Guide to Exclusive Care Insurance Coverage for Addiction Treatment

Those who struggle with substance use can feel alone and isolated in their battle, but the truth is that misusing substances is more common than many realize. In 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 8.1 million Americans had at least one illicit drug use disorder, and 14.8 million Americans struggled with alcohol use disorder.^{1, p. 37-38}

Now that you know you’re not alone, how can you get the treatment you need to break free? If you work for the county of Riverside, California, you may be able to use your Exclusive Care insurance to pay for some or all of the costs of rehab.

The amount of coverage you’ll get will depend on your specific plan, so be sure to call the phone number listed on the back of your insurance card to verify your coverage before you begin treatment.

This guide will help you understand more about how to use your Exclusive Care insurance coverage to get the care you need to break free of substance use.

Check Exclusive Care Insurance Coverage for Addiction Treatment

How can you know that Exclusive Care will help with the cost of substance use treatment? The answer is related to the Affordable Care Act (ACA). The ACA requires all long-term health insurance plans to cover 10 essential health benefits, which include mental health and substance use treatment.^{2, fifth bullet}

How do you know what treatment centers are part of your coverage or how much you can expect to pay out of pocket? All you need to do is verify your coverage before you commit to a rehab program. You can do that by calling the phone number on the back of your insurance card or by contacting American Addiction Center (AAC) by phone or online anytime, 24/7.

Our admissions navigators can review your insurance coverage in just a few minutes while they talk to you, and they are also able to answer any questions you have about how treatment works.

You deserve a happy, healthy life free of substance use. Don’t wait — check your insurance so you can get started on the path to freedom today.

What is Exclusive Care Insurance?

Exclusive Care is a health plan designed for County of Riverside, California employees, retirees, their families, and other qualified contractors.^{3, third paragraph} There is an In-Area plan and an Out-of-Area plan, and coverage differs between the 2.^{3, second paragraph}

Exclusive Care offers an Exclusive Provider Organization (EPO) plan with very little out-of-pocket cost to members.^{3, fifth paragraph} However, an EPO plan only provides coverage within the provider network, so it’s important to choose in-network providers when you use your Exclusive Care rehab insurance.⁴

The goal of Exclusive Care is to provide the best services for the lowest out-of-pocket costs in order to give members quality care while saving them money.^{3, first paragraph} Members receive extensive coverage that includes preventive care, specialty services, prescription drugs, and hospital coverage.^{3, fifth paragraph}

Exclusive Care Health Plans

There are two primary plans, In-Area and Out-of-Area.^{3, second paragraph} The Out-of-Area plan is for qualified employees and their dependents who live outside the EPO service area.^{5, p. 7, Health plan eligibility}

For the In-Area plan, you can choose a primary care physician that is within the network.^{5, p. 11, third paragraph} A PCP is required, and you must choose one that is within 30 miles of where you live or work.^{5, p. 11, When selecting your PCP} If you get care from a non-network medical provider or specialist, the services are not likely to be covered by the plan and you’ll likely need to pay the full cost of care.^{5, p. 12, 8th paragraph}

For the Out-of-Area plan, plan members can get treatment from any licensed and qualified provider, and then must seek reimbursement from the plan.^{5, p. 39, Schedule of benefits} There is a $300 deductible for the member each year and you’ll pay a maximum of $5,000 in out-of-pocket costs.^{5, p. 39, Schedule of benefits}

The Exclusive Care plan requires you to have substance use treatment pre-authorized by the County of Riverside Employee Assistance Service (EAS) in order to get coverage, so make sure you take the right steps to access the insurance coverage provided by your plan.^{5, p.34, last paragraph}

What will Exclusive Care insurance cover?

