If you want to get help from an out-of-network provider, you have to get prior authorization from your insurance company, and they will determine whether there is a medical necessity. Medical necessity means they want to make sure there are no in-network providers available in your area, in which case you have no other option. 

However, this is rarely the case because the insurance provider works hard to generate a reputable list of top-rated rehab programs and mental health specialists in-network. So how do you find one?

Ask. 

If you are struggling with addiction or mental health problems, you can turn to your primary care physician and ask them for a list of inpatient rehab centers that are covered by your plan. You can also reach out directly to your insurance provider for the same.

Once you have that list, it’s up to you to narrow down the results and find a facility that best fits your needs. Consider the following:

How qualified is the staff?

Verify how qualified the staff is. If, for example, you are looking for partial hospitalization or outpatient detox service from your rehab center, you will probably want a facility that has a doctor as part of their staff to administer medications as necessary during the worst of your symptoms.

Make sure that they are board-certified and that any nursing staff also has certificates or a great deal of experience with things like rehab, mental health, and holistic care.

Do they provide assistance with insurance questions?

If you are looking for treatment coverage by Tufts health plan information, it can get very complicated trying to find a copy of your summary benefits or linger on hold while customer service asks you to verify 17 different account numbers. 

Instead, you might consider searching for a facility that offers assistance verifying rehab coverage by Tufts health plan and explaining certain billing practices or common questions you might have.

How do they develop treatment plans?

Talk to the facilities, call them, and ask how they develop treatment plans. You might have a treatment plan that includes a psychologist, physician, and nurse all working together. Good rehab facilities will have you complete an initial evaluation or assessment with their staff to help determine the most appropriate therapy for your situation. Good rehab facilities won’t provide a cookie-cutter plan but will customize treatment.

Do they provide individual or group-only therapy?

You might prefer having individual or one-on-one therapy sessions instead of any type of group setting. Perhaps you have tried therapy before but only with a group and found it difficult to express yourself. No matter the reason, you should be able to discuss these needs with the facility you are considering. Your in-network rehab for Molina health insurance should allow you to tailor a plan that meets your needs.

Remember that group settings can offer social opportunities, emotional support, and encouragement that you simply can’t get elsewhere. So consider with openness integrating both types of therapies into your routine at a comfortable pace.