Jillian English

While over 40 million people in the United States reported struggling with a substance use disorder in 2020, many will not receive treatment for the disorder.1 The reasons for this are many, but a major one may be a fear of or inability to pay the cost of treatment. Luckily, due to sweeping healthcare reform implemented in the past few decades, many may be able to use this public or private insurance plans to cover some or all of the cost of addiction treatment. While coverage may vary, understanding what your insurance covers, how to use your insurance at rehab centers, and where to find rehab centers that accept your insurance can help you get started in achieving recovery. Does Health Insurance Cover Rehab? Under the Affordable Care Act (ACA), signed into law in 2010, almost all health plans are required to provide coverage in some capacity for 10 essential health benefits, one of which is treatment for behavioral and mental health services.3, 4 This law means that almost all health plans, including public and private insurance plans, must provide some level of coverage for the treatment of substance use disorders, provided those services are deemed medically necessary. In addition to this, the Mental Health Parity and Addiction Equity Act (MHPEAEA) ensures that plans cannot be more restrictive in covering mental health and substance use disorder services than they are for medical and surgical services.5 While these legal protection do a great deal to help people in need access vital addiction treatment services, this doesn’t mean that insurance will cover all the costs of treatment. There are various factors that may result in an insurance plan only offering partial coverage, or perhaps no coverage at all. Where you attend treatment, whether a rehab is in-network or out-of-network with your insurance plan, how intense the treatment is, how long the treatment lasts, and what accommodations and amenities are provided are all factors that can result in your coverage varying. It’s important to reach out to your insurance provider to check your coverage before committing to treatment. Types of Addiction Treatment Covered by Insurance The types of addiction treatment that your health insurance plan may cover will vary. However, some common addiction treatment types may include: Detox: Many treatment programs involve a patient completing medical detox (also referred to as medically managed withdrawal), which is the medically supervised process of ridding the body of substances.6 Inpatient rehab: In an inpatient rehab program, a patient will stay at a facility round-the-clock for a predetermined amount of time to receive 24/7 medical supervision and care.7 This type of program can last for days, weeks, or months.7 Outpatient rehab: At an outpatient rehab program, patients attend various treatment sessions like drug education or group counseling, but they don’t stay overnight at the facility.6 Aftercare: An aftercare program is known as any type of follow-up or continuing care that is rendered after a patient completes their initial rehabilitation.7 How to Check Your Rehab Insurance Coverage There are various ways that you can check your rehab insurance coverage. First, you can call the number on the back of your insurance card to speak with your insurance company’s customer service member. You can also access your coverage details by signing on to your insurance company’s website or member portal. Finally, you can usually call the rehab center directly and have them check your benefits and coverage for you. [vob-aktify-cta title="Does your insurance cover rehab or detox?" subtitle="Check your coverage online or text us your questions for more information"]  How to Use Your Insurance Benefits For Rehab The exact steps you need to follow to use your insurance benefits for rehab will depend on your plan, so it’s important to check with your insurance provider before seeking care whenever possible. Usually, you’ll start by finding a facility that accepts your insurance plan. Then, you can verify coverage with both the rehab center and the insurance carrier. The facility itself and your insurer can help you determine whether you need to gather any necessary documentation, including pre-authorization or referrals. You’ll want to save any communications or receipts to help facilitate a smooth claims process. Using Private Insurance for Rehab Private health insurance is a type of insurance plan provided by a private corporation.8 A private health plan could be offered by a non-government employer or purchased directly from an insurer, depending on your circumstance.8 There could be various types of plans to choose from, including a high deductible health plan, preferred provider organization, health maintenance organization, exclusive provider organizations, or point-of-sale plans.9 Depending on your plan, you may be limited to where you receive care (e.g., plan network) if you want to obtain coverage for eligible services. Most private insurance plans are subject to the ACA’s EHB mandate for mental and substance abuse services, including rehab, which means you can likely use your private insurance to cover some of the cost of medically-necessary substance use disorder treatment. Using Public Insurance for Rehab Using public health insurance programs like Medicare or Medicaid, eligible individuals can help pay for rehab programs.8 These government-sponsored programs can offer low-cost or free health insurance benefits to eligible individuals or families (e.g., elderly individuals, those with disabilities, low-income individuals, etc.).8 Eligibility requirements may vary, and not every