Rocky Mountain HMO Insurance Coverage for Rehab and Detox Centers Near Me

Coloradans struggling with addiction may be researching how to take the first step toward recovery. For many, attending an alcohol and/or drug rehab program is a possibility to consider. However, receiving treatment at these facilities can be expensive. Fortunately, if you have a Rocky Mountain Health plan, you may be able to use your insurance to cover some or all of the costs associated with drug and alcohol addiction treatment.

Every health insurance plan is different, which means that coverage for alcohol and drug rehab may vary from plan to plan. If you are a Coloradan who has a Rocky Mountain Health Plan, you can check your coverage by calling the number on the back of your insurance card or logging in to your online portal. Most rehab centers will also help you verify your benefits.

Call the rehab center you’d like to attend and work with a staff member to discuss information about your insurance and potentially find out what may or may not be covered through your insurance at their facility.

Check Rocky Mountain Health Plans Insurance Coverage for Addiction Treatment

Because RMHP provides a variety of health plans, including individual and family plans, Medicare plans, Health First Colorado (Medicaid), and CHP+ plans, addiction treatment coverage will vary from plan to plan.¹

To help keep healthcare costs as low as possible and avoid surprise medical bills, it’s always recommended that you check your Rocky Mountain Health Plans benefits and coverage. While the task of checking your coverage details may seem daunting, American Addiction Centers is here to help.

AAC is an industry leader in addiction care and treatment. Our staff is trained to help evaluate patients and work through the nitty gritty details of insurance coverage and care needs. By calling our confidential helpline, you will speak to a real-life person who can help you find out what treatments may be covered under your plan. In most cases, we can check your benefits right while you’re on the phone. If you’d prefer, you can enter your insurance information in the form below and instantly check your coverage.

What are Rocky Mountain Health Plans?

For over 40 years, Rocky Mountain Health Plans has been providing healthcare coverage to Coloradans.^{2 para 1} The plan was first founded by community leaders and physicians in Grand Junction, and today, they are partnered with UnitedHealthcare to provide care through their platform.^{2 para 1}

RMHP offers a variety of health plans, including plans for employer groups, families and individuals (Marketplace plans), retirees, and beneficiaries of Colorado’s Medicaid program and Child Health Plan Plus.^{2 para 2}

Collectively, across the state and all plan types, 281,457 enrollees are covered under a RMHP.^{2 para 3} These numbers are current as of June 2022, and specifically, there are 22,042 members enrolled under Individual & Family plans, 5,371 enrolled in Medicare Advantage plans, 3,321 enrolled in RMHP Dual Special Needs Plans, 46,043 enrolled in RMHP CORAE Prime plan, 197,416 enrolled in a Health First Colorado plan, and 7,264 enrolled in Child Health Plan Plus (CHP+) plans.^{2 para 3}

In addition, when it comes to behavioral health networks, RMHP members have access to 4,625 behavioral health providers and 101 behavioral health specialty providers.^{2 para 4} To learn more about your personal plan, call the number on the back of your insurance card.

What will Rocky Mountain Health Plans insurance cover?

What is covered by Rocky Mountain Health Plans insurance in terms of addiction care and treatment will vary based on your specific plan. While coverage depth will be unique to you and your plan, your specific policy may partially or fully cover any or all of the following treatments:

• Inpatient or residential rehab. A patient who undergoes inpatient or residential rehab treatment for addiction will be staying at the facility for the duration of care, which could range from days to weeks or months. Here, a patient will receive round-the-clock medically supervised care, which could include medically supervised detox.^{3, Pg 8, “What types of treatment programs are available?”}
• Outpatient rehab or therapy. A patient who undergoes outpatient rehab treatment for addiction will typically attend 1 or 2 treatment sessions each week, where they may have therapy or group counseling. No overnight stay is required.^{3, Pg 10, Para 2}
• Intensive outpatient programs (IOP). A patient who undergoes an IOP addiction treatment typically attends a minimum number of hours of treatment each week, usually 9 hours each week.^{3, Pg 10, Para 3}
• Partial hospitalization programs (PHP). A patient who undergoes a PHP treatment typically involves going to a facility for 4–8 hours a day, multiple days a week. This structure has earned this type of treatment the nickname “day programs,” but they don’t include overnight stays.^{3, Pg 10, Para 1}

Please note that just because a treatment type is listed above, that does not mean that you have full or partial coverage for said treatment under RMHP. Nor does it mean that your behavioral or mental health provider may recommend that type of treatment for your recovery. Be sure to work with your plan representative, AAC, and your personal provider to find the right treatment path for you.

