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How does it work?
Insurance Contracts
INN & OON
Going In Network or Staying Out of Network
INN Benefits
Higher & More Consistent Census
Payers actively refer patients to INN providers via their portals, EAPs, and hospital discharge teams. INN listings = free marketing to millions.
Predictable Cash Flow
Direct billing & Faster Payment at contracted rates.
Higher Effective Reimbursement
Lower per-day rate is more than offset by volume, faster payments, lower strain on the client and facility.
Regulatory Tailwinds
Payers must prove network adequacy for SUD/MH or face massive losses that can include, denying reimbursement for services, initiating audits, or even refusing future claims.
Patient Accessibility & Mission Alignment
Lower rates mean you can treat teachers, nurses, first responders, and middle-class families - the people who are most likely to not recieve help.
Staff Recruitment & Retention
Steady census = stable payroll, better benefits, lower burnout. Clinicians want to work where beds are full and revenue is reliable.
OON Benefits
While most programs are better off with at least selective in-network contracts, a small, elite segment of the market still thrives by remaining fully or mostly out-of-network.
Voluntary rate Negotiation
You set your price; no renegotiating every 1–3 years when payers squeeze rates.
Out-of-network providers do not have a contract with the insurer, so they are not obligated to accept the insurer's desired rate. This can mean higher reimbursement at or closer to you daily rates.
Treatment and Care
Providers have flexibility to use a wider range of evidence-based and innovative therapies.
Faster Cash Flow (When Collected)
Patient (or family/guarantor) pays up to 100% upfront or on a payment plan - money in your account Day 1. The facility agrees to reimburse when the claims are paid by the insurance company.
Privacy & Exclusivity Branding - For Private Pay Only Programs
Market as “private-pay only,” “insurance-free,” or “concierge-level” care — appeals to executives, celebrities, professionals worried about EHR access by insurers.
Ability to “Single-Case Agreement” (SCA) When approved
For the insured patients with Only INN benefits that are approved to recieve OON services, negotiate an SCA at higher rates than standard INN network rates.
The (Hybrid) Approach
The strategy many growing programs now use is Hybrid - Utilizing Out-of-Network (OON) benefits and Private Pay Options for broader access to patients while simultaneously going selectively In-Network (INN) for commercial insurance and Medicaid patients.
Key Components of a Hybrid Model
- In-Network (INN): The facility contracts with specific insurance providers, accepting negotiated, lower rates in exchange for a steady stream of patient referrals and a simplified billing process for those patients.
- Out-of-Network (OON): The facility does not have contracts with certain insurers and can charge its full rates. Collecting partital or full payment of services fromt the patient up front with reimbursement after insurance claims are paid in full.
- Private Pay (Cash Pay): Patients pay the full cost of treatment directly out-of-pocket, entirely bypassing the insurance process. This allows for immediate admission, individualized care, greater confidentiality, and full autonomy over the treatment plan and length of stay.