Insurance plans focus on paying for medically necessary care. For the Exclusive Care Plan, you’ll need to work with the Employee Assistance Service (EAS) to get approval for substance use treatment.^{5, p. 35, second paragraph}

There are many ways to treat substance use, and no single option is best for everyone. Some of the most common treatment approaches include:^6,7

• Inpatient Rehab. Inpatient care is a way to get away from your home environment and focus on your recovery. At a treatment facility, you will receive group and individual therapy, as well as education about how to live free from substance abuse. You will also learn new habits that can help you stay substance-free in the long run.
• Outpatient Rehab. Outpatient treatment allows you to get the help you need while still being able to live at home and attend school or work. It’s a few hours a week of therapy, counseling, or activities that can help you start or continue your treatment journey.
• Intensive Outpatient Programs (IOP). Intensive outpatient treatment is an excellent step up from regular outpatient care. It offers more focused care, with counseling, educational programs, and medication management if needed. Treatment usually takes place several hours a week, but does not require you to live in a facility.
• Partial Hospitalization Programs (PHP). PHP programs offer a full-time, high-level care experience while allowing you to stay at home on nights and weekends. This type of program consists of a variety of therapies, including counseling, educational programs, and medication management if required. You attend treatment every day for several hours a day.

The most important part of your treatment program is ensuring you finish it. It’s common to want to leave when you start to feel better, but the best way to break free from substance use long-term is to see the entire program through to graduation.

Does Exclusive Care Insurance Cover Mental Health Care Treatment Facilities?

It’s common to struggle with mental health and substance use at the same time. Did you know that 50% of those who struggle with substance use also have a mental health diagnosis (known as a co-occurring disorder)?^{8, second paragraph}

What’s important is to treat both your mental health and substance use at the same time. This integrated approach to treatment has been shown to be far more effective than treating only one or the other alone.^{9, first paragraph}

You might wonder if you can use Exclusive Care insurance for mental health. You can, especially because mental health treatment is one of the essential health benefits required by the ACA.^{2, fifth bullet}

Keep in mind that Exclusive Care has specific requirements for mental health treatment.^{5, p. 35, second paragraph} You’ll want to ensure you get the proper pre-authorization before you begin treatment.

How Long Does Exclusive Care Insurance Cover Rehab?

How long will you be in rehab? It’s a common question, but the answer is different for everyone.

Studies show that most people need at least 90 days to make a significant change in their substance use, including stopping substance use.^{10, fifth point} That’s why treatment programs are generally at least 3 months long.

However, you might need to be in treatment longer. It will depend on your specific needs, including what substances you use, how long you’ve used them, and what your usage triggers are.

Your Exclusive Care insurance behavioral health coverage might only cover a specific amount of time, or they could cover the entire program as long as it’s within the provider network. It’s important to review your coverage before you commit to a rehab program.

To do so, contact the insurer directly or connect with AAC online or by phone. We’re available 24/7 to help you get the care you need. We can review your coverage and answer any questions you have about getting free from substance use.

What if my Exclusive Care policy does not cover rehab?

As you look into your Exclusive Care insurance rehabilitation coverage, you might find that your insurance covers only part of the cost of your treatment program. Or, maybe the treatment center you’re most interested in isn’t part of the Exclusive Care EPO network, which means you’ll pay the full cost yourself.

Don’t let this discourage you from getting the treatment you need. There are many ways to pay for rehab, and your insurance plan is only one part of the puzzle. For example, some treatment centers offer scholarships or payment plans to make affording rehab easier.

Or, you might be able to borrow money from friends and family to help you pay for the cost of getting free from substance use. However you do it, once you’re clean, you’ll be far better able to manage your financial obligations.

The key is to get treatment as soon as you can. Substance use has serious long-term legal and health consequences, and you want to get the help you need before it’s too late.

Exclusive Care Insurance In Network vs. Out of Network Rehab Centers

Because Exclusive Care is an Exclusive Provider Organization (EPO), it’s especially important to understand what an in-network provider is versus an out-of-network provider.^{5, p. 12, 8th paragraph}

All insurance plans have a group of providers that have agreed to treat plan members at a lower cost.^{11, p. 1 What’s a Provider Network} These providers are the insurance plans network.^{11, p. 1 What’s a Provider Network}

Because Exclusive Care insurance benefits are an EPO, there is no coverage provided when you get care outside the provider network.^{11, p. 2, Why do some plans…} That means that you’d have to pay the full cost.^{11, p. 2, Why do some plans…}

To get the coverage you deserve from Exclusive Care, focus on finding a treatment provider within the network. If that’s not possible, though, don’t panic. Remember, there are many ways to pay for rehab.

You deserve a happy, productive life free of substance use and related problems. We can help you get started. Contact us today.