Addiction, whether to drugs or alcohol, can quickly overtake a person’s life. When a person who is struggling with addiction realizes it is time to get help, finding a provider who offers addiction treatment services in a trustworthy, safe environment is critical. However, most individuals will also worry about the cost of treatment.

In Maine, people who have Community Health Options as their insurance provider will find that they have coverage to assist them in affording the treatment and detox services they need.

Community Health Options is a Maine-based health insurance company offering services to individuals, families, and businesses. To meet the needs of members, Community Health Options offers many different plans with varying deductible amounts. They also offer both a preferred provider organization (PPO) plans and health maintenance organization (HMO) plans.

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Does Community Health Options Cover Drug And Alcohol Detox?

Community Health Options offers drug and alcohol detox services through its behavioral health benefit. Members who have the PPO plan receive their first three behavioral health visits each year for free, then they will either pay a copay or pay toward their deductible followed by a coinsurance charge. The copay is between $20 and $30 depending on the plan, while the co-insurance charge is 30 percent when applicable.

HMO members have varied policies. The two lowest-tier plans require members to meet their deductible first, then the detox will be covered in full or with a coinsurance charge. The Community Partner and Community Capital HMO plans offer three free behavioral health visits, then requires a $20 copay for additional visits.

Detoxing is the process of allowing the body to rid itself of a substance that an individual is addicted to. This process usually leads to withdrawal symptoms, and those symptoms need medical management. Drug and alcohol detox refers to the medical and psychological management necessary to support someone through this process.

Does Community Health Options Cover Inpatient Rehab?

Community Health Options covers inpatient drug and alcohol rehab across all of its plans. The member will need to meet their deductible, but insurance will cover the remaining costs after the deductible is met.

Sometimes, those who need addiction treatment can benefit from round-the-clock support. Residential addiction treatment programs offer treatment in an immersive, drug- and alcohol-free living environment where patients are protected from triggers and the stress of daily life.

Does Community Health Options Cover Outpatient Rehab?

Members who have Community Health Options for their insurance provider have coverage for outpatient treatment. The first three visits for outpatient rehab treatment or any other behavioral health services may be available free of cost. After that, the insurance plan’s deductible, copay, and coinsurance rules apply.

Not all types of addiction require inpatient treatment. Sometimes, patients can continue living at home while attending therapy or treatment sessions throughout the day. This option allows the individual to maintain a normal family or work obligations.

Does Community Health Options Cover Medication-Assisted Treatment?

Community Health Options offers prescription drug coverage that extends to medication-assisted treatment for addiction. When a medical provider prescribes medication for detox or rehab, the prescription coverage applies. For some plans, prescriptions are paid after the deductible is met, while others offer a $5 to $30 copay or 50 percent coinsurance structure.

Sometimes the best way to successfully break free from addiction is with the help of medication. For example, individuals with an opioid addiction can take Diskets (methadone) to prevent withdrawal and block the pleasurable effects of opioids. People addicted to alcohol can benefit from ReVia (naltrexone) to keep cravings at bay.

Medication-assisted treatment may take place in an inpatient setting, or the individual’s doctor may prescribe medications for use on an outpatient basis. Either way, these medications are an effective component of a recovery plan.

Does Community Health Options Cover Sober Living Houses?

Sober living houses are a valuable resource for those who have completed detox and rehab. They offer a safe, alcohol- and drug-free environment to live in while practicing the therapies and strategies learned in treatment. Sober living homes provide additional time to adjust to life in sobriety.

Because sober living houses do not involve treatment or detox, they are typically not covered under insurance, including Community Health Options. Sometimes, individuals who need this level of care can use their normal budgeted housing payment to pay for a stay in a sober living house.

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In-Network Vs. Out-Of-Network Services

Depending on which insurance policy a member has, they may or may not have the flexibility to seek addiction treatment outside of the Community Health Options provider network.

The Community Health Options PPO plan offers some flexibility for members. PPO members are able to seek treatment outside of the company’s provider network, though out-of-network providers will cost more. However, treatment is cheaper when it is through an in-network provider because in-network providers have a pricing agreement with the insurance company that results in lower out-of-pocket expenses for patients.

The Community Health Options HMO plans require members to use providers that are in-network. Members with the HMO plans also will need a referral for behavioral health services.

When dealing with an addiction, getting treatment that is the right fit for a patient’s needs is crucial.

Sometimes, it may appear that insurance does not cover a particular treatment, but contacting the treatment center to verify benefits may reveal that it does. Even if the center seems to be out-of-network or the services appear not to be covered, individuals should have their chosen treatment center verify coverage.

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

1) Contact Addiction Campuses for an immediate verification of benefits. Addiction Campuses 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.