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Teachers Health Trust Insurance Coverage For Drug And Alcohol Rehab

Teachers Health Trust offers health insurance that includes coverage for addiction treatment. Many levels of drug rehab services are included in these plans. Teachers Health Trust Insurance Coverage For Drug And Alcohol Rehab

Teachers Health Trust insurance is provided to teachers by a board of trustees who are also educators. Members of Teachers Health Trust have access to insurance coverage for multiple types of addiction treatment.

Addiction to drugs and alcohol claimed the lives of at least 72,000 people in 2017, and only about 10 percent of people who suffer from a substance use disorder will ever seek formal treatment, according to USA Today.

Teachers Health Trust provides two levels of insurance coverage through the Performance Plus Medical Plan and the Hospital Supplement Plan, the latter of which only provides coverage for hospital services. The Performance Plus Medical Plan covers treatment for chemical dependency, including inpatient programs, medicinal addiction therapy, and medication-supported chemical dependency detox, all of which require prior authorization through the Human Behavior Institute.

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Does Teachers Health Trust Insurance Cover Drug And Alcohol Detox?

Teachers Health Trust covers detox medications if used or prescribed for chemical dependency treatment. However, prior authorization is required.

Detoxing from a chemical dependency often serves as a precursor to the behavioral therapy and counseling sessions of addiction treatment. Detox is not always a standalone service; it is sometimes an integrated part of drug and alcohol rehabilitation. Medical detox will likely be covered by Teachers Health Trust insurance if it is part of an inpatient program.

Does Teachers Health Trust Insurance Cover Inpatient Rehab?

Teachers Health Trust covers inpatient drug rehab to some extent in both in-network and out-of-network treatment facilities. Teachers Health Trust does require prior authorization for treatment in an inpatient care facility for chemical dependency.

For treatment received from an in-network provider, the plan will pay up to $400 per day toward treatment with a maximum of $800 paid per admission, and the plan deductible does not apply.

For out-of-network residential addiction treatment services, Teachers Health Trust offers a 40 percent coinsurance rate after the deductible is met, plus any charges over eligible medical expenses.

Regardless of whether an in-network provider or out-of-network provider is chosen, Teachers Health Trust will only cover 100 days of treatment per calendar year for services related to chemical dependency.

Inpatient drug rehab, often called residential addiction treatment, involves a patient living in a treatment facility while they participate in the program. These residential programs offer communal settings and a multitude of recovery-based therapies, daily activities, and group support sessions. Inpatient drug rehab programs provide the most intensive level of addiction treatment care.

Does Teachers Health Trust Insurance Cover Outpatient Drug Rehab?

Teachers Health Trust does cover outpatient services for chemical dependency with a prior authorization from the member’s doctor. Outpatient drug rehab services are covered with a 20 percent coinsurance cost. The deductible is not applicable when treatment services are provided by an in-network provider.

Teachers Health Trust insurance also covers outpatient group therapy sessions and individual therapy sessions with a $20 copayment requirement.

For partial hospitalization chemical dependency services, Teachers Health Trust offers a plan benefit of $150 per day with a maximum of $900 per admission. Outpatient addiction treatment involving medication-assisted treatment is also covered, with prior authorization.

Much like inpatient drug or alcohol addiction treatment programs, outpatient drug rehab involves multiple forms of therapy and recovery activities to help a patient achieve a sober life. There are several types of outpatient addiction treatment, including:

  • Medication-assisted outpatient rehab
  • Intensive outpatient drug rehabilitation
  • Partial hospitalization outpatient rehab

Outpatient drug rehab as a standalone treatment can also come in the form of one-on-one therapy sessions with an addiction treatment counselor. In these cases, the therapy sessions may be covered by Teachers Health Trust but will usually require a prior authorization.

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Does Teachers Health Trust Insurance Cover Medication-Assisted Treatment?

Teachers Health Trust does cover prescription-assisted drug rehab treatment, but a prior authorization will be required for these medications, according to the drug detox protocol. These medications are not covered outside of chemical dependency or detox.

Many drug rehab facilities, both inpatient and outpatient, provide medicinal support to patients during chemical dependency treatment. The common medications used during addiction treatment include medications like Diskets or Methadose (methadone) and Suboxone (buprenorphine and naloxone). These medications are used to enhance treatment success, prevent withdrawal and deter relapse in many cases.

It is rare for a doctor to prescribe medications for addiction without some concurrent psychological therapy involved. A structured medication-assisted treatment program will combine medications with behavioral therapies designed to address all aspects of addiction. If the medication is prescribed without treatment, it can be more difficult to obtain preauthorization for the medications so they will be covered through Teachers Health Trust.

Does Teachers Health Trust Insurance Cover Sober Living Houses?

Unfortunately, sober-living houses are not usually deemed as a necessary form of therapeutic treatment for addiction by health insurance companies. Therefore, this type of treatment is not covered by most health insurance plans, including Teachers Health Trust unless it is an integrated component of another program.

Living in an alcohol- and drug-free environment after completing a residential addiction treatment program has been shown to help prevent relapse and strengthen coping skills. Sober-living houses are sometimes recommended to patients during outpatient rehabilitation or after inpatient treatment. Those who take advantage of these services have an increased chance of maintaining their sobriety beyond treatment.

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

Teachers Health Trust insurance is unique in that it does cover the costs of some in-network and out-of-network treatment, even though working with an out-of-network treatment provider can be extensively more expensive. Addiction treatment centers may offer to verify insurance benefits before admitting a patient to determine if their services are covered and to what extent.

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USA Today -

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