Providence Health Plan insurance covers large portions of Oregon with individual, group, and supplemental insurance policies. It means that many people struggling with addiction are dependent upon them for accessing Providence rehab coverage. Although Providence substance abuse treatment is covered, there are restrictions. Therefore, all people insured by the company must understand what their policy covers and how to use it for substance abuse rehab.
Providence Substance Abuse Treatment Policy
Providence drug and alcohol treatment is given under most of their healthcare plans. However, there are restrictions on insurance coverage, including how long the company is willing to cover a single period in substance abuse rehabilitation and what steps must be taken before seeking help.
Before using this coverage, insured individuals should verify their policy terms and limits with their provider. Call the phone number on the back of your insurance card to get the details of your plan.
Providence Detox Coverage for Drugs & Alcohol
Providence detox 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, Providence inpatient rehab coverage will only kick in when there is a significant risk to the patient’s health. Detox from alcohol and specific drugs are covered, but many are left out.
Providence Inpatient Rehab Coverage
Inpatient rehab is an effective tool in treating substance use disorders. They provide around-the-clock care and supervise patients on their journey to recovery. Inpatient rehabs require patients to stay in the facility typically for 30-90 days. Providence Health Plan covers inpatient drug rehab, but the duration of the stay covered may vary.
Before the insurance 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.
Outpatient treatment is also covered under 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 in the network, they do not need prior authorization. However, copay or coinsurance will need to be paid at each visit. Patients must meet their deductible before Providence rehab coverage kicks in.
Does It Cover Medication-Assisted Treatment?
Yes, certain anti-addiction medications are covered under the insurance plan.
- Acamprosate calcium
- Naltrexone HCl (Revia)
- Buprenorphine HCl
- Opioid reversal agents
- Naloxone (Narcan)
The patient’s doctor must attest that they believe medication-assisted treatment is critical to a positive outcome to get these medications covered. In addition, the patient will be expected to pay their standard prescription copay based on whether the medicine is a brand name or generic. For many in recovery, having this access is the key to staying clean, making it a valuable part of Providence rehab coverage.
Individual And Family Coverage
Insurance plans can come in a variety of packages. They are generally divided into three primary types, offering variations within them. They are Connect, Standard, and HAS Qualified plans.
Connect plans combine the medical home model of care with a provider network tailored to the patient. The patient selects the medical home of their choosing, giving 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 are covered.
Standard plans do not include out-of-network benefits except for emergency and urgent care. These options have low copays, starting at just $10, making Providence inpatient rehab easier to afford. A referral is needed to see a specialist.
HSA Qualified Plans
These plans have high deductibles but very low premiums. It 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.
There are also other options available through the federal marketplace and ones available to the members of federally recognized tribes.
In-Network vs. Out-Of-Network Providers
With the Providence health plan, 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 in the network, anyone looking to use Providence detox or rehab coverage must seek out an in-network provider.
The company has a searchable directory on its website. Using their member ID number, those with this coverage can see all the providers within their network.
However, users should remember 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 has access to Providence rehab center coverage. Users should first verify their rehab insurance coverage and then locate a rehabilitation provider that is within their network. The sooner addiction is addressed, the better the outcome.
Before starting treatment it’s advisable to learn more about addiction, treatment options, and effective approaches. To deal with the problem one must understand it, and how it affects the body and the mind.
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- Providence Health Plan, Find a doctor, clinic, pharmacy, or other care provider. https://phppd.providence.org/
- INDIVIDUALS & FAMILIES: Plan Overview. Providence Health Plan. 2021. https://www.providencehealthplan.com/-/media/providence/website/pdfs/indi-fam/plan-overviews/2021_plan_overview_or.pdf