Health Net offers health insurance to individuals, families, and groups in Arizona, Oregon, Washington, and California. They also offer plans to Medicare and Medi-Cal beneficiaries.
Health Net covers behavioral therapies as necessary, so this means addiction treatment will be included to some degree. It covers these needs through its subsidiary, Managed Health Network.
Insurance Coverage for Addiction
Treatment for addiction to drugs and alcohol is a major step forward in reclaiming your life. Though it is a gratifying move toward better health, you need to understand a few logistical matters before enrolling in rehab.
Insurance Companies Must Cover the Following Services if They Offer Plans on the Federal Marketplace:
- Treatment for substances use disorders
- Behavioral health treatment
- Mental health services
Current laws stipulate that you cannot be denied coverage for preexisting conditions, such as a substance use disorder or mental health condition. Coverage for your preexisting condition must begin when your plan takes effect.
In addition, there can no longer be a lifetime cap on the services you require for your condition, including treatment for substance use disorders. This means that health insurers must cover at least some parts of your addiction treatment.
Factors That Affect Treatment Costs
Even though Health Net must cover at least several aspects of your treatment, the specifics can vary greatly according to your circumstances and your policy.
Some factors that could influence how much you pay for treatment include:
Treatment type.
Residential treatment can make a big difference in your success in recovery, but it will be more expensive because you are living at the treatment facility. Such centers usually have medical staff and addiction specialists available around the clock.
With outpatient treatment, you continue living at home. As a result, it is generally much cheaper. These programs have set hours of operation. They do not provide 24-hour care.
Amenities offered to clients.
Some people can afford inpatient centers that provide more than standard care. This can include services, such as spa treatments, personal trainers, renowned chefs, hot tubs, saunas, and massages. This may incur average costs of $20,000 to $80,000 per month, or even up to $120,000 per month.
Location of the treatment center.
Most people will probably go with what is closest to them, but some people can afford to pay for treatment in a beautiful setting. Programs in picturesque locations tend to be more expensive.
Treatment length.
If you are attending a facility because of a court order, your sentence will determine a mandatory length of time. In all other cases, you decide how long you will stay. A counselor will set up an interview with you and give you their recommendations.
Depending on your evaluation, you may need to receive treatment for anywhere from 28 to 90 days. A longer time in treatment is correlated with higher success rates in recovery.
If you are receiving treatment for heroin misuse, you may require methadone or medically assisted treatment for up to a year. The National Institute on Drug Abuse estimates that a year’s worth of methadone maintenance costs $4,700 annually.
Average Levels of Coverage
Health Net States That Their Behavioral Health Services Cover the Following:
- Case management
- Transportation (emergency and nonemergency)
- Assessments and evaluations
- Health promotion, skills training, and employment support (psychosocial rehabilitation)
- Medical-assisted therapy for opioid use
- Screening
- Services for rural substance abuse
- Family, group, and individual counseling
- Psychotropic medications and necessary monitoring or adjustments
Many of the items covered under Health Net’s behavioral health services can be used to cover some of the aspects of drug or alcohol treatment you may need. It is important to understand the specifics of your plan and how it works. Contact a Health Net representative to get a clear answer on exactly what is covered and at what dollar amount.
Also, Health Net works as dual coverage for patients who have Medicare coverage as well. However, their policy states that Health Net Access will act as your coverage if you have dual coverage.
How Coverage Works
Though Health Net covers many services that can financially assist you with rehab, some people may receive benefits through its subsidiary Managed Health Network (MHN).
MHN States That Your Plan May Offer You Mental Health and Substance Misuse Benefits, Such As:
- Inpatient evaluations and treatment
- Outpatient evaluations and treatment, including counseling and treatment from therapists, psychologists, and psychiatrists
- Alternative care, including residential treatment, outpatient care, and some hospitalizations
MHN does not cover pharmaceutical or prescription medication benefits. Per their website, most outpatient services are paid for without previous authorization, but some things are only covered if they are authorized beforehand.
Health Net vs. Other Insurers
Though Health Net offers many benefits that could assist you with the cost of treatment, a 2018 report states that Health Net received two warnings from the state of California for not paying providers that offer substance abuse treatment. This is a violation of federal law.
In a December 2017 exposé from the Los Angeles Times, patients such as James Millman mentioned they decided to use Health Net because of its extensive services for people dealing with substance use disorders.
In 2016, HealthNet stopped paying for treatment services to enrollees, and many treatment centers stopped accepting Health Net enrollees as patients. Health Net stated that they were trying to verify patients’ claims, but many of these had been preapproved beforehand.
Avoid Issues With Coverage
To avoid issues with coverage, ask thorough questions of Health Net and their subsidiaries to make sure you will be covered under their plans. Consult with a representative from your chosen rehab facility as well to confirm coverage. Make sure you are fully aware of any out-of-pocket costs you may incur.
