Does HealthSmart insurance cover Alcohol and Drug Rehab?
HealthSmart is a provider of insurance plans to self-insured employers.1, first paragraph If you work for one of these employers, you might have a HealthSmart health plan or benefits administered by the HealthSmart company.
One struggle that is common to millions of people across the country is substance use. In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) found that in 2018, 8.1 million Americans had at least one illicit drug use disorder, and 14.8 million Americans struggled with alcohol use disorder.2, p. 37-38
If you have a HealthSmart health plan, can you use your coverage to get the help you need for substance use? The good news is that you can. However, your specific benefits will vary depending on your plan, so be sure to call the phone number on the back of your insurance card to verify your coverage before you enroll in a treatment program.
This guide will help you understand how to use a plan or benefits from the HealthSmart health system to get the help you need to break free from substance use.
Check HealthSmart Insurance Coverage for Addiction Treatment
Because every insurance plan is different, it’s important to know the details of your plan before you commit to a rehab program. Fortunately, it’s easy to find out what to expect.
The Affordable Care Act (ACA) requires all long-term insurance plans to cover at least some of the cost of 10 essential health benefits, 1 of which is mental health and substance use treatment.3, fifth bullet That means your HealthSmart coverage will cover at least some of the cost of your treatment.
To learn more about how much the insurance will cover and how much you will be responsible for, you can check your coverage details. One way to do this is to call the phone number on the back of your insurance card, or you can contact American Addiction Centers (AAC) by phone or online, 24/7.
Our admissions navigators can review your coverage in just a few minutes while they talk to you, and they are also happy to answer any questions you have about rehab or treatment.
You deserve a life that’s happy, productive, and free of substance use. Take the first step now by using the form below to check your insurance coverage.
What is HealthSmart?
The HealthSmart Health system is 1 of the largest third-party health insurance administrators in the country.1, first paragraph The company provides customizable health insurance plans for self-funded employers, which helps reduce costs while allowing employees to access high-quality care.1, first paragraph
The company focuses on improving health while lowering costs and works hard to keep up with the future developments of care as well.1, Delivering value, Our future
HealthSmart provides health benefit plans, care management, prescription solutions, and provider networks, among other benefits.1, bulleted list If you have a HealthSmart health plan, you can count on high-quality care that meets your needs.
What will HealthSmart insurance cover?
Health insurance plans focus on covering medically necessary care, so the first thing you’ll need to do is work with your doctor to determine the best treatment for your situation. Your doctor will ask about what substances you use, how long you’ve used them, your home environment and triggers, and other questions.
From there, your doctor will create a personalized treatment plan for your needs. There are a variety of treatment options for substance use, but the most common include:4,5
- Inpatient Rehab. Inpatient rehab is a process that allows you to live away from home in a treatment facility, so you can get out of your environment and limit your use triggers. You’ll learn how to deal with challenges without substances and create new habits to live a healthier lifestyle.
- Outpatient Rehab. Outpatient rehab doesn’t require you to live in a treatment center, so you can attend school or work while receiving treatment. You will get individual and group counseling a few hours a week.
- Intensive Outpatient Programs (IOP). An IOP gives you more support and treatment than a regular outpatient program, but you still don’t have to live at the facility. Instead, you’ll have several hours of treatment per week. You may be able to work or go to school part-time around your treatment hours.
- Partial Hospitalization Programs (PHP). Partial hospitalization is an option for those who need intensive, full-time treatment but don’t want to live at a facility. You’ll attend counseling and other activities several hours a day, five or six days a week.
Of course, your treatment plan will help you most if you complete it fully. It’s common to want to leave treatment partway through, especially if you’re doing better, but you don’t yet have all the tools you need to be successful long-term. Instead, follow through with your program to give yourself the best chance at a new life.
Does HealthSmart Insurance Cover Mental Health Care Treatment Facilities?
HealthSmart offers a variety of plans, so it’s common to wonder if mental health care is included. This is especially true because it’s so common to struggle with substance use and have a mental health addiction, which is called a co-occurring disorder. In fact, 50% of those who struggle with substance use also have a mental health concern.6, second paragraph
It’s important to treat both your mental health and substance use together because integrated treatment has been shown to be far more effective.7, first paragraph Fortunately, there are a lot of high-quality treatment programs that are equipped to treat co-occurring disorders.
