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Centene Corporation Insurance Coverage For Drug And Alcohol Rehab

Centene Corporation provides multiple insurance plans that include coverage for addiction treatment. Coverage levels will vary by plan type and by state. Centene Corporation Insurance Coverage For Drug And Alcohol Rehab

Insurance coverage is just one of the many concerns that families who are looking for drug and alcohol rehab have, but it is an important one. Centene Corporation is a large, publicly-traded insurance company with several sectors that include Medicare supplement, small business, individual plans and TRICARE military insurance programs.

Centene offers insurance in 28 states from Arizona to Wisconsin, so the exact coverage amount will depend on the policies offered in that state. Some states only cover Medicaid and some only include correctional facilities, while others provide individual and group insurance plans.

In most states that offer individual or group plans, Centene Corporation plans are ranked by metal levels. Metal levels help consumers and businesses shopping for insurance get a clear view of out-of-pocket expenses. Bronze is the lowest coverage level, and platinum offers the highest. Not all states offer Centene policies at all metal levels.

Centene Corporation also works under multiple brand names, including Ambetter and Health Net. Within most states, Centene plans under Ambetter are organized by metal level and the federal poverty level percentage. For example, Ambetter Essential Care 2 HSA (2018) Pima County in Florida is designed for incomes that fall into the 300 percent-and-above federal poverty level. Ambetter Essential Care 1 (2018) Maricopa County is for those at 300 percent and below that level.

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The coverage amount is dependant on the plan format as well. In some states, such as California, Centene Corporation offers different plan formats under the Health Net brand:

  • Health Maintenance Organization
  • Exclusive Provider Organization
  • Healthcare Service Plans
  • Preferred Provider Organization

PPO plans often provide both in-network and out-of-network coverage. An HMO, PPO or HSA policy will typically only cover in-network facilities, with a few exceptions.

Each insurance program will offer different levels of coverage for addiction treatment. What can people expect Centene Corporation to pay for drug and alcohol rehab?

Does Centene Corporation Cover Drug and Alcohol Detox?

Detoxification is the first step in the rehab process. Withdrawal begins a short time after a person stops taking a drug or drinking alcohol, and it can come with unpleasant side effects such as:

  • Nausea
  • Vomiting
  • Chills
  • Fever
  • Mood swings
  • Muscle cramps
  • Seizures

The intensity of these withdrawal symptoms depends on the drug and the intensity of the addiction. Medically assisted drug and alcohol detox helps ease these symptoms in a safe and monitored environment.

Most insurance companies, including Centene Corporation, will cover the cost of detox either in part or in full. In some cases, the insured will be required to pay a copayment or coinsurance fee or to meet a deductible.

Does Centene Corporation Cover Inpatient Rehab?

Centene Corporation offers comprehensive insurance coverage that may pay for inpatient drug and alcohol rehab. How much Centene pays will depend on many factors, including location and plan type.

Ambetter Plans

With a variety of plans available in many different states, it’s difficult to know how much of the inpatient rehab bill Centene Corporation will cover. It’s important to check the actual policy to find out. Some possible coverage levels include:

  • Bronze: No charge or no charge after deductible
  • Silver: No cost to a 20 percent coinsurance fee
  • Gold: Copays of $375 dollars or more. Some copays are per admission and others per day. Some of the policies require a coinsurance fee instead. For example, the Illinois Ambetter Secure Care 1 (2018) with 3 Free PCP Visits: IlliniCare Health Network gold policy has a 20 percent coinsurance fee.

Most states do not have platinum level plans.

Health Net Plans

The Health Net plans also vary significantly from state to state. For instance, in California the EPO plans typically require:

  • Bronze: From 0 to 100 percent coinsurance fee, depending on the plan
  • Silver: 20 percent coinsurance fee
  • Gold: 20 percent coinsurance fee
  • Platinum: 10 percent coinsurance fee

Health Net PPO plans in California offer different coverage:

  • Bronze: 100 percent coinsurance after the meeting the deductible.
  • Silver: 20 percent coinsurance and the deductible may or may not apply
  • Gold: 20 percent coinsurance
  • Platinum: 10 percent coinsurance, 50 percent coinsurance after meeting the deductible.

PPO plans pay around 50 percent of the bill for out-of-network facilities. One thing most of the Centene Corporation plans have in common is a preauthorization requirement.

Does Centene Corporation Cover Outpatient Rehab?

In general, insurance plans from Centene Corporation include coverage for outpatient rehab. How much the plan pays will depend on the state, policy type, and metal level. Some coverage possibilities include:

Typically, most office visits have a copay, but the amount varies. It might be 10 dollars or it might be 50 or more, depending on the policy.

In some cases, there is no charge after meeting the deductible, and in others, the deductible doesn’t apply.

Some Centene policies have coinsurance fees instead of copays. The cost could be 10 percent or more of the total bill, depending on the metal level and state.

Patients will need preauthorization for any outpatient treatment, and most policies do not cover out-of-network treatment. The exception would be PPO plans, which may pay 50 percent for out-of-network care.

Does Centene Corporation Cover Medication-Assisted Treatment?

By offering medication-assisted treatment to those who are addicted to opioids or alcohol, addiction treatment providers are able to provide an effective path to sobriety. FDA-approved medications like methadone or Suboxone (buprenorphine and naloxone) take the place of illegal or abused opioids, allowing the individual to break the addiction over time and without many of the withdrawal symptoms. It is likely that Centene Corporation will pay for at least a portion of this service.

Does Centene Corporation Cover Sober Living Houses?

Most Centene plans offer outpatient treatment, and this may include sober living environments. Sober living houses provide those finishing an inpatient rehab program with a safe place to live while they adjust to sober, independent life.

What Is The Difference Between In-Network And Out-Of-Network?

In-network treatment centers have a partnership with Centene. As part of this agreement, they have set fees they can bill for each service. The goal is to keep costs down.

A majority of Centene Corporation policies do not pay for out-of-network facilities Out-of-network facilities do not have the same pricing agreement as in-network facilities, but that doesn’t mean the treatment center cannot make an arrangement with the insurance provider.

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How To Find Drug And Alcohol Rehab Centers That Accept Centene Corporation

1) Contact Addiction Campuses for an immediate verification of benefits. Addiction Campuses can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.

2) Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.

3) Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.

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