Health Net Insurance Coverage For Drug And Alcohol Rehab

Health Net offers insurance coverage for addiction treatment. Copays, deductibles and in-network facilities will vary from plan to plan.

Health Net Insurance Coverage for Drug and Alcohol Rehab

People searching for drug or alcohol rehab often look to their insurance provider first to see what services are covered and which facilities are in-network. Health Net offers healthcare benefits to around 5.9 million people through individual insurance policies and group plans.

With a focus on wellness and preventive care, Health Net offers comprehensive drug and alcohol treatment benefits, but the amount paid varies based on the policy.

Health Net provides a variety of plan types, including:

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

Health Net offers catastrophic insurance as well, but that policy type may not cover drug and alcohol rehab. Each format will likely have different coverage options.

Health Net uses the metal rating system for many insurance plans. Metal levels allow insurance shoppers to get an idea of how much they must pay for healthcare in the program.

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Bronze is the lowest metal plan level. Bronze plans typically come with higher deductibles and lower premiums. Bronze-plan clients can expect out-of-pocket expenses of 40 percent, with Health Net covering 60 percent of treatment expenses. Platinum-plan premiums tend to cost more but require less money out-of-pocket.

Health Net metal levels include:

  • Bronze – 40 percent
  • Silver – 30 percent
  • Gold – 20 percent
  • Platinum – 10 percent

Health Net focuses on four states when offering insurance programs:

  • Arizona
  • California
  • Oregon
  • Washington

Health Net may not currently offer all metal level plans in all these states.

Health Net may negotiate group plans with businesses, and those agreements affect the copay and coinsurance amounts. Group plans for small or large companies might be available in all 50 states. There may also be a difference in coverage levels between individual plans purchased by a single consumer and group plans purchased by a business as part of its employee benefits package.

Arizona HMO Plans

In Arizona, Health Net currently offers silver and gold HMO plans. Clients of silver and gold HMO plans can expect to pay:

  • Silver – 30 percent coinsurance fee for in-network facilities
  • Gold – 20 percent coinsurance fee for in-network facilities

These HMO plans do not cover out-of-network treatment or services. Health Net will likely require preauthorization for in-network care.

Arizona PPO Plans

Health Net offers PPO plans in Arizona with a variety of coverage options. The PPO plans mostly follow the metal levels on inpatient care:

  • Bronze – 50 percent coinsurance fee
  • Silver – 30 percent coinsurance fee
  • Gold – 20 percent coinsurance fee
  • Platinum – 20 percent coinsurance fee

There may be some variations among the different plans on each level, though. Health Net PPO policies require a 50 percent coinsurance fee for out-of-network services, as well as preauthorization. Without it, Health Net will only pay 50 percent for in-network treatment plans and will not pay for out-of-network care.

California HMO Plans

California’s residents have access to a variety of metal level plans. Exact benefits will vary, but there are some similarities:

  • Silver HMOs mostly require a 20 percent coinsurance fee.
  • Gold plan benefits range from a $600/day copay for the first five days of treatment to a 20 percent coinsurance fee, depending on the policy.
  • Platinum plans typically require a $250/day copay for the first five days.

Health Net does not offer bronze HMO plans in California. All plans require preauthorization and do not include coverage for out-of-network treatment.

California PPO Plans

Health Net PPO plans include metal levels. PPO metal levels include:

  • Bronze – 100 percent coinsurance after the deductible has been met
  • Silver – 20 percent coinsurance and the deductible may or may not apply
  • Gold – 20 percent coinsurance
  • Platinum – 10 percent coinsurance, with 50 percent coinsurance after the deductible has been met

All the Health Net PPO plans in California pay 50 percent for out-of-network care and require preauthorization. Without it, out-of-network treatment is not covered and there is a penalty for in-network care. However, the $0 Cost Share EnhancedCare PPO plan pays the entire amount for both in-network and out-of-network care.

California EPO

Health Net also offers EPO plans in California, which are similar to HMO policies. As with HMO plans, the metal levels provide a range of coverage:

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

EPO policies do not cover out-of-network care and will require preauthorization.

Oregon Plans

Health Net offers fewer options in the state of Oregon. The Bronze PPO plan may pay the entire bill for inpatient and out-of-network drug rehab with preauthorization. The Silver plan requires a 30 percent coinsurance fee, or 75 percent coinsurance for out-of-network facilities with preauthorization.

Washington Plans

In Washington, Health Net does not use metal levels for individual or family PPO plans. In general, expect to pay at least 20 percent for in-network facilities and 50 percent for out-of-network care. Health Net also requires preauthorization in this state.

Does Health Net Cover Drug and Alcohol Detox?

Health Net offers a variety of policy options, some of which cover drug and alcohol detox. During detox, drugs and alcohol are withheld and the body goes into withdrawal. Withdrawal can lead to some unpleasant and even dangerous side effects, including:

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

Medically supervised detox allows a care team to manage withdrawal symptoms so detox is safer and more comfortable. Health Net plans mostly cover this cost as long as the policy has behavioral health benefits.

Does Health Net Cover Inpatient Rehab?

Health Net provides many different plans to both individuals shopping for personal insurance and businesses looking for group coverage. Most of these plans include inpatient drug and alcohol rehab.

Health Net policies typically require either a copayment or a coinsurance fee for residential addiction treatment. Copays are flat amounts that the insured pays out-of-pocket, while coinsurance fees are percentages of the entire bill. For example, if the inpatient rehab bill comes to $10,000 and the policy has a 10 percent coinsurance fee, the insured person pays $1,000 for treatment.

Does Health Net Cover Outpatient Rehab?

Health Net offers coverage for outpatient addiction treatment. Most of the states follow the same metal level format.

In general, Health Net’s HMO plans do not require a copay for outpatient office visits. Some may have a coinsurance fee for other types of outpatient care, though.

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PPO, EPO and HSA plans may fully cover outpatient office visits, with some coinsurance fees for other services. Health Net PPO plans pay 50 percent for out-of-network care. Preauthorization is required for all services.

Does Health Net Cover Medication-Assisted Treatment?

Medication-assisted treatment gives those who are addicted to opioids a safer path to sobriety using prescriptions like methadone and Suboxone (buprenorphine and naloxone). Health Net offers MAT coverage for qualified patients.

Does Health Net Cover Sober Living Houses?

In most cases, Health Net will pay at least part of the bill for aftercare options like sober living houses, but coverage depends on the plan. Sober living houses provide a safe environment for those who are leaving an inpatient facility to continue working on relapse prevention skills while adjusting to sobriety.

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

In-network facilities have an arrangement with Health Net that determines the cost for healthcare services. Out-of-network treatment centers do not have this partnership. All facilities perform a verification of benefits during each patient’s admissions process, though, and it is possible an out-of-network center might be able to make arrangements with Health Net.

How To Find Drug And Alcohol Rehab Centers That Accept Health Net

  1. Call 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.

Addiction Campuses accepts many forms of insurance. For a free, confidential verification of insurance benefits, call today.

Source:

  1. Health Net—Summary of Benefits and Coverage
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