A partial hospitalization program (PHP) is an intensive addiction treatment option that still allows clients to live at home or in a sober living home. These programs are generally time-limited, rigorous, and allow for substantial clinical attention during the day.
You can expect to receive treatment in a hospital-like setting during the day, anywhere from three to five days per week. Often, you’re at the treatment center for about six hours per day.
PHPs are highly structured. They offer group and individual therapy, and you’ll learn the skills you need to successfully recover from substance abuse. Throughout the course of your care, you’ll connect with social workers, nurses, psychiatrists, and other health care personnel.
It’s likely that at least part of your PHP treatment will be covered, but you may need to meet certain requirements your provider outlines. For example, you may need prior authorization from your primary care physician (PCP) before coverage for your PHP is approved.
As of 2014, the Affordable Care Act (ACA) mandated that substance use disorders be included in the 10 essential health care benefits. Policyholders have more access to mental health and substance abuse treatments as a result.
Healthcare.gov says that all insurance plans must cover the following services:
The ACA also stipulates the following:
The ACA also stipulates the following:
Insurers are also required to provide parity protections. Mental health and substance use disorder treatment limits cannot be different than those that exist for physical or surgical treatments. There may be guidelines related to:
Again, most insurance companies will cover a PHP, but they often require preauthorization. Your state’s laws may influence how your provider handles your case. Each provider may also handle the preauthorization process differently.
Some may ask you to give your insurance information to a potential clinic. The clinic will then call the insurer directly to see if they cover the PHP you are interested in. You can usually get a general estimate of how much will be covered and how much you’ll be expected to pay out of pocket.
You’ll receive higher levels of coverage if you opt for an in-network provider. Your insurance company may be able to give you referrals to providers they cover.
You can still access care from out-of-network providers, and many insurance plans still offer some level of coverage for these options. Expect to pay more out of pocket if you choose an out-of-network provider.
Differences Between Coverage for a PHP vs. an Inpatient Program
Inpatient programs are different from PHPs in that they require clients stay at the treatment facility 24 hours a day. As a result, inpatient addiction treatment programs are more expensive than outpatient options.
Health Affairs outlines a few factors that could influence how your insurer may pay for your services if you choose a PHP versus an inpatient program. The variables below apply to people who use Medicare to pay for services. They can give you an idea of what you can expect from other insurance providers.
You will still be responsible for copayments whether you choose inpatient treatment or a PHP. Some insurance providers may use an inpatient program to determine whether or not you remain eligible for other services later on.
Oftentimes, insurance companies require that you first attempt outpatient treatment before inpatient treatment will be covered. Since a PHP is an outpatient program, you are more likely to initially receive coverage for this than an inpatient rehab program.
A PHP can work well if you need a rigorous treatment program, but still want flexibility to live at home.
To determine the right plan for you, you’ll need an assessment from a prospective treatment center. The clinician will assess your situation and recommend a course of care that is appropriate.
The National Institute on Drug Abuse (NIDA) says that substance use treatment should be customized to your unique needs. If you enroll in a PHP, it shouldn’t feature a cookie-cutter approach to recovery. It should be tailored to your individual situation.
With careful planning and help from a doctor or addiction specialist, you can find the best program to fit your needs.