Independent Health Insurance Coverage For Drug And Alcohol Rehab

Independent Health is a critical part of the health insurance program in the state of New York, and the company provides many different plans that include coverage for drug and alcohol rehab.

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Independent Health is a nonprofit insurance provider operating in New York. The company offers many plans for individuals, families and employers along with Medicare supplemental programs and low-income services, most of which cover drug and alcohol rehab.

Independent Health covers nearly 400,000 people in eight counties in western New York. The company was given a high rating, 4.5 out of 5, by the national regulatory organizations and promotes wellness care to all clients.

Families who are researching options for drug and alcohol rehab often explore their insurance coverage first so they know what to expect. What can New York residents with Independent Health insurance expect when it comes to drug and alcohol rehab?

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Does Independent Health Cover Drug and Alcohol Detox?

Independent Health focuses on treating the needs of every individual, and insurance policies cover part of the cost of detox. Independent Health offers a large number of plans, though, so how much the company pays will depend on the exact policy.

Independent Health’s 2018 HMO plan specifies detox in their list of covered services. The out-of-pocket cost is $25 to $30 per visit.

Withdrawal begins around eight hours after a person stops using a drug or drinking alcohol. Withdrawal can be challenging, because it comes with uncomfortable and sometimes dangerous symptoms like:

  • Nausea
  • Vomiting
  • Muscle cramps
  • Chills
  • Fever
  • Mood changes
  • Paranoia
  • Seizures

Medical detox professionals work to control withdrawal symptoms with medication and comfort care in a safe, supported environment.

Does Independent Health Cover Inpatient Rehab?

Independent Health does cover inpatient rehab, but these insurance plans typically require the insured to share some of the cost of treatment. Independent Health’s policies tend to focus on copays, which is a flat fee for a specific service like inpatient rehab.

The alternative to a copay is a coinsurance fee. A coinsurance fee is a percentage of the total cost of care. For instance, if the policy lists a 30 percent coinsurance fee, then Independent Health pays 70 percent of the bill and the rest is the responsibility of the insured.

Independent Health offers a wide variety of insurance policies, and each may have different benefits. This insurance provider also customizes plans for employers. Independent Health has a specialized plan in place for New York state employees, for instance.

There are some standard elements among policy benefits that show what Independent Health might cover for inpatient rehab, such as:
iDirect HMO High Option deductible plan requires a $500 copay per admission. This policy does not cover out-of-network care.

For the iDirect HMO Standard Option deductible plan, the copayment goes up to $750 per admission, with no out-of-network coverage.
Each iDirect plan indicates that they pay for a semi-private room and board plus inpatient diagnostic tests and therapy. These plans specify that advanced radiology testing may cost an additional $750 copayment per calendar year.

The New York state employees PPO plan requires no copayment for inpatient rehab but specifies the insured must have a semi-private room and preauthorization. Most PPO plans provide the option to go out-of-network for care. In this policy, though, they will not cover out-of-network treatment.

The Essential plan, created for low-income families, also pays for inpatient rehab but requires a copayment of $150 per admission for Plan 1. This program categorizes plans into four separate options based on income. Plan 1 is for the highest income bracket. Independent Health covers the full cost of inpatient drug and alcohol rehab for the lower-tier plans. There is no option for out-of-network coverage with the Essential plans.

Does Independent Health Cover Outpatient Rehab?

Independent Health does cover outpatient rehab, but, as with the inpatient services, coverage limits depend on the plan. Some policies, such as the iDirect HMO plans, specify what outpatient care services are covered as well.

On the iDirect HMO plans, Independent Health lists:

  • Professional services of licensed mental health and substance abuse practitioners, including psychiatrists, psychologists, clinical social workers, licensed professional marriage and family therapists
  • Diagnostic evaluation
  • Crisis intervention and stabilization
  • Medication evaluation and management
  • Individual and group therapy
  • Electroconvulsive therapy
  • Detox
  • Partial hospitalization

The out-of-pocket expense for each iDirect HMO plan is different:

  • High option – $25 copay per visit, with no charge for laboratory fees. There is an additional $25 per visit copay for diagnostic testing and a $40 copay for specialist diagnostic testing. This plan specifies a $25 copay for routine radiology services.
  • Standard option – $30 copay per visit, with no charge for laboratory fees. There is an additional $30 per visit copay for diagnostic testing and $50 for specialist diagnostic testing. This plan specifies a $40 copay for routine radiology services.

Those with a Plan 1 Essential policy can expect to pay a $15 copay for outpatient rehab. Additional plans have no copay, indicating that Independent Health covers the entire cost of outpatient drug and alcohol treatment.

Does Independent Health Cover Medication-Assisted Treatment?

It is possible that Independent Health pays at least part of the bill for medication-assisted treatment (MAT) when using FDA-approved drugs like:

  • Suboxone
  • Methadone
  • Naltrexone

These medications can prevent withdrawal from opioids, and some can cause those with alcohol addiction to feel sick if they drink. The goal is to reduce the risk of relapse.

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MAT is listed as one of the covered costs in the outpatient services section of the iDirect HMO plan. Although the other programs don’t specify MAT, it seems likely that with proper authorization Independent Health will pay for this treatment, minus out-of-pocket expenses such as a copay.

Does Independent Health Cover Sober Living Houses?

As with the MAT service, some policies list aftercare services in the benefits summary, including:

  • Halfway houses
  • Full-day hospitalization

The benefits summary says the plan covers halfway houses, which is another term for sober living houses. Sober living offers a drug- and alcohol-free living environment, but treatment is not included. How much Independent Health pays depends on the policy. The iDirect HMO plans list a $25 to $30 copay for halfway houses.

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

“In-network provider” refers to a facility or healthcare professional that partners with Independent Health. In-network care providers can bill the insurance company directly and receive payment directly from Independent Health. In-network providers may bill the insured for any out-of-pocket expenses, though.

Out-of-network facilities have no billing arrangement with Independent Health. The insured or a family member should contact the insurance provider or treatment center to see if they are in-network or out-of-network.

Being out-of-network doesn’t mean families must choose a different facility, however. All treatment providers go through a coverage verification process, and outcomes may vary. Payment arrangements are settled before treatment begins.

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