TRICARE Coverage for Behavioral Health Treatment

When people struggle with behavioral health issues, it can be overwhelming. It can also leave them feeling alone. So when they are ready to get help, insurance and finances should be the last thing they worry about. 

 At Sana Lake Behavioral Wellness Center, we take care of getting the most out of Tricare insurance policies. We do this so members can focus on their recovery. Through our partnership with TRICARE, members in Missouri can receive chronic whole-person behavioral health treatment. 

What is TRICARE Insurance?

TRICARE is supplemental healthcare for active and retired military members and their families. It was once called the Civilian Health and Medical Program of the Uniformed Services. TRICARE is a United States Department of Defense Military Health System program. TRICARE coverage includes members of:

TRICARE Insurance Terms

TRICARE and other insurance companies use terms that are crucial to understand. Although at Sana Lake BWC, we handle all the insurance details for our members, it’s good to know the meanings. 

Premium

A premium is a payment that members make to TRICARE to keep their plan active. 

 Out-of-Pocket Maximum

This maximum is the most a member will pay per year for healthcare services. After members reach their max through copays and deductibles, TRICARE covers the remaining costs. 

Policy Effective Date

A policy effective date is the date policy starts. It’s also when it’s “deemed effective.” On this date, members can receive benefits.

Deductible

A deductible is an amount members pay out-of-pocket. Deductibles cover services before Tricare starts paying. 

Copayment

Copayments or copays are the cost members pay before a healthcare appointment. For example, if a treatment center costs $2000, TRICARE may cover half depending on your plan. But, the member will have to pay a $500 copay first.   

What Services Does TRICARE Cover?

Because TRICARE made big changes in 2017, their mental health coverage now includes substance use disorder treatment. The expansion also includes opioid use disorder treatment and other substance use disorder treatment. 

Alcohol and substance misuse is an ongoing issue in the military. But, many members hide their issue in fear of their superiors finding out. However, with these changes, more members are seeking help for behavioral health issues. 

TRICARE may cover services such as:

However, many factors determine what services a member has coverage for. These factors may include plan details, where the member lives, and the type of treatment. 

Healthcare Plans with TRICARE

Like other insurance companies, TRICARE has many options for members to choose from. However, all plan options meet or exceed the Affordable Care Act standards. The act ensures people have quality healthcare plans to fit their needs. 

Eight healthcare plans TRICARE offers include:

In-Network Treatment Centers vs. Out-of-Network Treatment Centers

Typically, TRICARE offers full coverage for select treatment centers. However, these centers go through an approval process. In-network providers have an agreement to charge specific pricing for treatment. As a result, members only pay a small out-of-pocket portion of treatment costs. 

If members choose an out-of-network treatment center, they will have to pay more and file a claim. But, out-of-network treatment centers generally charge more for services. However, members in the following plans can use out-of-network at no extra charge.

Inpatient Behavioral Health Treatment and TRICARE

If a member meets specific conditions, then TRICARE will cover inpatient or residential treatment. In fact, TRICARE will cover emergency and non-emergency inpatient treatment. The specific conditions include:

TRICARE will also cover the costs of detox, stabilization, and medical issues. However, for non-emergency treatment, a member needs prior authorization. With approval, TRICARE covers both substance use disorder and mental health disorders, also known as behavioral health. 

TRICARE and Outpatient Behavioral Health Treatment

TRICARE also covers outpatient treatment. However, members must meet specific criteria for coverage. These criteria include them having an active addiction or mental health disorder. But, these issues don’t need around-the-clock care. TRICARE covers the following outpatient programs:

These outpatient programs offer the same therapies as inpatient treatment. Therapies include individual and group therapies. Just like inpatient treatment, these therapies are attended multiple times a week. Therapies in treatment aid in preventing recurrence of use and building coping skills. 

What Behavioral Health Treatments Does TRICARE Cover?

Depending on the insurance plan and other factors, TRICARE may cover the following treatments:

TRICARE also covers alternative therapies, including yoga, meditation, and mindfulness.

The Scope of Addiction in Military Members

According to the National Institute on Drug Abuse, active and retired service members are at risk of substance use disorder. For example, military life and deployment stress can increase substance use disorder and mental health issues. 

Stigmas around addiction still exist. Besides making changes, service members may be afraid to seek treatment. However, substance use in service members is lower than in the general public. But, binge drinking and prescription drug misuse are rising.

The Department of Defense (DOD) has policies for all aspects of substance misuse and addiction. They provide awareness and education, testing, and evidence-based treatments. Furthermore, after treatment, active members must return to duty. 

The DOD provides drug education to service members. Additionally, each military service operates its addiction program. The military also offers a take-back program for medications. This program eliminates members battling addiction from using leftover drugs. 

Addiction Treatments TRICARE Covers

TRICARE typically covers:

Does TRICARE Cover Telemedicine?

TRICARE covers using video conferencing for essential services. A secure connection can be established through computers or cell phones. Services include:

Depending on a member’s TRICARE policy, they may need prior authorization. However, active duty service members will need a referral for telehealth services.

Due to Covid-19, TRICARE has updated its telehealth policy. But, these changes are temporary and include:

Does TRICARE Cover Recovery Supportive Housing?

Recovery supportive housing may be covered under TRICARE PHP coverage. Recovery supportive housing allows members to receive treatment for substance use disorder while encouraging recovery. Also, recovery supportive housing helps develop skills to prevent recurrence of use. 

Members must be unable to maintain recovery without outpatient treatment. For example, the impairment from addiction must disrupt daily life. If these requirements are met, TRICARE covers recovery housing through PHP coverage. 

Sana Lake Behavioral Wellness Center Takes Care of Getting Your TRICARE Benefits

At Sana Lake BWC, we handle getting the most coverage for your behavioral health treatment. After looking over your policy coverage, we can let you know how much is covered. Our goal is to provide the highest quality care at affordable costs. 

After we verify your benefits through TRICARE, we can let you know:

Seeking the Behavioral Health Treatment You Deserve

If you are serving, did serve, or are family of someone who did, you deserve a life free of addiction and mental health issues. Life in the military isn’t easy. And sometimes hard to handle on your own. But, drugs and alcohol are not the answer. Contact us today and find out how you can live a life of recovery. 

References:

https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

https://www.tricare.mil/CoveredServices/Mental/GettingMHCare

https://tricare.mil/CoveredServices/IsItCovered/ResidentialTreatmentCenters