Providence Health Plan insurance covers large portions of Oregon with the individual, group, and supplemental insurance policies. This means that many people struggling with addiction are dependent upon them for accessing Providence Health Plan drug rehab coverage. It is imperative that all people insured by the company understand what their policy covers and how to use Providence Health Plan for substance abuse rehab.
Learn About Providence Insurance Coverage For Drug Rehab:
Does Providence Health Plan Cover Drug Rehab?
Providence insurance coverage for drug rehab is given under the majority of their healthcare plans. However, there are restrictions on drug rehab coverage, including how long the company is willing to cover a single period in substance abuse rehab and what steps must be taken before seeking treatment.
Before attempting to use this coverage, insured individuals should verify their policy terms and limits with their provider.
Does Providence Health Plan Cover Drug And Alcohol Detox?
Providence insurance detox coverage is offered. This is part of the behavioral health services coverage from the company. However, they do require prior authorization before the first visit. In general, drug detoxification is an inpatient service, and the fees for inpatient treatment will apply.
Detox will only be approved for coverage if it is deemed medically necessary. While withdrawing from many substances is uncomfortable, drug rehab coverage will only kick in when there is a significant risk of things going wrong. As such, detox from alcohol and specific drugs are covered, but many are left out.
Does Providence Health Plan Cover Inpatient Rehab?
Yes, Providence Health Plan covers inpatient drug rehab. They divide this into two categories: inpatient rehabilitation and outpatient habilitation. Inpatient rehabilitation is covered for 30 days per the calendar year, and the same is true for outpatient habilitation. Patients must get advance approval before seeking inpatient addiction treatment.
Before drug rehab coverage kicks in, the patient must meet their deductible. Once they meet their deductible, there will still be coinsurance to pay. Although it will not be free, Providence insurance for rehab makes it more affordable.
Does Providence Health Plan Cover Outpatient Rehab?
Outpatient treatment is also covered under Providence drug rehab insurance. However, this coverage is highly limited. Just 30 visits are covered per the calendar year, with the possibility of getting 30 more covered by seeking special approval. The same time limits apply to outpatient habilitation as well.
As long as the patient seeks a provider that is in the network, they do not need prior authorization. Copay or coinsurance will need to be paid at each visit. Patients must meet their deductible before Providence drug rehab coverage kicks in.
Does Providence Health Plan Cover Medication-Assisted Treatment?
Yes, certain anti-addiction medications are covered under Providence insurance drug rehab coverage. These include:
- Acamprosate calcium
- Naltrexone HCl (Revia)
- Buprenorphine HCl
- Buprenorphine HCl/naloxone HCl
- Opioid reversal agents
- Naloxone (Narcan)
To get these medications covered, the patient’s doctor must attest that they believe medication-assisted treatment is critical to a positive outcome. The patient will be expected to pay their standard prescription copay based on whether the medication is brand name or generic. For many in recovery, having this access is the key to staying clean, making it a valuable part of Providence insurance coverage for rehab.
Providence Individual And Family Coverage
Providence health insurance plans can come in a variety of packages. In general, they are divided into three primary types, offering variations within them. They are Connect, Standard, and HAS Qualified plans.
Connect plans are designed to combine the medical home model of care with a provider network tailored to the patient. The patient selects the medical home of their choosing, which then gives them access to a team of healthcare providers that will support them in everything from preventative care to substance abuse treatment. There are no out of network benefits for most aspects of care, but emergency and urgent care is covered.
Standard plans with Providence health for drug rehab and other services do not include out-of-network benefits except for emergency and urgent care. These options have low copays, starting at just $10, making outpatient and inpatient treatment easier to afford. A referral is needed to see a specialist.
HSA Qualified Plans
These plans have high deductibles but very low premiums. This makes them affordable on a day-to-day basis, but it does mean paying for drug rehab will be more difficult, as the deductible will be harder to meet. Emergency and urgent care services remain the only ones accessible out of network and referrals are needed.
Below is a comparison of the various plans offered directly by Providence insurance drug rehab coverage as they pertain to outpatient and inpatient rehabilitation services.
|Plan||Outpatient Services||Inpatient Services|
|Connect 2500 Silver||$45||30%|
|Connect 7900 Bronze||$65||Covered in full|
|Covered in full||Covered in full|
|HSA Qualified 6650 Bronze||Covered in full||Covered in full|
There are also other options available through the federal marketplace, as well as ones available to the members of federally recognized tribes.
Providence Group Plans
Under 50 group plans are as follows:
- Total Enhanced
- HSA Qualified
- Standard Silver and Gold
- Standard Bronze
For groups of 51 or more, plans to choose from include:
- Option Advantage
- Option Advantage A
- Option Advantage B
- Option Advantage AB
- HSA Qualified
- HSA and HSA E Qualified
- Integrated HSA, HRA or FSA
- Connect Plans
- Choice Plans
- Pharmacy Plans
- Chiropractic Manipulation and Acupuncture
- Vision Plans
- Providence Dental
What someone can do with their Providence health insurance for drug rehab will depend on which plan they have.
Providence Signature Network
The Providence Signature Network is the largest network available through Providence Health Plan, giving patients access to the most options for substance abuse rehab. It covers nearly 1 million providers and over 350,000 specialists nationwide. For 51+ groups, Option Advantage and HAS Qualified plans are available in this network. For those with 50 or less, Total Enhanced, Balanced, HAS Qualified, and Standard plans are offered.
Providence Choice Network
Choice network plans are only offered to groups of 51 or more. Insured individuals get to select a medical home from almost 300 different primary care clinics in select counties in Oregon and Washington. Counties covered include:
- Clark (Wash.)
- Hood River
- Yamhill (city of Newberg)
It is suggested that users select their medical home based on which location is most convenient for them.
Providence Connect Network
The connect network gives patients access to over 70 primary care clinics in Washington, Multnomah, Clackamas, Hood River counties, and the city of Newberg in Yamhill county. It is open to groups of all sizes.
In-Network vs. Out-Of-Network Rehab Coverage
With Providence insurance, what is considered in-network will depend on where the insured person is located and what type of health plan they have enrolled in. Because their benefits only apply to those who are in the network, it is vital that anyone looking to use Providence insurance coverage for rehab seeks out an in-network provider.
Providence insurance coverage makes this easy to do as they have a searchable directory on their website. Using their member ID number, those with this coverage can see all the providers who are within their network.
Users should remember, however, that emergency and urgent care providers do not need to be in the network. If someone is having an emergency, including those related to substance abuse, they should seek care without worrying about their network.
Verifying Insurance For Substance Abuse Treatment
Anyone who is enrolled in Providence insurance coverage has access to substance abuse rehabilitation coverage. Users should first verify their drug rehab coverage and then locate a rehabilitation provider that is within their network, talking to their primary care provider about the facility if a referral is needed.
- INDIVIDUALS & FAMILIES: Plan Overview. Providence Health Plan. 2019. https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/individualplans/2019/plan%20overview.pdf.
- Limitations and exclusions. Providence Health Plan. 2019. https://healthplans.providence.org/individuals-families/2019/health-plan-details/limitations-exclusions/.
- GROUPS SIZED 51+: Plan Overview. Providence Health Plan. 2019. https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/producers/2019/Large%20Group%20Plan%20Overview.pdf.
- GROUPS SIZED 1-50: Plan Overview. Providence Health Plan. 2019. https://healthplans.providence.org/~/media/Files/Providence%20HP/pdfs/producers/2019/Small%20Group%20Plan%20Overview.pdf.