You’re ready to seek treatment for an addiction. You have so many questions. Which are the most effective treatment options for me? How will I pay for it? Does Molina cover drug and alcohol rehab? What do they cover?

Whether you’re the one suffering from the addiction or it’s your loved one, know that you’re not alone.

According to SAMHSA, an agency within the HSA responsible to tracking trends in mental health and substance abuse, the number of Americans dealing with substance abuse disorder exceeds 20 million.

7.7 million Americans struggle with both an addiction and a mental illness, further complicating treatment effectiveness.

The Centers for Disease control (CDC) reports that 10% of people over 12 have used illegal drugs.

Struggles with substances begin early and completely take over a person’s life. Without effective treatment the road to recovery is rarely found.

Fortunately, there are effective treatment options with respected facilities. And Molina does cover much of your drug and alcohol treatment.

Let us help you understand:

  • What Molina insurance for rehab covers.
  • What addiction treatments may require a prior authorization.
  • What, if any, restrictions there might be in regards to Molina insurance coverage for drug rehab.

Please note: Coverage is based upon your individual plan. We will provide some very useful information, but you will need to additionally refer to your policy for details specific to your plan.

If you need assistance understanding your specific coverage, tackling financial barriers or locating effective treatment options, call our free, confidential helpline today to speak with a compassionate and knowledgeable professional.

Identifying your Molina Insurance Network

To understand what Molina covers you will first need to look at your network.

HMO – If you have their HMO coverage, you select a primary care physician (PCP) who directs your care to medical providers and facilities within Molina’s network through referrals. Not getting a referral from your PCP or going to see an out of network provider could lead to services not being covered.

PPO – With Molina’s PPO or POS plans, you will often have a preferred Molina network, but you have the options to go outside that network as long as you’re willing to pay more.

To get the most cost-savings out of your insurance coverage stay within Molina’s preferred network — or in the case of Medicaid — within your home state’s approved network.

Determining How Much Molina Rehab Insurance Covers

Molina covers many substance abuse services. You may be responsible for a portion of your bill based upon your plan. You’ll want to review the following to determine how much you might be responsible for.

Deductible – You may have a deductible. This is an amount of money that you will need to pay before insurance will pay anything.

Copay/Coinsurance – After your deductible has been paid, Molina will cover a portion of your bill. You will still be responsible for either a percentage or a flat fee for each visit, day, treatment, etc. For example you may pay $185/day for an inpatient stay while Molina pays the rest. Or you may pay 30% for a treatment while Molina pays 70% of the bills. If you have a Medicaid plan, you’re copays/coinsurance will be much lower.

Out of Pocket –  Out of pocket is the maximum that you have to pay. Once you pay this amount, Molina pays for covered services at 100%.

Do I Need a Prior Authorization?

All non-emergent inpatient and most outpatient services require prior authorization.

What Does Molina Typically Cover?

Diagnosis – Diagnosis includes visiting a doctor or doctors who will talk with you and run tests to determine the severity of the addiction. The doctors will then direct you to professional and facilities where treatment is received or you’ll recieve a doctor’s order that you can take to the facility of your choice. Diagnosis is covered by Molina.

Medical Detox – In medical detox a person is in a controlled environment under medical supervision while the drug is eliminated from the body over several days. Molina covers detox in the inpatient setting. Outpatient detox is not covered.

Drug Replacement Therapy –  In this therapy the drug of choice is replaced by a more manageable, “less harmful” drug, which is then stepped down over time. The goal is to “wean” the person off a substance without painful withdrawals  

Coverage is specific to your plan. Molina doesn’t cover methadone maintenance, which is a replacement therapy in which the methadone dosage is not being reduced over time. In this case the replacement drug is simply used to prevent cravings and reduce harm while leaving the individual addicted to a similar substance.

Outpatient services – This may include intensive outpatient which is several days a week for several hours a day. It includes counseling, group therapy, life-management classes and other services. These are typically covered. Outpatient can also be over an extended period of time. This is also typically covered by Molina.

Inpatient rehab – This involved either living a hospital or home-like setting during which treatment and counseling are received. This is covered by Molina.

Relapse prevention – After rehab, those in recovery need ongoing care to prevent relapse. Regular visits with a psychiatrist or counselor to prevent relapse are covered by Molina.

Getting Help With Insurance Questions is committed to helping those suffering from addiction and their families find lasting healing through treatment. If you’re feeling overwhelmed with treatment options, trying to work through finances or just need someone to talk you through getting help, our team of compassionate mental health professionals, licensed counselors and those in recovery are waiting to take your call. You’re not alone. Call us today.