First Health And Cofinity Insurance Coverage For Drug And Alcohol Rehab

First Health and Cofinity are two subsidiaries of Aetna that merged and now represent more than 350 payers and 5.5 million members. Offering clients a preferred provider network (PPO), First Health and Cofinity provide a wealth of resources for those in need of treatment for a substance use disorder.

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First Health and Cofinity are two subsidiaries of Aetna that merged and now represent more than 350 payers and 5.5 million members. Offering clients a preferred provider network (PPO), First Health and Cofinity provide a wealth of resources for those in need of treatment for a substance use disorder.

First Health and Cofinity insurance coverage for drug and alcohol rehab will vary based on many factors. The exact coverage depends on many things such as the payer, the location and what type of treatment is necessary.

What kind of addiction treatment coverage do First Health and Cofinity offer?

Do First Health and Cofinity Plans Cover Drug and Alcohol Detox?

First Health and Cofinity insurance may pay for a portion of the cost of medically supervised detox. The patient will be responsible for any applicable deductibles or other out-of-pocket expenses like copay and coinsurance fees.

Copayments are flat-rate charges, such as $50 per admission or $250 per day. Coinsurance represents a percentage of the final bill. For example, a 30 percent coinsurance fee means the insured is responsible for 30 percent of the bill.

When a person who is chemically dependent stops taking drugs or drinking alcohol, their body goes into withdrawal. Withdrawal symptoms range from unpleasant to potentially dangerous and may include:

  • Nausea
  • Vomiting
  • Chills
  • Fever
  • Mood swings
  • Hallucinations
  • Seizures

The exact symptoms and their intensity depend on the type of substance and the severity of the addiction. In a medically managed detox program, healthcare professionals monitor patient symptoms and intervene as necessary. Medications may be provided to prevent or minimize withdrawal symptoms.

Do First Health and Cofinity Plans Cover Inpatient Rehab?

First Health and Cofinity may pay for a portion of the cost of inpatient rehab. Exact coverage levels will depend on which insurance plan the patient has and what residential addiction treatment program they choose to attend. Preauthorization may be required for all inpatient rehab services.

First Health and Cofinity work with other insurance providers to create specialized insurance products. Each plan can potentially have a unique set of benefits and coverage levels. The only way to be sure that First Health and Cofinity will pay for inpatient rehab and to find out what the coverage limits would be is to to check the insured’s policy.

Regardless of policy, First Health and Cofinity offer PPO insurance, so the insured most likely has a choice between in-network or out-of-network facilities. The amount covered is usually lower for out-of-network care.

Most insurance policies require a copayment or coinsurance fee. Payment for out-of-pocket expenses can come from an employee assistance plan, health savings account or personal finances. In some cases, the treatment facility might offer payment arrangements.

Individual plans may offer coverage for specific inpatient services. Inpatient rehab services likely will include:

  • Screening and lab tests
  • Dual diagnosis evaluation
  • Medical exams
  • Housing costs
  • Medication
  • Therapy

Do First Health and Cofinity Plans Cover Outpatient Rehab?

As with inpatient care, First Health and Cofinity may pay for all or part of outpatient rehab, depending on the policy and the exact services provided. Outpatient treatment can involve different types of care plans, including:

  • Individualized therapy: one-on-one sessions with a therapist, as needed
  • Partial hospitalization programs: patients attend a schedule of therapy sessions at a treatment center during the day and go home at night
  • Group therapy: organized meetings with individuals facing many of the same challenges
  • Continuing care peer therapy: working with a peer sponsor or sober living coach

The out-of-pocket expense might be a copayment fee for one service and a coinsurance charge for another. The cost may also differ based on in-network or out-of-network providers.

Do First Health and Cofinity Plans Cover Medication-Assisted Treatment?

It is possible that First Health and Cofinity will cover medication-assisted treatment (MAT) when recommended for those who have an alcohol or opioid addiction. MAT combines behavioral therapies with prescription medications to decrease the risk of relapse. Medications used as part of the therapeutic process may include:

  • Diskets (methadone)
  • Suboxone, Bunavail (buprenorphine, naloxone)
  • ReVia, Vivitrol (naltrexone)

Do First Health and Cofinity Plans Cover Sober Living Houses?

Insurance companies sometimes cover aftercare and alumni services. First Health and Cofinity may include sober living as part of an overall addiction treatment plan. First Health and Cofinity may have specific criteria to ensure payment, such as medical referral or preauthorization.

What’s The Difference Between In-Network And Out-Of-Network?

First Health and Cofinity offer PPO plans, and there is a difference in coverage levels between in-network and out-of-network providers. In-network facilities are part of the provider network established by First Health and Cofinity. In-network rehab centers charge agreed-upon rates and bill First Health and Cofinity directly for payment.

Out-of-network rehab facilities are not part of the insurance company’s organized network. They independently determine what rates to charge and may have to make arrangements with First Health and Cofinity for payment specifics, like whom they bill. The insured may need to receive the bill and then file a claim with First Health and Cofinity themselves.

Being out-of-network doesn’t mean families shouldn’t consider that rehab center. All treatment centers verify coverage for patients before admission, and the results may vary. First Health and Cofinity have a growing list of clients, and they work with each to create a custom plan for drug and alcohol addiction treatment.

How To Find Drug And Alcohol Rehab Centers That Accept First Health And Cofinity

1) Contact Addiction Campuses for 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.

First Health and Cofinity - https://providerlocator.firsthealth.com/home/index

Cofinity - https://www.cofinity.net/PPONAB/Cofnonsec/Tools/CofinityNetworkQuickOverview.pdf

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