Tell us about your plan

Call us or fill out the verification form with your member ID, date of birth, and carrier name. Takes 90 seconds.
Step 2

We do the legwork

Our verification team contacts your plan directly — confirming benefits, deductible status, pre-auth requirements, and approved length of stay.
Step 3

You get a clear picture

We walk you through exactly what your plan covers, what you'll owe, and what payment options exist. Then you decide whether to proceed.

Questions about your specific plan?

Call admissions 24/7 or use our secure form. We don’t need your card on file to answer benefits questions.

Call 24/7 (626) 635-3737