Will health insurance cover the cost of your mental health treatment? Because the ACA lists both mental health care and substance use treatment as an essential health benefit, you can rely on HealthSmart mental health coverage to cover at least some of the cost.3, fifth bullet
Of course, the details of your coverage depend on your plan, so be sure to verify your coverage before starting a treatment plan.
How Long Does HealthSmart Insurance Cover Rehab?
How long will I be in rehab? It’s a common question, but there’s no singular right answer for everyone. Research shows that most people need at least 90 days to make a significant difference in their substance use habits, so most programs are at least 3 months long.8 However, your treatment plan may be longer, depending on your needs.
It’s important to get the treatment that your substance use needs so that you can truly break free into the new life you deserve. Don’t let anyone else’s path distract you. Your journey is uniquely for you. If you’re wondering how to find out how long your insurance plan will cover your treatment, be sure to check your coverage details by calling the number on the back of the insurance card or contact AAC anytime by phone or online.
What if my HealthSmart policy does not cover rehab?
As you research different treatment programs and verify your insurance coverage, you might find that your insurance plan will only cover part of the treatment cost, and you have to cover the rest. Or, you might discover that the treatment program you’re interested in isn’t covered by your insurance plan at all.
Don’t let that stop you from getting the treatment you need. There are many options for paying for treatment, and your insurance plan isn’t the full picture.
For example, some treatment programs offer a sliding scale of fees based on your income, while others might have scholarships available. You may also be able to set up a payment plan or borrow money from friends and family.
However you pay for rehab, you’re making the right choice for your future. Once you’re free of substance use, you’ll be in a much better position to manage your financial obligations. Don’t delay in getting the treatment you need. Misusing substances has significant long-term health and legal consequences, and you want to get free before it’s too late.
HealthSmart In-Network vs. Out-of-Network Rehab Centers
As you look at different treatment programs, you’ll notice that some are “in-network” with your insurance plan, while others are “out-of-network”. What does that mean?
All insurance plans have a network of providers that have agreed to provide care for plan members at a lower cost.9, p. 1 What’s a Provider Network In return, the plan refers members to those providers.9, p. 1 What’s a Provider Network
Many plans provide very limited—and often no—coverage outside their provider network.9, p. 2, Why do some plans… That means if you choose a doctor or facility that’s not included in the network, you could pay all of the cost of care yourself.9, p. 2, Why do some plans…
In order to maximize your insurance plan coverage, look for programs that are within the network if at all possible. However, even if you do need to pay some or all of the cost yourself, don’t let that deter you from getting treatment. As we mentioned above, there are other ways to pay for rehab as well.
What’s important is that you break free from substance use as soon as possible so that you can move forward with the happy, healthy life you deserve.
HealthSmart is a plan administrator, so the plans available to you will depend on your specific employer. HealthSmart allows your employer to offer flexible custom-built benefit plans to employees at an affordable price.10, bulleted list
There is also a member portal for HealthSmart plans that allow you to see details about your health insurance plan online, no matter what time or day it is.10, bulleted list
To get more details about your health insurance plan, you can talk to your employer or call the phone number on the back of your insurance card. To find out what kinds of substance use treatment you can access with your specific insurance plan, feel free to contact AAC anytime by phone or online.
We’re here to help you break free from substance use once and for all. Take the first step by contacting us today.
- HealthSmart. (2022). About HealthSmart.
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2019, August). Key substance use and mental health indicators in the United States: results from the 2018 national survey on drug use and health.
- Healthcare.gov. (n.d.). What Marketplace health insurance plans cover
- Findtreatment.gov. (2019, October). Treatment Options.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
- National Institute of Mental Health. (n.d.). Substance Use and Co-Occurring Mental Disorders.
- National Institute on Drug Abuse. (2020, April). What are the treatments for comorbid substance use disorder and mental health conditions?
- National Institute on Drug Abuse. (2018, January). Principles of Effective Treatment.
- Marketplace.gov. (2021, May). What you should know about provider networks.
- HealthSmart.(2022). Plan Administration.