Scott And White Health Plan Insurance Coverage For Drug And Alcohol Rehab
Access to effective addiction treatment can allow those who seek recovery to find the help they need. Scott and White Health Plan insurance offers multiple plans that include coverage for drug and alcohol rehab.
Headquartered in Temple, Texas, Scott and White Health Plan offers health insurance throughout the state of Texas. The company has grown over the years to provide insurance for more than 230,000 members.
Patients in Texas who have Scott and White Health Plan insurance can choose between two types of plans. The company offers health maintenance organization (HMO) plans, as well as exclusive provider organization (EPO) plans. The plans available at Scott and White Health Plan include Prime HMO Bronze 7300 and Select EPO Bronze 7300.In addition to offering the HMO and EPO plans, Scott and White Health Plan also offers Medicare and STAR Medicaid, the latter of which is available through the RightCare plan.
For individuals seeking coverage for substance use disorders, both outpatient and inpatient services are included in the HMO and EPO plans. These plans include several supportive features that could benefit someone seeking recovery from a substance use disorder.
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Does Scott And White Health Plan Cover Drug And Alcohol Detox?
Alcohol and drug detoxification is a critical first step in treatment for many individuals who suffer from a substance use disorder. Scott and White Health Plan insurance plans do not specifically address drug detox services. However, if alcohol and drug detox is considered to be medically necessary for treatment, then it may be applicable for this coverage.
Another consideration is the use of medication during detox to control withdrawal symptoms. When medically supported inpatient detox is available, these medications are most likely covered under the prescription drug portion of Scott and White health insurance plans.
Does Scott And White Health Plan Cover Inpatient Rehab?
Yes, Scott and White Health Plan offers coverage for inpatient drug rehab services for patients who are experiencing a substance use disorder. An inpatient rehab is defined as a residential facility where patients must be onsite for a minimum number of hours, such as 30 hours a week, as determined by the state.
When patients choose or are required to participate in an inpatient drug rehab program, the treatment provider may require detoxification prior to starting the program. Ensuring all traces of drugs or alcohol are out of the dody and the acute withdrawal symptoms have passed allows the patient to fully focus on the behavioral therapy and counseling sessions involved in rehab.
Does Scott and White Health Plan Cover Outpatient Rehab?
Scott and White Health Plan insurance policies cover outpatient drug and alcohol rehab. Outpatient addiction treatment varies from inpatient care in that patients return home each evening after treatment. Patients may come to the treatment facility for group or individual therapy and other recovery activities at different times during the day. As a result, patients who require minimal therapy can benefit from this less-intensive form of addiction treatment.
For patients who have non-negotiable work or family responsibilities or who need treatment but lack financial resources, outpatient care is often the only choice. Outpatient treatment options include intensive outpatient rehab and partial hospitalization programs. Each of these outpatient treatment options involves a more in-depth approach to care than basic outpatient programs.
Does Scott And White Health Plan Cover Medication-Assisted Treatment?
Medication-assisted treatment combines medications with behavioral therapy to address addiction to alcohol and opioids. Diskets (methadone), Suboxone (buprenorphine and naloxone) and ReVia (naltrexone) are commonly used to prevent withdrawal and deter relapse.
As with detox services included as part of an outpatient or inpatient treatment program, medication-assisted treatment may be covered under a plan’s drug coverage. While Scott and White Health Plan does not specifically state that it covers medication-assisted treatment, coverage for this treatment format may fall under prescription drug coverage.
Does Scott And White Health Plan Cover Sober Living Houses?
A sober living house offers residents a safe place to adjust to independence while in early recovery. As treatment is not typically included as part of a sober living arrangement, Scott and White Health Plan does not offer coverage for sober living for patients recovering from substance use disorders.
What’s The Difference Between In-Network And Out-Of-Network?
Scott and White Health Plan HMO and EPO plans have no out-of-network provisions. If a patient chooses to use a doctor or facility that is not in the network of providers, then no health insurance coverage is applicable. The patient is required to pay out of pocket for the full cost of services provided.
In-network counties for the HMO plan include:
In-network counties for the HMO and EPO plans include:
- Tom Green
- San Saba
When a patient selects an in-network provider or facility and is using health insurance coverage, they may have to pay either a deductible or copay. The Scott and White Health Plan deductible for inpatient hospitalization, including for drug rehab, is $7,300 for an individual.
In addition to paying a deductible before health insurance covers the cost of drug rehab, the patient is also responsible for 20 percent of the cost of treatment:
- Patients must first meet the deductible.
- After the deductible is met, patients pay 20 percent of inpatient hospitalization expenses for the rest of the calendar year.
- This 20 percent also applies to outpatient lab work and prescription drugs, including those used for medication-assisted treatment.
For outpatient drug rehab services, patients are responsible for a copay fee of $50 for the first visit to a treatment facility. For all subsequent visits, patients are required to first meet their deductible and then pay 20 percent of the cost of treatment, as with inpatient services.
How To Find Drug And Alcohol Rehab Centers That Accept Scott And White Health Plan
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
Scott and White Health Plan - https://www.swhp.org/Portals/0/Files/Forms/BSWH/SWHP_IFP_PEK_2018.pdf
Scott and White Health Plan - https://www.swhp.org/Portals/0/PDFs/plandocs/2018/INDV-Prime-HMO-Bronze-7300-SBC.pdf
Scott and White Health Plan - https://www.swhp.org/Portals/0/PDFs/plandocs/2018/INDV-Select-EPO-Bronze-7300-SBC.pdf