Coverage for Recovery Services From Beacon Health Options

If you or a loved one is struggling with a substance use disorder of any kind, it’s important that you seek treatment early on. When you obtain treatment quickly, many side effects and symptoms of addiction lessen in severity. 

However, recovery programs can be expensive, which is why it’s important to explore all options. One such option that may be available to you is to cover the program with insurance. If you currently have a Beacon Health Options policy, it’s important that you’re aware of coverage for recovery services.

How the ACA Has Shaped Addiction Treatment Coverage

When the Affordable Care Act was formally signed into law in 2010, the ruling significantly increased coverage for addiction treatment and recovery services. There are also numerous provisions within the ACA that reduce the costs of treatment and extend coverage. When looking at improvements to insurance coverage for addiction, the ACA has:

The majority of treatment facilities will accept various insurance plans directly from the Health Insurance Marketplace. Many insurance providers focus on providing quality plans at affordable rates. If a state is fully compliant with the ACA, typical insurance coverage for addiction includes:

Every insurance plan that falls under the ACA must also include:

Keep in mind that addiction coverage also extends to adolescents and can include outpatient services like:

What In-Network Means

Before looking at coverage for recovery services, it’s important to know the difference between in-network and out-of-network. Certain facilities are in-network facilities, which means that pricing arrangements and contracts are held with Beacon Health Options. 

Upon enrolling into an in-network facility, Beacon Health Options receives claims for treatment. If you or a loved one has an insurance policy with Beacon, it’s important to seek in-network treatment.

What Out-of-Network Means

Any treatment programs that are out-of-network aren’t covered by Beacon Health Options insurance plans. However, out-of-network facilities can establish pricing agreements in some situations. 

If the preferred treatment option is out-of-network, you or a loved one should still be able to receive treatment without changing providers. Beacon Health Options will verify insurance coverage for addiction before the program begins, which means that you will know if coverage is available before making payments.

What Forms of Treatment Are Typically Covered?

An insurance policy covers numerous forms of treatment, which include everything from drug detox to outpatient treatment.

Detox

At least some or all of the costs for detox are typically covered by Beacon Health Options. If insurance only covers a portion of the treatment, the remaining balance could be covered by a health savings account or employee assistance program. To effectively rid the body of a substance without experiencing severe withdrawal symptoms, medically assisted detox is necessary.

 Detox treats symptoms of withdrawal like:

The withdrawal process lasts anywhere from several days to several weeks.

Inpatient Treatment

Inpatient recovery programs are commonly covered with insurance. If a preferred program offers dual diagnosis treatment, a Beacon Health Options insurance plan should cover it. 

Dual diagnosis treatments provide treatment for a substance use disorder and a mental health disorder. By treating both of these conditions at once, chances for a full recovery increase. The inpatient services that are usually covered include:

The inpatient stay costs include 24-hour supervision and housing for the duration of treatment. The main benefit of enrolling in an inpatient facility is the drug-free environment. The exact amount of coverage depends on the specific plan or the employer. 

A coinsurance fee or payment is usually required for inpatient treatment. This fee could be around $250 and must be paid by the patient.

When you must pay a coinsurance fee, this fee is a percentage of the total bill. For instance, the fee could be 20 percent, which means that 20 percent of the final bill must be paid out-of-pocket. Unlike other forms of treatment, in-network inpatient facilities are the only ones covered by Beacon.

Outpatient Treatment

Insurance covers outpatient treatment if the specific plan provides coverage for them. In the majority of cases, your insurance plan should provide some coverage. This coverage may include:

Outpatient treatment is typically covered when attending an in-network program. However, out-of-network programs and facilities can contact Beacon to make arrangements.

Medication-Assisted Treatment

Medication-assisted treatments are oftentimes covered by Beacon Health Options. This service is mainly available to individuals who suffer from an opioid use disorder. The medications available in this treatment include:

For most of these medications, there are several different brands that are covered.

Mental Health Coverage

As touched upon previously, mental health coverage is typically available with a dual diagnosis program. In some situations, a substance use disorder worsens over time with the presence of a mental health disorder. When treating substance use disorder and mental health disorder at the same time, the chances of recovery are higher.

How to Cover Other Services That Aren’t Covered By Insurance

When a Beacon Health Options insurance plan doesn’t cover certain treatments and services, there are options available to you or your loved one. For instance, government programs offer funding and assistance for treatment. These programs are available at the local, state, and federal levels. 

While some government programs only offer partial assistance, others may cover all expenses for recovery services. The top programs include Medicaid, Medicare, and the ACA. Financing options are also available through private lenders. While the costs associated with treatment can be higher, the benefits are worth it for most people.

Now that you understand the amount of coverage available through Beacon Health Options, you or your loved one should be ready to seek treatment. Contact us today to learn more about how to recover from a substance use disorder and begin Recovery for Life.