IBEW Local 697 Insurance Coverage For Drug And Alcohol Rehab
People seeking help for an addiction often rely on health insurance to help cover the cost of treatment. IBEW Local 697 offers plans that include coverage for drug and alcohol rehab.
The International Brotherhood of Electrical Workers (IBEW) is a labor union consisting of more than 750,000 workers and retirees in the electrical industry. Found throughout the US, Canada, Panama, and Guam, this union was founded in 1891 and offers apprenticeships, pension benefits, and health care coverage to its members. IBEW Local 697 is headquartered in Merrillville, Indiana.
All addiction treatment programs perform a verification of insurance benefits before a new patient is admitted. Most hospitals and medical centers will complete this on behalf of the person seeking treatment. Once approved, treatment at an in-network facility will be covered based on the plan’s levels. IBEW Local 697’s network of hospitals and treatment facilities generally fall into two tiers: Level A and Level B.
Insurance Tier Levels
Level A hospitals and treatment centers will not charge the patient anything above what the plan pays. However, individual providers may bill for services separate from the center’s charges.
In other words, if a person seeks treatment for a substance use disorder at a Level A treatment facility, all coinsurance and deductibles are waived for the facility. However, the patient may receive a separate bill for the doctor or medical staff overseeing their services. At that point, the patient would have to pay their deductible and coinsurance.
Level B hospitals and treatment centers receive 90 percent of the contracted rate paid to Level A hospitals and can charge the patient up to 10 percent coinsurance of the negotiated rate for treatment. The patient will also be required to pay any deductibles and copays that are due for services received from providers.
Does IBEW Local 697 Cover Drug And Alcohol Detox?
IBEW Local 697 covers drug and alcohol detox that takes place in an inpatient treatment facility. Services must be pre-certified.
Out-of-network facilities are covered at a different rate than in-network centers. Anything an out-of-network hospital or treatment facility charges that is over a preset amount will be billed directly to the patient, in addition to any coinsurance and deductibles owed.
There are special circumstances where IBEW Local 697 would cover an out-of-network facility the same way they cover an in-network treatment facility, such as:
- If the patient’s legal residence is more than 50 miles from a northwest Indiana PPO hospital
- Charges at facilities in the Evolutions Healthcare Systems PPO network are paid at the same rate as Level B facilities
- If the case is complex, severe or life-threatening and care at an out-of-network hospital is medically necessary
- Any treatment at an out-of-network hospital must be pre-approved, even if any of the above reasons apply.
What Is Drug And Alcohol Detox?
For many people, drug and alcohol detox is the first step toward recovery from addiction. Detox does not address the behavioral and emotional aspects of addiction, but before someone can begin dealing with the psychological aspects that underlie the addiction, they need to get the substance out of their system.
Detox is usually conducted in an inpatient setting, under the supervision of medical personnel. In some cases, this may be as simple as waiting for the effects of alcohol or drugs to wear off. In others, the person may need medication to help them deal with withdrawal symptoms. Withdrawal symptoms may include:
- Unpredictable heart rate
Does IBEW Local 697 Cover Inpatient Rehab?
IBEW Local 697 covers inpatient rehabilitation that meets certain conditions:
- The patient has been hospitalized for at least three days for substance use.
- Treatment begins within 30 days of the initial hospitalization.
- The attending physician certifies that the patient needs daily, skilled rehabilitation.
- Treatment is pre-certified.
- Inpatient rehab happens at a contracted facility.
What Is Inpatient Drug And Alcohol Rehab?
Inpatient addiction treatment patients live on-site while participating in the program. These residential treatment facilities often employ medical staff who are on hand 24 hours a day to oversee the physical aspects of recovery, as well as certified counselors and social workers who treat the emotional and psychological aspects.
Inpatient rehab lasts 30 to 90 days or longer. This duration allows patients enough time to fully develop the relapse prevention skills that will ensure a lasting recovery.
Does IBEW Local 697 Cover Outpatient Rehab?
IBEW Local 697 covers outpatient rehabilitation the same way it covers outpatient hospital services. However, there are certain criteria that must be met:
- The facility must be in-network.
- Treatment must be pre-certified.
- Outpatient rehab must be medically necessary.
- Treatment must be provided by certified medical staff, including licensed clinical social workers, psychologists, psychiatrists, and physicians.
What Is Outpatient Rehab?
Outpatient rehab offers the same therapies that inpatient rehab does, but the patient lives at home while participating in the treatment program. In some cases, someone with an intense drug or alcohol addiction may start with inpatient rehab and then move to outpatient rehab.
Does IBEW Local 697 Cover Medication-Assisted Treatment?
IBEW Local 697 may classify the prescriptions used in medication-assisted treatment as specialty medications. Prior authorization for their use is required, and doctors must establish medical necessity before coverage will apply. These medications are also billed under “non-formulary brand.” Patients are responsible for 20 percent of the cost, with a minimum charge of $35.
What Is Medication-Assisted Treatment?
Medication-assisted treatment includes the use of certain FDA-approved medications that help improve drug and alcohol addiction treatment outcomes. Some medications help curb withdrawal symptoms that often happen with opioid use, others cause the user to feel sick if they drink and other medications block the pleasurable effects of drugs and alcohol. All of these medications have been shown to reduce the likelihood of relapse.
Questions About Treatment?
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Does IBEW Local 697 Cover Sober Living Houses?
IBEW Local 697 does not cover sober living houses, halfway houses or other transitional housing. However, the treatment that happens in an in-network, inpatient facility may be covered as long as it is pre-certified and medically necessary.
What Is A Sober Living House?
Sober living houses are substance-free group living arrangements that offer those new to recovery a chance to practice their sober-living skills. It also helps those who have been in an inpatient treatment program to slowly transition back to independent life. While there are usually supervisors on hand, treatment is not typically offered through sober living houses.
How To Find Drug And Alcohol Rehab Centers That Accept IBEW Local 697
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.Article Sources