The first step for most people who are looking for drug and alcohol rehab, whether it is an inpatient or outpatient program, is to consider insurance coverage. Beacon Health Options, formerly known as ValueOptions, is not a traditional health insurance provider. Beacon focuses specifically on behavioral health services, including treatment for substance use disorders.

Beacon works with various health plans around the country and has more than 50 million customers. What kind of drug and alcohol rehabilitation benefits does Beacon Health Options offer?

Does Beacon Health Options Cover Drug and Alcohol Detox?

Beacon Health Options covers drug and alcohol detox as part of the overall addiction care plan for many people. If Beacon does not pay for the full cost of treatment, most plans cover at least a portion of it. The balance might be reimbursable under an employee assistance program or health savings account.

Withdrawal occurs after a person stops using an addictive substance like prescription opioid painkillers or alcohol. It comes with some unpleasant and potentially dangerous side effects, so medically supervised, inpatient drug and alcohol detox is the safest way to break a physical dependence.

Depending on the addiction, healthcare staff may provide medications to prevent or minimize the symptoms of withdrawal such as:

  • Nausea
  • Vomiting
  • Muscle cramps
  • Chills
  • Fever
  • A headache
  • Anxiety
  • Seizures

Withdrawal can start anywhere from a few hours after last use to a few days later, depending on the substance and severity of the addiction. Acute withdrawal may last a few days to a few weeks. Once detox is complete, therapy can begin.

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Does Beacon Health Options Cover Inpatient Rehab?

Generally, Beacon Health Options plans cover inpatient rehab, and many programs focus on dual-diagnosis treatment. Often individuals with an addiction have an underlying mental health issue like depression, anxiety or bipolar disorder. The goal of dual-diagnosis programs is to treat both conditions at the same time to improve chances of a full recovery and reduce the risk of relapse.

Beacon Health Options creates custom benefit programs for clients. The exact coverage level depends on the plan an employer or health insurance provider has with Beacon.

Inpatient services most likely covered by Beacon Health Options include:

  • Screening and initial assessment, including dual diagnosis evaluation
  • Medical exams
  • Residential costs for the inpatient stay
  • Medication
  • Therapy

“Residential costs” for inpatient addiction treatment means payment for residential housing and 24-hour supervision. People who participate in an inpatient addiction treatment program live in the facility with other patients who are in recovery. Inpatient care also provides a safe environment free from potential triggers that could lead to a relapse.

Beacon Health Options offers a unique service that is just for behavioral health, so there are many variables that affect what services are covered and at what rate. The amount Beacon Health Options pays may depend on the plan the employer or health insurance provider signed up for. The facility might also factor into the payment equation.

In some cases, there may be a copayment or coinsurance fee to pay. For example, if the copay is listed as $250 per admission, the patient would be obliged to pay that amount of money.

A coinsurance fee is a percentage of the final bill. If the policy lists a coinsurance fee of 20 percent, the insured pays 20 percent of the bill and Beacon Health Options pays the remaining 80 percent.

The one similarity most benefit packages from Beacon Health Options have is that the plans do not cover out-of-network care providers. The business model Beacon Health Options follows creates partnerships with both the insurance provider and the treatment facility. This means that those looking for a drug and alcohol treatment center must choose from the Beacon’s list of providers or let the facility work out an arraignment for payment.

Does Beacon Health Options Cover Outpatient Rehab?

As with the inpatient care, Beacon’s coverage for outpatient drug and alcohol rehab will depend on the package provided with the plan. In most cases, there should be some level of coverage offered for outpatient addiction treatment such as:

  • Day programs where the client receives therapy at the facility during the day and goes home with family or friends at night.
  • Private and group outpatient counseling
  • Continuing-care peer groups

Patients seeking outpatient drug and alcohol rehab will most likely have to select an in-network provider or let the desired out-of-network facility make arrangements with Beacon Health Options. In some cases, outpatient care is covered under another insurance plan such as major medical.

Does Beacon Health Options Cover Medication-Assisted Treatment?

It is likely that Beacon Health Options covers medication-assisted therapies for those with an opioid addiction. Drugs used in medication-assisted treatment include:

  • Suboxone (buprenorphine and naloxone)
  • Zubsolv (buprenorphine and naloxone)
  • Bunavail (buprenorphine and naloxone)
  • Revia (naltrexone)
  • Vivitrol (naltrexone)

Beacon Health Options has a strong commitment to fighting the current opioid crisis and lists medication-assisted treatment as a cost-effective option that leads to better outcomes.

Does Beacon Health Options Cover Sober Living Houses?

Aftercare options like sober living houses are sometimes covered by insurance providers as part of addiction treatment. Beacon Health Options does have different benefits plans, though, and some plans may not offer this option.

Sober living houses provide a safe environment for those who are transitioning back into regular life after a residential substance use disorder treatment program. It might be necessary to pick an in-network facility for full payment or let an out-of-network program work with Beacon Health Options to arrange payment.

What’s The Difference Between In-Network And Out-Of-Network?

In-network facilities have a contract and pricing arrangement with Beacon Health Options. The facility will file their claims with Beacon for reimbursement.

Out-of-network treatment programs don’t have an agreement with Beacon Health Options. An out-of-network facility can possibly call to establish a pricing agreement though. In some cases, the insured may file a claim with Beacon themselves.

Families should not be deterred by the fact that a treatment center they prefer does not appear to be in the Beacon Health Options’ network. All facilities, whether inpatient or outpatient, perform an insurance coverage verification as part of the admission process for each patient. The outcomes vary, but it is settled before the program begins.

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How To Find Drug And Alcohol Rehab Centers That Accept Beacon Health Options

1) Call Vertava Health for an immediate verification of benefits. Vertava Health can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.

2) Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.

3) Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.