Magellan Healthcare Insurance Coverage For Drug And Alcohol Rehab

Magellan Healthcare partners with employers and health insurance providers to ensure patients have access to drug and alcohol rehab when they need it. Coverage amounts and deductibles will vary by plan.

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Researching insurance coverage is a normal part of planning for drug and alcohol rehab. Magellan Healthcare offers a variety of health solutions that include specialized employee assistance services such as treatment for substance use disorders.

Magellan partners with health insurance providers like Blue Cross Blue Shield of Texas to provide behavioral health services for patients. Magellan also creates tailored health plans for state and federal employers and supplemental assistance for programs such as Medicaid. Coverage amounts, copays, coinsurance and deductibles will vary by plan.

What Are Copays And Coinsurance?

Copays are flat fees paid per visit or admission. For instance, if the copay is $15, the insured pays this amount to the treatment center.

Coinsurance fees are percentages of the total bill. If the coinsurance is 20 percent, patients should expect to pay that much of the bill out of pocket. If the final treatment cost is $50,000, the insured’s portion is $10,000.

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The out-of-pocket expense may be paid via:

  • Health savings account (HSA)
  • Flexible spending account (FSA)
  • A personal bank loan
  • Savings
  • Employee assistance program

Does Magellan Healthcare Cover Detox?

Magellan Healthcare works with employers to develop employee assistance programs that focus on substance abuse and other mental health concerns. Magellan’s stated goal is to ensure each person has access to the help they need, and programs provide treatment plans designed by in-house counselors that might include detox.

Coverage for medically recommended detox services could come from a major medical insurance plan as opposed to Magellan. It will depend on the plan Magellan has with the patient’s employer.

In most cases, a person can expect at least partial coverage from Magellan Healthcare or their insurance partner. Some plans will require either a copayment or coinsurance fee. In some cases, the detox facility will enter into a payment arrangement with the insured for the balance of the bill.

Withdrawal is the time immediately after a person stops using a drug or drinking alcohol. Medically supervised detox provides withdrawal therapy that allows the patient to transition smoothly from substance use to a rehab program by managing or preventing withdrawal symptoms, such as:

  • Nausea
  • Vomiting
  • Muscle cramps
  • Chills
  • Fever
  • Anxiety
  • Mood changes

Does Magellan Healthcare Cover Inpatient Rehab?

Magellan Healthcare or its partners will most likely cover inpatient addiction treatment, at least in part. Inpatient care allows for the insured to participate in drug and alcohol rehab while living in a specialized care facility.

Patients stay in this safe environment during treatment and work with substance abuse professionals to find a road to lasting sobriety. Most programs last for at least 30 days, but some may extend to 90 days, 120 days or longer.

Magellan behavioral health plans may pay part or all of the inpatient treatment bill. They may also require a copay or coinsurance fee. A patient’s out-of-pocket expenses for inpatient rehab depends on the programs contracted for by the employer or insurance provider. For example, the State of Michigan offers substance abuse treatment through the Magellan behavioral health system. That service includes a 10 percent coinsurance fee as long as the inpatient care is medically necessary.

Inpatient care may also fall under a plan’s major medical benefits. An insurance company that partners with Magellan for behavioral health services may be responsible for paying inpatient treatment bills. The out-of-pocket expense will depend on the major medical plan the insured has from their employer.

Does Magellan Healthcare Cover Outpatient Rehab?

Magellan Healthcare behavioral services cover outpatient treatment with most plans. Magellan manages outpatient treatment by customizing a plan for each person.

Magellan may have their therapists work with patients directly or have the patient partner with a local service. As with all programs, coverage depends on what the employer or insurance provider arranges with Magellan.

Outpatient treatment covers a variety of treatment options, and each one may have a different coverage specification. Some common outpatient services include:

  • Day programs that allow the patient to participate in treatment in a safe environment during the day and then check out at night to go home
  • Outpatient counseling, both private and group; Magellan behavioral services will arrange this therapy with an in-house counselor in most cases
  • Continuing care via peer groups; organizations like Magellan often partner with 12-step programs such as AA or NA to provide ongoing support.

To have treatment covered, employees will need to let Magellan guide their outpatient care and follow their recommendations. Going out of network or beginning a new treatment plan without consulting Magellan may mean the insured is responsible for the bill.

Does Magellan Healthcare Cover Medication-Assisted Treatment?

Magellan Healthcare may cover a medication-assisted treatment program if their in-house professionals recommend it. MAT is a treatment option used to decrease the likelihood of relapse for those who are addicted to opioids or alcohol.

MAT combines behavioral therapies with medications such as:

  • Suboxone, Zubsolv, Bunavail (buprenorphine, naloxone)
  • Vivitrol, ReVia (naltrexone)

Since Magellan’s behavioral program partners with major medical providers, all or part of this coverage might fall on them as long as Magellan recommends it. The insured would need to pay whatever that plan specifies for an out-of-pocket expense like a copay or coinsurance fee.

Does Magellan Healthcare Cover Sober Living Houses?

Sober living houses are often part of aftercare options for those leaving an inpatient rehab. By staying in a sober living house, the person remains in a protected environment while either continuing their treatment in an outpatient program or while simply adjusting to independence.

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It’s unlikely that Magellan behavioral services covers sober living facilities, but major medical might pay for it if it is recommended. For instance, the Michigan employee benefits package covers in-network halfway houses 100 percent for those on the PPO plan. The plan may even will pay 50 percent for out-of-network facilities.

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

In-network facilities partner with the insurance provider to offer treatment at agreed-upon rates. With Magellan, an in-network provider could be one of Magellan’s in-house counselors or a local counselor recommended by Magellan. It may also mean a provider that is part of the insurance company’s network. In-network providers can bill the insurance company directly to get payment.

Out-of-network healthcare providers don’t have an arrangement with either Magellan or the insurance provider. Out-of-network providers can work with the insurance company for direct payment or may send the bill to the insured, and the patient would then be responsible for seeking reimbursement from Magellan.

If a treatment center doesn’t seem to be in-network, that doesn’t mean families have to pass on it. All treatment facilities perform a verification of benefits for a patient before their admission to the program, a process that may allow them to make payment arrangements with either Magellan or the primary medical insurance provider.

How To Find Drug And Alcohol Rehab Centers That Accept Magellan Healthcare

  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.

Magellan Healthcare - https://www.magellanhealth.com/mh/home.aspx

State of Michigan - https://www.michigan.gov/documents/mdcs/15-16_Benefits_Summary_Brochure_497805_7.pdf

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