Using Sierra Health Insurance for Drug or Alcohol Treatment - Withdrawal

Using Sierra Health Insurance for Drug or Alcohol Treatment

Sierra health insurance, a subsidiary of United Healthcare and Behavioral Health Option, may be able to help you cover the cost of rehab.


What you will learn
  1. Sierra Health rehab coverage options.
  2. How to check your Sierra Health plan rehab coverage.
  3. How to find rehabs that accept Sierra Health insurance

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.

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 to get connected with critical addiction care services and check your benefits while you’re on the phone.



 

 



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