The first step to getting help for an addiction is often deciding to visit a rehab facility. Sadly, one of the most common reasons people with substance use disorders do not take this step is that they are worried about costs. If you have insurance through AllWays Health Partners, price should never stop you from seeking addiction treatment. Check out this guide on how AllWays Health Partners handles coverage of addiction treatment.
Explore AllWays Health Partners Insurance Plans
Located in Massachusetts, AllWays Health Partners has been providing health care to people in New England for over 30 years. The company offers both individual health care plans and larger insurance plans for companies. AllWays has a large network of providers through Optum, so it can deal with all sorts of health issues, including mental health. This nonprofit company has always stated that one of its main goals is to put the needs of patients first. Therefore, it is no surprise that its comprehensive coverage includes access to addiction care. There are a few different sorts of plans that AllWays Health Partners offers, and all of them have their own ways of handling addiction care.
The majority of AllWays Health Partners plans are health maintenance organizations, or HMO plans. These plans work by accessing a network of doctors and specialists who have agreed to give AllWays Health Partners a discount. You select one of these doctors as your primary care physician and give them a visit first to talk to them about your struggles with substance abuse. Then, the doctor can refer you to one of the in-network AllWays Health Partners specialists who provide addiction treatment. This plan means that you do not have a huge number of clinics to choose from, but the big perk is that your monthly premium plans are lower.
AllWays Health Partners offers several different types of plans with varying deductible and copay levels to suit your budget and health care needs. The company even has a special type of HMO called a ConnectorCare HMO. This is a subsidized type of insurance where people on the plan do not have to pay money for their visits to doctors or rehab centers. If you want to be on this plan, you have to meet certain regulations like a maximum income level. It can be an excellent way for Massachusetts residents to get addiction care regardless of whether they have enough money.
AllWays Health Partners also has a plan called PPO plus. This is a plan that follows the preferred provider organization method of health insurance. This insurance plan costs a little more, but it gives you more flexibility with your health care. You can pick from in-network addiction care or pay slightly higher costs to see an out-of-network specialist. This lets you seek rehab clinics that might not be part of AllWays Health Partners’ usual suggested clinics. Another difference is that those using AllWays Health Partners PPO plans do not need referrals from their main doctor to visit a specialist. If you think you need addiction care, you can go ahead and start looking for rehab centers right away.
Does AllWays Health Partners Make You Pay for Rehab?
Though AllWays Health Partners does provide coverage for substance use disorders like any other type of health condition, this does not necessarily mean it is completely free. On almost all of the AllWays Health Partners plans, you can expect to end up covering some of the costs yourself. Most AllWays Health Partners plans require that you pay a deductible before the company starts contributing to the majority of your health care costs. Some types of treatment also have a copay that you pay instead of the full cost both before and after meeting the deductible. This flat rate is used for visits to a specialist on the HMO or PPO plans, and it is far lower than costs would be without insurance.
You typically only quit paying copays for addiction care once you reach your out-of-pocket maximum, which can vary depending on the plan you have picked. The only AllWays Health Partners plan that will cover 100% of the cost for addiction treatment is the ConnectorCare plan. Since this plan does not require a deductible or a copay for specialist visits, you can see mental health experts without paying anything out of pocket.
Because the amount of coverage you get will vary depending on which plan you have, it is a good idea to sign in to your online AllWays Health Partners account if you are thinking about rehab. This will tell you exactly which plan you have and how much coverage your plan will give you. It will also let you know how close you are to hitting your deductible or out-of-pocket maximum for the year.
AllWays Health Partners Coverage for Outpatient Rehab
Outpatient rehab is the most basic type of rehab, and it is almost always covered by AllWays Health Partners. As the name implies, you are a patient of the rehab center, but you do not actually live there. Just like an outpatient procedure at a hospital, you stay for the day and then go back home at night. The rehab center will give you a custom schedule to follow where you visit the facility for therapy, classes and counseling on a regular basis. The exact number of visits you schedule per week will depend on the intensity of your addiction. Some people may go for several hours a day, five days a week, and others may just make a weekly visit for an hour-long session.
Outpatient rehab is extremely versatile. You can get help without having to quit work or school, and it is easy to spend time with family and other loved ones. Some types of outpatient rehab are partial hospitalization programs, so they can even give you medical care as you go through withdrawal. Since there are all sorts of outpatient rehab programs covered by AllWays Health Partners, finding the right treatment is easy.