cost may be covered. Enrollees may be subject to networks and cost-sharing requirements, similar to private insurance plan coverage.8 How Much Does Rehab Cost With Insurance? The cost for rehab can vary greatly. Factors such as the type and length of care needed, the treatment setting and provider, the amenities provided, and the insurance coverage you have will affect the overall cost of your rehab treatment. You may be able to ask your rehab facility for an estimated quote of services to get an idea of what the cost of getting treatment may entail for you under your plan details. How to Go to Rehab Without Insurance Those without insurance don’t need to delay or forgo care. There are many low-cost or free rehabs available through some public medical insurance programs. These programs can help take off some of the high costs often associated with attending rehab for those who don’t have private insurance options. Finding a Rehab Center That Accepts Medical Insurance If you’re ready to take the next step toward recovery, you’re likely wondering how to find a rehab center that accepts either private or public medical insurance. You can start the process by visiting your primary care doctor, using SAMHSA’s treatment locator tool, or calling the number on the back of your insurance card. Once you find a treatment center, you’ll want to double-check that it is a covered facility under your insurance plan before committing to treatment. Doing so can help you avoid surprise medical bills after receiving care. Finding a covered facility can be overwhelming, but it doesn’t have to be. Call the American Addiction Centers (AAC) addiction helpline at [phone] or you can text us for help determining the extent of your insurance coverage today. [accordion title="Rehab at American Addiction Centers"] Laguna Treatment Hospital Adcare - Boston Sunrise House Desert Hope Greenhouse Oxford Treatment Center Recovery First River Oaks [/accordion][accordion title="Rehab insurance coverage"] Aetna Ambetter American Family AmeriHealth Anthem Beacon BHO Blue Cross Blue Shield Cigna Connecticare Geisinger HCSC Harvard Pilgrim Health Plan of Nevada Highmark Humana Kaiser Permanente Magellan Magnacare Meritain Health Medicare and Medicaid Optum Oxford Health Providence Qualcare Sierra Health Tricare Triwest Tufts United Healthcare UPMC Zelis [/accordion][accordion title="Rehab near me"] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [accordion title="Rehab"] Choosing a rehab center Couples rehab Court ordered rehab COVID-19 and rehab Dual-diagnosis rehab Deciding you need rehab Helping a loved one go to rehab Medication assisted rehab Preparing for rehab State-funded rehab Teen rehab Veterans rehab [/accordion][accordion title="Detox"] 24/7 detox hotlines Inpatient detox Outpatient detox Dangers of detoxing at home The cost of detox [/accordion] [sources] Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). National Institute on Drug Abuse. (2018, January). How effective is drug addiction treatment? Healthcare.gov. (n.d.). Affordable Care Act (ACA). Healthcare.gov. (n.d.). Mental health & substance abuse coverage. MentalHealth.gov. (2020, March 18). Health insurance and mental health services. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (Third Edition). Types of treatment programs. Substance Abuse and Mental Health Services Administration. (2014). What is substance abuse treatment? National Alliance on Mental Illness. (n.d.). Types of health insurance. UnitedHealthcare. (n.d.). What are HMO, PPO, EPO and POS health insurance plans? [/sources] ...

Sierra Health and Life (SHL) Insurance is a UnitedHealthcare company that provides health and life insurance solutions to covered members.1 SHL insurance was first established in California in 1906 as primarily a life insurance and health indemnity insurance company.1 In the present day, it is licensed in the District of Columbia and 43 states.1 In 2008, Sierra Health Services and Health Plan of Nevada, one of Sierra Health Services’ subsidiaries, were acquired by UnitedHealth Group.1 In 1991, UnitedHealthcare created a sister company to SHL called Behavioral Healthcare Options.1 This helps provide Sierra Health and Life members with mental health and addiction treatment services.1 If you have a Sierra Health insurance plan, you may be able to use it to cover some or all of the costs of alcohol or drug addiction treatment. Does Sierra Health Cover Rehab Treatment? Under the Affordable Care Act, almost all U.S. health plans, including Sierra Health plans, are required to provide some level of coverage for the medically necessary treatment of mental and behavioral health.2 Specifically, health plans must fully or partially cover treatment for substance use disorders (e.g., rehab), inpatient mental and behavioral health services, and behavioral health services (e.g., counseling).2 Despite the mandate, there may be some factors that could affect coverage. Factors could include the type of insurance plan that you have, whether the treatment is deemed medically necessary, and whether the rehab facility you attend is an in- or out-of-network facility. Types of Addiction Treatment Covered by Sierra Health What is covered under your Sierra Health plan in terms of addiction treatment will depend on what plan you have. Every health plan is different, making it important for you to verify your insurance before seeking care whenever possible. The following 4 aspects of addiction treatments may be fully or partially covered under your Sierra Health plan: Medical Detox: The first stage of addiction treatment is usually detox. Detoxification is the process in which substances