Cornerstone

Understanding Health Choice Drug Treatment Coverage

Learn about using your Health Choice insurance policy to cover substance abuse treatment

Alcohol and Drug Treatment Coverage with Health Choice

If you or a loved one is struggling with addiction, finding the right treatment can be overwhelming.

However, your health insurance through Health Choice can offer essential support during this difficult time.

This guide will explain what your Health Choice plan covers for alcohol and drug treatment, including network inclusions, navigating the claims process, different plan options, and other services.

The path to recovery is challenging, but your Health Choice coverage makes it more manageable at every step.

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Health Choice drug treatment coverage

When you choose an In-Network treatment provider through Health Choice, you’ll typically enjoy the highest level of coverage and lowest out-of-pocket costs. In-network providers have contracted rates with Health Choice, so you won’t be hit with unexpected charges or worry about surprise bills. The claims process is streamlined when you stay in-network, requiring less paperwork. However, your options may be more limited compared to going out-of-network. It’s essential to research the in-network facilities in your area to ensure they offer the specific type of treatment and level of care you need.

Information about Health Choice Plan Types

This Medicaid plan offers integrated physical and behavioral health services, including preventive care, hospital services, and prescriptions. Key features include no-cost coverage for primary care visits, behavioral health treatments, and extensive network access, designed to provide comprehensive care for low-income individuals and families.

This plan for dual-eligible individuals offers extensive benefits including $0 copays for primary care and specialist visits, and additional benefits like a $600 quarterly OTC allowance and $4,000 in dental coverage. It also includes coordination services to assist with managing complex healthcare needs.⁴

Understanding Policy Terminology

AHCCCS Health Choice covers a wide range of medical and behavioral health services, including preventive care, doctor visits, hospital stays, prescription drugs, and more. This plan typically does not require members to pay deductibles for covered services, which means members can access necessary care without significant upfront costs.

Health Choice Approval Process for Treatment

When you choose a treatment center, they will verify your coverage with Health Choice to clarify the specifics of your plan, including whether you have any copayments or out-of-pocket costs, as well as the services covered under your plan. Since Health Choice typically does not require deductibles, this verification helps ensure that you are fully informed about any financial responsibilities.

Adjudication is the process where Health Choice reviews a submitted claim to determine if the services provided are covered under your plan. This involves verifying the details such as the type of treatment, the provider, and the dates of service to ensure they match the plan’s coverage criteria. Since Health Choice plans typically do not have deductibles or copayments for covered services, this process primarily focuses on validating the claim’s accuracy and applying the plan’s benefits.

After a claim is adjudicated and approved, Health Choice will pay its portion directly to the treatment center. Since Health Choice plans typically do not have deductibles or copayments, members often have minimal or no out-of-pocket costs. However, if there are additional costs not covered by the plan, such as certain non-standard services or limits beyond the plan’s coverage, the member is responsible for paying any remaining balance.

If your claim is denied, the treatment center’s billing department will likely file an appeal on your behalf. At Cornerstone, we are experienced in navigating the appeals process to ensure your Health Choice plan covers medically necessary services. The approval process aims to provide you with the coverage and support needed during addiction treatment. By working closely with your treatment center, you can focus on recovery while they manage the insurance logistics.

FAQs About Using Health Choice Benefits
to Pay for Alcohol and Drug Treatment

What levels of care will Health Choice cover?

Health Choice Insurance (of Arizona) provides coverage for various care levels to meet the diverse treatment needs of our members.¹

Depending on the individual plan, coverage can include:

Outpatient Treatment: Offers weekly therapy sessions and treatments, enabling individuals to stay home and keep up with their everyday activities while undergoing treatment.
Intensive Outpatient Programs (IOP): Recognizing the importance of accessible yet profound treatment modalities, Health Choice covers IOP services. These are crucial for individuals who must balance life’s responsibilities with the recovery process, providing therapy, counseling, and group support in a flexible schedule.
Partial Hospitalization: Delivers comprehensive day treatment, allowing individuals to spend evenings at home after receiving intensive care during the day.
Inpatient Treatment: Provides round-the-clock care in a hospital or residential environment, tailored for those who need extensive support to overcome addiction and achieve lasting sobriety.

Factors like addiction severity, health history, and personal situation determine the appropriate care level for each member.

Through collaboration with a network of esteemed providers, Health Choice Arizona commits to offering our members access to high-quality care tailored to their recovery needs.

Does Health Choice cover Co-Occurring or Dual Diagnosis treatment?

Yes, Health Choice Arizona offers coverage for dual diagnosis treatment, encompassing both substance abuse and mental health disorders.²

Treating dual diagnosis is crucial in substance abuse recovery as it simultaneously tackles the addiction and any coexisting mental health issues that might be fueling substance use.

Such treatment typically involves a combination of therapy, medication management, and additional supportive measures aimed at addressing both the substance dependency and the mental health condition.

Insurance providers recognize the need for holistic treatment and cover various dual diagnosis treatment approaches, ensuring members access the comprehensive care required for sustained recovery.

Do I need Prior Authorization for addiction treatment?

Most insurance plans, including Health Choice, typically require prior authorization for rehab, though this depends on your specific plan and benefits.

Please get in touch with us for an insurance verification so we can review the details of your plan and start the process of getting you into treatment today.

What if Health Choice denies my claim for addiction treatment?

If Health Choice denies your claim for addiction treatment, Cornerstone will file an appeal on your behalf.

Our knowledgeable team is dedicated to ensuring you receive approval and access to treatment as quickly as possible.

Verify your insurance with us today so we can get you into treatment!

Sources

[1] Member Complete Handbook | Health Choice/AHCCCS

[2] Behavioral Health | Health Choice AZ

[3] 2024 Health Choice Arizona Behavioral Health Residential Facility (BHRF) Prior Authorization and Continued Stay Criteria and Treatment Requirements

[4] BCBSAZ Health Choice Pathway

CLINICALLY REVIEWED

Lionel Estrada, LISAC

CLINICAL DIRECTOR

Lionel, our Clinical Director is a Licensed Independent Substance Abuse Counselor (LISAC) with over 4 years at Cornerstone, specializes in addiction and mental health. Trained in EMDR therapy, he employs a trauma-informed, empathetic approach to address the underlying causes of these issues.

Still have questions about treatment?

Our admissions specialists are here to explain the process, answer any questions you may have, and ensure you’re getting the help you need to live a healthy life free from addiction.