If you run a substance use disorder (SUD) treatment center, you’ve probably wrestled with the in-network vs. out-of-network question more times than you’d like. It can feel a little like deciding between waiting in the “short” line at the DMV (which never really moves) or braving the longer line because at least you know what you’re getting. Either way, it’s complicated.

So let’s cut through the noise: yes, you can still run a SUD center as an out-of-network provider. But (and you knew there’d be a “but”), it comes with unique challenges and some important considerations. Let’s break it down.

What Does “Out-of-Network” Actually Mean?

When your SUD center is out-of-network, it means you don’t have a contracted agreement with a patient’s insurance company. Patients can still use their benefits to receive care at your center, but coverage is often less predictable. Out-of-network typically means higher costs for patients, more paperwork, and occasionally—awkward conversations about surprise bills.

That said, many centers operate out-of-network successfully. It’s not “wrong” or “less than.” It just means you need to understand the landscape, set the right expectations, and have strong billing processes in place.

The Pros of Staying Out-of-Network

Let’s start with the good news: operating as an out-of-network SUD provider comes with some real advantages. The biggest one is flexibility. Without being tied to strict payer contracts, your center has more freedom in setting rates and determining the services you offer. This independence can be especially valuable if you want to tailor care more closely to your patients’ needs without worrying about whether every line item is pre-approved by an insurance company.

Another benefit is the room for negotiation. In some cases, out-of-network centers are able to bill at higher rates than an in-network contract would allow, depending on the payer and the patient’s insurance plan. While it’s not always guaranteed, this can create opportunities for better reimbursement and more sustainable revenue streams.

Finally, there’s simply less red tape. In-network credentialing and contracting can be a long, complicated process filled with paperwork, waiting, and back-and-forth with insurers. Out-of-network centers skip that process, allowing staff to focus more on patient care and less on administrative hurdles. For new or smaller SUD treatment centers, this freedom can be a game-changer.

The Challenges of Staying Out-of-Network

Now for the “but” we mentioned earlier—being out-of-network also comes with some significant hurdles. The first is patient affordability. Because insurance plans usually cover less for out-of-network providers, patients may be responsible for higher out-of-pocket costs. This can discourage them from choosing your center in the first place, or in some cases, lead to early drop-off when the financial burden becomes too heavy.

Another challenge is unpredictable reimbursements. Out-of-network billing often comes with more delays, denials, and partial payments. This uncertainty can make it difficult to manage cash flow and plan ahead financially. For a treatment center that’s already balancing staffing, operations, and patient care, the added stress of waiting on unpredictable reimbursements can create real strain.

Finally, there’s the issue of more administrative work for your staff. Without payer contracts in place, your team will likely spend more time verifying benefits, double-checking eligibility, and negotiating with insurers just to secure payment. While this is all part of the process, it can take valuable time and energy away from what your staff does best: supporting patients.

So yes, you can run a SUD center as an out-of-network provider, but it requires a smart strategy, a strong billing process, and, let’s be honest, a good amount of persistence.

Where Integrity Billing Comes In

This is where strong billing support makes all the difference. Out-of-network billing for SUD centers isn’t for the faint of heart, but you don’t have to go it alone. A partner like Integrity Billing can handle the complexities, from verifying benefits and managing claims to advocating with payers, so you can focus on patient care.

Think of it like having a GPS when you’re driving cross-country. Sure, you could print out MapQuest directions and wing it, but why risk getting lost when you can have real-time guidance every step of the way?

At Integrity Billing, we’ve built our reputation on helping SUD treatment centers thrive, whether they’re in-network, out-of-network, or somewhere in between. Our team doesn’t just process claims; we act as an extension of your staff, ensuring compliance, maximizing reimbursements, and removing the day-to-day stress of revenue cycle management. With our support, you gain the confidence that your billing is in expert hands, giving your team the freedom to stay focused on changing lives.

Yes, You Can Run an Out-of-Network Provider—With the Right Support

So, can you still run a SUD center as an out-of-network provider? Absolutely. Many treatment centers do it successfully. But success depends on having strong processes, realistic expectations, and a billing partner who knows the ropes.

At Integrity Billing, we specialize in helping SUD centers navigate both in-network and out-of-network billing challenges. If you’re weighing your options, let’s talk. We will help you find the right path forward for your center and your patients.