are rid from the body. It is often done in a medically supervised manner to help manage the side effects of withdrawal.3 Inpatient Care: Treatment that is administered in a facility where a patient lives at the facility for the duration of their care is called inpatient care. Inpatient rehab programs involve patients receiving round-the-clock medically supervised care for their stay.4, Outpatient care: Treatment that involves a patient visiting a facility 1 or 2 times per week to receive their services, but not staying overnight, is outpatient care. Common services rendered in outpatient care include group meetings and therapy.4, Aftercare and Sober living: Care that is rendered after rehab is completed is called aftercare. An example of aftercare is sober living, where patients live in a substance-free home with other recovering patients.5 How to Use Sierra Health to Pay for Rehab Using your Sierra Health insurance to pay for rehab is simple. Most substance use disorder providers will bill your Sierra Health and Life plan directly, provided that you show the provider your health plan ID card at each appointment or treatment.6 If you visit an out-of-network provider, you may need to submit a non-provider claim form, which your provider must help fill out.6 Prior authorization is often necessary to help ensure that you’re receiving medically necessary care. But your provider will help you coordinate the care you need, and you can work with staff to understand how your plan works. Beyond this, you may owe various out-of-pocket costs, including deductibles and copays. [vob-aktify-cta title="American Addiction Centers accepts Sierra Health" subtitle="Check your coverage online or text us your questions for more information"] How Much Does Sierra Health Cover? How much addiction treatment Sierra Health covers will vary greatly, as there are many different plan types and tiers. Factors that affect what your plan covers may include the type of plan you have, the length and intensity of treatment you receive, and where you attend treatment. There may be differences in coverage depending on whether you attend an in-network or out-of-network facility. To find out what your plan covers, be sure to call the number on the back of your insurance card. Do Rehab Facilities Need to Be In-Network with Sierra Health? A network refers to the suppliers, providers, and facilities that are contracted with your Sierra Health plan to provide health care services at a specific agreed-upon rate to covered members like you. In most cases, you will need to attend rehab at a rehab facility that is in-network with your Sierra Health plan to receive your full benefits and coverage. If you choose an out-of-network provider, you may need to submit a prior authorization claim, but it’s not guaranteed that your Sierra Health plan will cover care costs from an out-of-network provider. Finding Rehab Centers that Accept Sierra Health If you’re ready to get the care you need finding a covered rehab facility near you is one of the first steps. Another first step to take is to get in contact with a doctor who can help determine you or your loved one’s medical needs. Doctors may be able to conduct a screening or evaluation to determine the types of care you or a loved one may need—and they also may be able to refer you to a rehab facility for treatment. You can then call the rehab center directly and ask whether they will accept your Sierra Health plan. Or you can call the number on the back of your insurance card to speak to a plan representative that can explain covered facilities near you. If you’d prefer to work with a third party, you can use SAMHSA's online treatment locator to help find local covered addiction rehabs. American Addiction Centers (AAC) can also help you learn more about your health plan and find nearby covered treatment centers. Call the AAC addiction helpline today at [phone] to get connected with critical addiction care services and check your benefits while you’re on the phone. [accordion title="Rehab at American Addiction Centers"] Laguna Treatment Hospital Adcare - Boston Sunrise House Desert Hope Greenhouse Oxford Treatment Center Recovery First River Oaks [/accordion][accordion title="Rehab insurance coverage"] Aetna Ambetter American Family AmeriHealth Anthem Beacon BHO Blue Cross Blue Shield Cigna Connecticare Geisinger HCSC Harvard Pilgrim Health Plan of Nevada Highmark Humana Kaiser Permanente Magellan Magnacare Meritain Health Medicare and Medicaid Optum Oxford Health Providence Qualcare Tricare Triwest Tufts United Healthcare UPMC Without insurance Zelis [/accordion][accordion title="Rehab near me"] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [/accordion][accordion title="Rehab"] Rehab Couples rehab Court ordered rehab COVID-19 and rehab Dual-diagnosis rehab Deciding you need rehab Helping a loved one go to rehab Medication assisted rehab Preparing for rehab Relapse prevention State-funded rehab Teen rehab Veterans rehab [/accordion][accordion title="Detox"] 24/7 detox hotlines Inpatient detox Outpatient detox Dangers of detoxing at home The cost of detox [/accordion]   [sources] Nevada Insurance Enrollment. (n.d.). Sierra Health and Life. Healthcare.gov. (n.d.). Mental health & substance abuse coverage. National Institute on Drug Abuse. (2020, June 3). Types of treatment programs. National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2019). Treatment approaches for drug addiction DrugFacts. Substance Abuse and Mental Health Services Administration. (2014). What is substance abuse treatment? (Original work published 2004). Sierra Health and Life. (n.d.). FAQs. [/sources]   ...