Does Asuris Northwest Health Insurance Cover Substance Abuse Treatment?
Providing local healthcare and insurance coverage for individuals residing in the state of Washington, Asuris Northwest Health insurance covered nearly 50,000 individuals as of 2014. Members have access to more than 6,000 medical treatment providers and 176 facilities that are within the Asuris Northwest Health network. Committed to overall wellness and health, Asuris Northwest Health offers a range of plans and levels of coverage for employers and employees alike.
Through the private Asuris Marketplace, employers can contribute to health insurance costs for their employees, giving them the freedom to shop for and choose their own plans. A set amount, a defined contribution, is set up by the employer, which allows them the ability to budget for health insurance expenses and then the employee gets to chose what option works best for them within the defined contribution amount. There are many different policies and levels of care to choose from. Asuris Northwest Health provides a full continuum of care, from preventative and wellness services to medical and mental health treatment and recovery.
Understanding Health Insurance
Health insurance can be used to pay for medical, surgical, and behavioral health services, which includes substance abuse treatment, at equal rates per the Affordable Care Act (ACA). The ACA made substance abuse and mental health part of the “essential” health benefits that are to be covered by any insurance plans sold on the federal Marketplace.
With over 8 percent of the American adult population battling addiction, according to the 2014 National Survey on Drug Use and Health (NSDUH), substance abuse treatment is recognized as helping individuals to manage the disease, promoting recovery for a more balanced and healthy life. The actual amount of coverage for substance abuse treatment can differ, depending on the exact Asuris Northwest Health insurance plan a person has, where they live, and what services are offered.
When assessing coverage, some general health insurance terms to know include:
- Deductible: This is the amount a member must pay before any insurance coverage will kick in.
- Monthly premium: This is the amount paid to the insurance provider each month as the cost of keeping the policy current and the member covered by insurance.
- Percentage covered: This is the percentage that health insurance covers; members pay the remaining uncovered percent themselves.
- Out-of-pocket expenses: This involves any fees or money paid by the member on top of their monthly premium; for example, if coverage is offered at 80 percent, the member is expected to pay the remaining 20 percent out-of-pocket.
- Maximum allowed: Services may have maximum allowable visits in a lifetime or in a calendar year; for example, addiction treatment programs may be covered for a total of 90-120 days, depending on specific coverage limits.
- Annual out-of-pocket maximum: Policies usually have a cap on out-of-pocket expenses for its members. After this amount is reached in a calendar year, the rest of the necessary medical services are covered 100 percent.
- Coinsurance: Additional insurance policies that can be combined to cover treatment services.
- Copay: This is a small amount that will be paid at the time services are rendered; copays do not usually count toward deductible amounts.
- In-network provider: Health insurance companies contract with healthcare providers to offer services at discounted rates; these providers are usually considered in network.
- Out-of-network provider: It is usually more expensive to see providers who are not in network; out-of-network providers do not have negotiated rates with the insurance company.
- HMO (health maintenance organization): This type of health insurance plan requires members to use providers that are in network in order for them to be covered. Often, referrals are necessary by a primary care provider for specialty services to be covered.
- PPO (preferred provider organization): Members are able to see both in-network and out-of-network providers; however, out-of-network services will be more expensive. Additionally, members may not need a referral to use specialty services.
- EPO (exclusive provider organization): Similar to an HMO, this plan requires members to stay in network; however, referrals are not generally necessary for specialty services.
- HSA (health savings account): This is a tax-exempt flexible spending account where money can be stored for healthcare-related expenses.
- HDHP (high-deductible health plan): Usually used with an HSA, these plans have high deductibles and copays and low monthly premium amounts.
- Bronze plan: This type of plan usually has the highest deductible and lowest monthly premium; coverage is generally offered at 60 percent.
- Silver plan: This middle-level plan typically provides coverage at around 70 percent, with medium-range deductible and monthly premium amounts.
- Gold plan: This plan has low deductibles, a high percentage of coverage at 80 percent, and high monthly premiums.
- Verification: Individuals may need to obtain a verification that services are “medically necessary” from a primary care provider before they will be covered.
- Preauthorization: Some services may require individuals to seek authorization prior to receiving specialty services in order for coverage to be considered.
How to Use Northwest Health Insurance for Substance Abuse Treatment
The best way to understand how to use Asuris Northwest Health insurance to pay for substance abuse treatment services is to contact the insurance provider directly and talk to a trained member services professional. Members can call the number on their insurance card to be connected to a trained professional who can help members better understand their coverage and what may be covered.
Asuris Northwest Health also provides its members with an online Treatment Cost Estimator that people can use to determine how much certain services may cost out of pocket based on their specific plan in order to budget accordingly. This tool also allows members to find and compare treatment providers based on cost, location, quality of care, and more.
Asuris Advice24 connects members who have eligible group members to a registered nurse who can help members understand their symptoms and find the appropriate form of care. This benefit is provided to members who have eligible health insurance policies at no extra cost to offer immediate support and help for health issues, no matter the time of day or night.
Preventative care is provided by Asuris Northwest Health at no out-of-pocket cost to its members. This means that there will be no copay and no required deductible amount for things like substance abuse screening and behavioral counseling for adult members.
Asuris Case Management is included with Asuris Northwest Health insurance plans and can assist individuals struggling with addiction by answering questions, working with treatment providers to support recovery, and helping members to better understand their treatment options.
In general, Asuris Northwest Health insurance will typically pay for detox services, which may need to be verified as being medically necessary; outpatient services, such as counseling, education, therapy, and community-based treatment services; and residential care when outpatient treatment is deemed insufficient. Often, a member will need to first try outpatient care before residential treatment will be covered. Depending on the plan held by the individual, which can vary from state to state and policy to policy, members may need to first see their primary care provider to obtain a referral for substance abuse treatment services. In conjunction, before entering into an addiction treatment program, members may need to first obtain preauthorization from Asuris Northwest Health for these services to be covered.
To find local behavioral health or other treatment services covered by Asuris Northwest Health insurance, members may use the online locator. Doctors, mental health providers, and substance abuse treatment professionals can all help individuals find treatment and learn how to maximize insurance coverage to help pay for services.