Does Rocky Mountain Health Plans Insurance Cover Mental Health Care Treatment Facilities?

In the United States, almost all health plans are required to cover mental health and substance use treatment in some capacity due to the mandates imposed by the Affordable Care Act (ACA).⁴ What this means is that inpatient mental health and behavioral health services, substance use disorder treatment, and outpatient behavioral health services must be covered at some level under RMHPs.⁴

How it is covered and other plan details, such as copays, prior authorization, and coverage levels, will depend upon your specific plan. For you, as a RMHP policyholder, this means that whether you need stand-alone heroin rehab treatment or co-occurring disorder treatment, your RMHP must provide some type of coverage for such services.

A co-occurring disorder, which is also referred to as dual diagnosis, is what it is called when someone has both a mental illness and substance use disorder.^{5, para 2} It is a common condition, as those with 1 condition are twice as likely to develop the other during their lifetime.^{6 “Does one cause the other?”}

Due to the interconnected nature of the conditions, integrated or tandem treatment, where the patient is treated holistically, and each condition is addressed at the same time, is recommended. ⁵ AAC can help you find nearby, covered rehabs that cover mental health care services like co-occurring disorder treatment.

How Long Does Rocky Mountain Health Plans Insurance Cover Rehab?

How long rehab is covered will range greatly depending on a multitude of factors. To begin, the plan that you have and where you seek care may play the largest contributing role in the coverage you receive for rehab. Some plans limit coverage to network providers, while others may allow out-of-network provider coverage up to a certain extent or amount. The type of treatment you need may also influence coverage details.

Be sure to work with AAC or your plan representative to find out more about your plan’s details before seeking care whenever possible. Regardless of what is explicitly covered under your plan, though, it’s important to prioritize getting the treatment you need, even if it means staying in rehab longer than what may be covered under your Rocky Mountain insurance.

The length of time you should remain in rehab is unique to you, as no 2 patients are the same, nor are their paths to recovery. Despite this, many experts and research point to remaining in a program for at least 90 days to stop or reduce substance use and improve overall outcomes.^{7, bullet 5} Please work with an AAC-trained professional and your mental health provider to discuss the best course of treatment for you on your recovery, including how long treatment should last for you in your situation.

What if my Rocky Mountain Health Plans policy does not cover rehab?

In some circumstances, your RMHP may not cover the costs associated with rehab. If you find yourself in this predicament, you may feel overwhelmed and be tempted to forgo getting the treatment you need. Remember, you should not push getting the care you need down the road. Get the care you need today.

Depending on the rehab facility, there may be alternate payment options available to you. For example, some facilities offer special financing or payment plans to patients whose insurance doesn’t fully or partially cover the costs of their treatment. You may also be able to apply for grants or scholarships to help offset the cost of treatment. Be sure to ask a facility director whether any of these situations are applicable or available to you.

Rocky Mountain Health Plans In-Network vs. Out of Network Rehab Centers

Depending on the plan you have through Rocky Mountain Health Plans, you may only be able to receive coverage for your care if you see a network provider. A network plan is a specific type of health plan that works with contracted providers (e.g., in-network providers) to provide healthcare services to covered members (you) at a discounted price.⁸

Generally speaking, seeing a provider who is within your plan’s network is more cost-effective than using an out-of-network provider. To find out more about your plan’s network stipulations, or find an in-network provider, click here.

Rocky Mountain Health (HMO) Plans

A health maintenance organization (HMO) is a specific type of health plan in which you are limited to coverage for services rendered by in-network providers only, except in the case of an emergency.⁹ Rocky Mountain Health Plans offers a variety of different plans, including some HMOs. Work with AAC to find out whether your specific plan is an HMO.