When you know it’s time to seek treatment for an addiction you begin exploring your options. You want to know: How much will it cost? Which are the most effective treatment facilities? Will Kaiser Permanente pay for some or all of my treatments?
You’re not alone as you take these first steps.
According to SAMHSA, the agency responsible for tracking mental health and substance abuse trends, 20 million Americans suffer from substance abuse disorder. That’s 1 in 12 people.
According to the CDC, 10% of people over 12 have used illegal drugs in the past month. Substance abuse problems can start early and without treatment may continue into adult life.
But fortunately, with treatment, you or your loved one suffering from addiction can find and stay on the road of lasting recovery.
Here we’ll help you to understand the following details about Kaiser Permanente insurance for rehab:
- What Kaiser Permanente covers.
- What, if anything, may require a prior authorization.
- What, if any, restrictions to coverage there might be.
Please note that coverage varies based upon your individual plan. You will need to refer to your plan in order to fully understand coverage. We will provide you with helpful information regarding what Kaiser normally covers and how this drug rehab insurance works.
If you need additional assistance understanding what your individual Kaiser plan covers, working through financial barriers or finding effective and respected facilities in your area, call our free, confidential helpline to talk with a compassionate and knowledgeable professional.
Identifying your Kaiser Permanente Rehab Insurance Network
To get the most out of your Kaiser coverage, you’ll first need to understand your network.
If you have an Kaiser HMO, you will have a select group of medical providers and facilities to choose from. You will have a primary care physician (PCP) who you must see first. This PCP will then refer you to in-network specialists and treatment centers as needed. If you choose not to see your PCP or you decide to go out of your Kaiser Network, Kaiser may not pay anything for your visits and addiction treatment.
If you have a Kaiser PPO or POS, you will still have a preferred network, but you can go out of network if you choose. However, if you decide to do so Kaiser will require you to pay a larger portion of the bill.
The most cost effective way use Kaiser Insurance is to always to stay within their network of providers. If you feel you will get greater benefit from an out of network treatment program, you will need to weigh the cost versus the benefit to the sufferer.
Determining How Much Kaiser Insurance Covers
In order to understand how much Kaiser will cover, you’ll need to understand 3 basic insurance terms.
Deductible – An amount of money you will need to pay each year before Kaiser will pay anything. Because your deductible must be met each year, make sure that you schedule rehab in such a way you don’t have to meet the deductible twice.
Copay/coinsurance – A percentage or flat fee that you will pay for each visit, treatment or day of a stay in drug rehab. For example, if you’re in inpatient rehab, you may need to pay $185/day with Kaiser picking up the rest. Or Kaiser may pay 80% of a certain type of treatment and you pay the 20%.
Maximum Out of Pocket – Most Kaiser plans will have a maximum out of pocket. Once you’ve reached this amount, they pay covered services at 100%.
Prior Authorization Requirements with Kaiser Permanente
All non-emergency outpatient and inpatient services require an authorization from Kaiser prior to treatment’s start. This is to ensure that only covered and medically necessary treatments are performed on their members to avoid unexpected bills after the fact.
What Does Kaiser Rehab Insurance Typically Cover?
Kaiser Permanente puts great importance of quality care for those suffering from addiction. They see it as a contribution to their member’s overall health as well as a contribution to society as a whole.
Diagnosis – During this phase you’ll see your PCP and possibly other doctors who will ask questions, observe and run tests to determine the severity of your addiction and best course of treatment. They with then write a doctor’s order (prescription) for the treatment. Kaiser will cover diagnosis.
Medical Detox – This is a hospital stay during which you are under the care of medical professionals while you eliminate the drug from your system. Kaiser covers medical detox which provides for safe drug withdrawal.
Drug Replacement – In this therapy, your drug of choice is replaced with a more manageable, “less harmful” drug. Over time the doctors then lower the dosage to slowly reduce the dependency. This is covered by Kaiser. They don’t, however, cover methadone maintenance in which the drug of choice is replaced with little or no intention of lowering the dosage over time. Because Kaiser considers this harm reduction without healing, they choose not to cover it.
Outpatient Rehab– Outpatient can be in the form of intensive outpatient or regular outpatient. Both programs include similar treatments like counseling, classes, group therapy. Intensive is just more days a week for more hours. Kaiser covers outpatient rehab.
Inpatient Rehab – Inpatient rehab can be in the form of a traditional hospital stay or it can be a setting that is more home-like, while removing your access to substances. During your stays you work with psychiatrists, counselors, teachers, therapists and nurses to learn how to manage your addiction. Kaiser covers inpatient rehab only after you have tried outpatient.
Getting Help With Your Rehab Insurance
Treatment options are overwhelming enough. You add trying to figure out insurance and other financials and it can really become too much to handle. Adrugrehab.org is dedicated to helping those suffering from addiction and their loved ones find lasting healing and recovery through treatment. When you call our helpline, you’ll speak with mental health professionals, licensed counselors and those in recovery. We’ll work with you to overcome challenges and barriers. Call us today.