AllWays Health Partners Coverage for Inpatient Rehab
Inpatient rehab is also called residential rehab because you actually live at the facility while you work on your sobriety. One of the big benefits of this type of rehab is that it gets you out of dangerous situations and puts you in a new environment where the focus is all about recovery. It also means that you constantly have trained professionals and health care experts around you, so you can get help whenever you have a problem. The 24/7 care ensures that there is always someone around if you go through a mental crisis or have a big health problem.
Since inpatient rehab is a more intensive experience, whether or not AllWays Health Partners will cover it is less certain. In some cases, the health care providers working with AllWays Health Partners may recommend that you try outpatient rehab first. Some reasons to skip going to outpatient rehab first may include a lack of outpatient facilities near your home or the severity of your substance use disorder. Your chances of coverage are higher if you stick with rehab facilities inside the AllWays Health Partners network since the type of pricey, luxury rehab centers that AllWays Health Partners may find unnecessary are usually classified as out-of-network specialists.
Other Addiction Treatments Covered by AllWays Health Partners
The sad nature of addiction means that many people with addiction are also suffering from physical health problems. AllWays Health Partners will cover any medical care you need for problems like skin infections or heart problems due to drug usage. If you are going through intense withdrawal symptoms, AllWays Health Partners will cover things like IVs, anti-anxiety medications and other treatments that help reduce the pain of withdrawal. If your substance use problem leads to an overdose, the insurer will even cover emergency care to reverse the overdose.
For those with an opioid addiction, medical-assisted treatment is becoming a very common method. This type of treatment involves using methadone, buprenorphine or other drugs to reduce withdrawal and cravings. These synthetic opioids are very mild, do not impair functioning and do not get the user high. Instead, they make it easier for long-time users to function without substance abuse. This treatment is typically covered by AllWays Health Partners, but the company may put a limit on how long you can continue it.
AllWays Health Partners does cover some alternative therapies like acupuncture as well if you prefer treatments other than standard behavioral therapy. These are usually approved on a case-by-case basis, so you would need to show that the therapy has some clinical evidence of being beneficial to people in your situation. If you visit a rehab center with holistic therapies not covered by AllWays Health Partners, you may still be able to access them if they are bundled into your payment plan. However, if they are not part of a flat-rate fee for treatment, you may need to cover the cost yourself.
How to Get Treatment When You Have AllWays Health Partners
Now that you know a little about the types of coverage offered by AllWays Health Partners, it is time to get into the actual practicalities of how you get this coverage. Like any other health insurance company, AllWays Health Partners has a standard procedure to follow if you want to get care. When you want the insurance company to help with your substance use disorder, you may need the company’s permission first. This is meant to keep patients from using services they do not need, but it should not stop people with substance use problems from seeking help.
First of all, any emergency treatment does not need prior approval from AllWays Health Partners or a referral from your doctor. If your health is at risk due to withdrawal, depression, overdose or any other addiction-related problem, you can go straight to urgent care for help. If you have an HMO plan, which almost all AllWays Health Partners customers do, you will need something called a referral if you want to work with an inpatient rehab clinic. To get this, you would visit your normal primary care physician, explain your problem and get them to refer you to a rehab clinic. Outpatient behavioral health services do not require a referral on most AllWays Health Partners HMO plans.
Even in cases where you do not need a referral, AllWays Health Partners will typically require an authorization. This is a form that the rehab clinic will fill out and send in to AllWays Health Partners requesting coverage. As long as you exhibit any of the signs of a substance use disorder, you will most likely get this authorization to go ahead with treatment.
Though the process might sound intimidating, it is actually quite simple. All you have to do is log in to your AllWays Health Partners account, learn about your benefits and then contact your primary care physician or a nearby rehab clinic. The good news is that your health care provider is supposed to handle any authorizations for you, so all you need to do is tell them your insurance information and let them deal with the rest.
Many people find that having a substance use disorder tends to use up a lot of their mental space, making it hard to focus on following these steps. Fortunately, many addiction treatment organizations recognize this problem, so they can help. You can call Massachusetts Emergency Crisis Services help line 24/7 at 1-877-382-1609. This help line is run by trained mental health specialists who can assist you with any sort of substance use crisis. They can walk you through the steps of getting coverage and help you find rehab facilities near you that are part of the AllWays Health Partners network. Many rehab centers also offer free consultations that include discussing your options for payment and insurance coverage.