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

When you or a loved one is struggling with addiction, getting the right treatment can feel overwhelming. However, your health insurance through Health Choice can provide crucial support during this difficult time.

In this guide, we’ll explain what your Health Choice plan covers for alcohol and drug treatment, from what’s included in your network to how to navigate the claims process. We’ll also discuss the different plan options, deductibles, and how Health Choice can help if you’re facing financial hardship.

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 important to research the in-network facilities in your area to ensure they offer the specific type of treatment and level of care you need.

Going Out-of-Network for drug or alcohol treatment gives you more flexibility to choose the provider and program that’s the best fit. This can be especially beneficial if you have specific needs or preferences that need to be more easily met by in-network options.

This added freedom comes at a cost. You’ll likely have to pay more of the total treatment expenses, and the claims process can be more complex. Health Choice may also require pre-authorization for out-of-network care. Understanding your plan’s out-of-network benefits and costs is critical before committing to a treatment center outside of Health Choice’s network.

Information about Health Choice Plan Types

With a Health Choice HMO plan, you must select a primary care physician (PCP) who will coordinate all of your care, including referrals to specialists. HMOs generally have lower monthly premiums but require you to stay within the plan’s network of providers to receive full coverage.

Health Choice PPO plans offer more flexibility, allowing you to see out-of-network providers, though you’ll pay more for that privilege. PPOs have a network of preferred providers where you’ll pay less, but you don’t need a referral to see a specialist.

An EPO plan is similar to an HMO, but you don’t need a referral to see a specialist within the plan’s network. You won’t receive coverage for out-of-network care like an HMO except in emergencies.

A POS plan combines elements of both HMOs and PPOs. You’ll need to select a PCP, but you can visit out-of-network providers, though you’ll pay more for that care.

Health Choice HDHPs have lower monthly premiums but require you to pay a higher deductible before coverage kicks in. These plans are often paired with a health savings account (HSA) to help cover out-of-pocket costs.

Health Choice also offers plans for those eligible for Medicaid or Medicare, providing comprehensive coverage tailored to each program’s specific requirements and guidelines.

For those on Medicaid, Health Choice offers plans like the AHCCCS (Medicaid) plan, which has a $0 or $43.20 monthly premium based on eligibility level.

This plan has no deductible, and if you lose your Medicaid eligibility, your maximum out-of-pocket responsibility is $7,550 per year.

The AHCCCS plan provides robust coverage, including:

$0 copay for inpatient hospital stays for days 1-90 per benefit period, plus 60 lifetime reserve days
$0 copay for outpatient hospital services, observation, and ambulatory surgical center visits

Understanding Policy Terminology

Your deductible is the amount you must pay out-of-pocket for covered services before your Health Choice plan starts paying.

For example, if your deductible is $500, you must cover the first $500 medical expenses before your plan kicks in. Deductibles can vary significantly between plan types, so review this carefully when selecting coverage.

You’ll have to pay this maximum for covered services in a given year. Once you reach your out-of-pocket max, your Health Choice plan will pay 100% of your covered medical expenses for the rest of the plan year. This protects you from facing unlimited costs if you require extensive treatment.

Understanding these key terms will help you choose the right Health Choice plan and manage your drug and alcohol treatment costs. Be sure to review each option’s specific deductibles, co-insurance rates, and out-of-pocket maximums to find the best fit for your healthcare needs and budget.

Health Choice Approval Process for Treatment

When you choose a treatment center, they will verify your coverage with Health Choice. This allows them to determine the specific details of your plan, including your deductible, co-insurance rates, and out-of-pocket maximum. The treatment center can then inform you exactly what your financial responsibility will be for your needed services. This ensures you’re fully informed and can plan accordingly. You can verify your Health Choice coverage by logging into your member account or by starting verification here with our tool.

Adjudication is when Health Choice reviews the submitted claim to determine if the services are covered under your plan. They will evaluate the details of the claim, such as the type of treatment, the provider, and the dates of service, to ensure they align with your benefits.

Once they have determined the services are covered, Health Choice will apply your specific plan details to calculate the approved amount. This includes applying your deductible, co-insurance, and other relevant cost-sharing requirements. For example, if your plan has a $500 deductible and 20% co-insurance, Health Choice would apply those to the total cost of the claim to determine how much they will pay and how much you are responsible for.

If your claim is denied, the treatment center’s billing department will likely file an appeal on your behalf. They are experienced in navigating the appeals process and will work to ensure your Health Choice plan ultimately covers any medically necessary services.

The Health Choice approval process is designed to provide you with the coverage and support you need during addiction treatment. By working closely with your chosen treatment center, you can focus on your recovery while they handle the insurance logistics.

Get Help Paying Your Deductible

File a Hardship With Health Choice

If you’re facing financial hardship and are struggling to meet your Health Choice deductible, you may be able to file for an exception.

Health Choice has a hardship process that evaluates your specific circumstances, such as your income, expenses, and ability to pay.

If approved, this could result in a reduced deductible or even a complete waiver, making treatment much more affordable.

Assistance Programs & Payment Plans

Many treatment centers also offer assistance programs and payment plans to help patients manage care costs.

These may include sliding-scale fees based on income, payment plans that allow you to spread out the costs over time, or connections to third-party financing options.

Be sure to ask the treatment center about any financial aid or flexibility they can provide.

Community Resources & Charitable Organizations

Local or national charitable organizations may be able to help cover your deductible or other out-of-pocket costs for addiction treatment.

Organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA) and state-level programs may have funding available to assist those in need.

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

Does Health Choice cover inpatient and outpatient addiction treatment?

Health Choice plans cover inpatient and outpatient addiction treatment services. Your coverage level and out-of-pocket costs will depend on your specific plan details, such as your deductible, co-insurance rates, and out-of-pocket maximum. Be sure to verify your benefits with Health Choice or your treatment provider.

Do I need prior authorization for addiction treatment?

Many Health Choice plans require prior authorization before receiving certain addiction treatment services, particularly for inpatient or intensive outpatient programs. Your treatment provider will typically handle obtaining the necessary prior authorization from Health Choice, which helps ensure the recommended level of care is covered under your plan.

What if Health Choice denies my claim for addiction treatment?

You can appeal the decision if Health Choice denies coverage for addiction treatment services. Your treatment provider’s billing department is experienced in navigating the appeals process and will work on your behalf to have the denial overturned. They can help gather the required documentation and submit the appeal to Health Choice.

Remember, understanding your Health Choice benefits and working closely with your treatment provider is key to maximizing your coverage and managing the costs of addiction recovery. Don’t hesitate to contact Health Choice or your provider if you have any other questions.

Sources

[1] Cornerstone Healing Center: Discusses Health Choice coverage for substance abuse treatment, including Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) and the types of addictions treated under Health Choice insurance.

[2] Granite Mountain Behavioral Healthcare

[3] healthchoiceaz.com

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.

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