According to the United States surgeon general, one in seven people in America will face addiction at some point. Perhaps even more alarming, only 10 percent of those people will ever receive treatment.

Many insurance providers, including Coventry Health Care, offer coverage for drug and alcohol rehab, making it easier for those who struggle with a substance use disorder to get the help they need. Coverage amounts, deductibles, and copay vary from plan to plan.

About Coventry Health Care

Coventry Health Care is one of the largest PPO insurance providers in the United States and is a subsidiary of Aetna insurance. Coventry offers insurance products through Medicare and Medicaid as well as employer-sponsored plans, and they have coverage options in multiple states. The benefits a person is eligible for will vary depending on their plan and state.

Coventry Health offers coverage for addiction treatment through MHNet Behavioral Health, including many levels of substance use disorder treatment services. Coverage can be different depending on the type of Coventry Health Care plan a person has, what state they reside in and whether the plan is through an employer or through a state or federally funded program.

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Does Coventry Health Care Insurance Cover Drug And Alcohol Detox?

Drug and alcohol detox is an essential first step of the addiction treatment process for many patients, and it is covered under most Coventry Health Care plans. To enroll in a detox program, the insured may be required to have a referral from their primary care physician. Physicians can obtain referral forms through MHNet Behavioral Health.

Detox programs can operate independently, offering only detox services, or they may be connected to an inpatient or outpatient rehab program that offers subsequent therapy and counseling. Whether the full cost of drug and alcohol detox will be covered may depend on a number of factors, including medical necessity and whether the detox is a standalone service or one component of a larger treatment plan.

Does Coventry Health Care Insurance Cover Inpatient Rehab?

Coventry Health Care insurance covers at least some level of inpatient rehab, no matter which of their insurance plans a person has. It is important to check specific plan benefits to learn exactly what portion of the costs will be covered.

For example, Kansas residents who are insured through the Silver $10 Co-pay PPO Exchange plan must pay a $500 co-pay for admission to an in-network treatment program and a $1,000 co-pay for an out-of-network provider. Members of this plan would also be responsible for between 30 and 50 percent of the cost of treatment. Pre-authorization is almost always required for an inpatient addiction treatment program.

Does Coventry Health Care Insurance Cover Outpatient Rehab?

For those who have a Coventry Health Care plan through an employer or Medicare or Medicaid, outpatient rehab is covered by Coventry Cares through MHNet. The extent of the costs covered depends on the type of coverage a person has.

Outpatient services are covered for those who have the Coventry Silver $10 Co-Pay Exchange program, but patients will have to pay a $75 co-pay for the first in-network visit or 50 percent of the service cost at an out-of-network provider. If a patient returns for two or more additional visits, they will be required to pay a co-pay and meet their deductible. However, MHNet no longer requires preauthorization to enter an outpatient addiction treatment program.

Does Coventry Health Care Insurance Cover Medication-Assisted Treatment?

For those with Medicare Part D coverage through Coventry Care, the prescriptions used in the medication-assisted treatment are covered. Suboxone (buprenorphine, naloxone), Diskets (methadone) and Antabuse (disulfiram) are all listed as covered medications.

With other types of Coventry plans, benefits will depend on the state and the plan. In states that have a Medicaid program that uses Coventry Health as one of the providers, the state may restrict some medications typically used in addiction treatment.

Does Coventry Health Care Insurance Cover Sober Living Houses?

Some health insurance providers do not offer coverage for sober living treatment. Most sober living facilities encourage residents to maintain employment to pay their monthly rent. However, if the sober living facility is associated with an outpatient drug or alcohol rehab program, some insurance providers will not differentiate between the two and may offer some amount of coverage.

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

An in-network rehab center or health care provider has contracted with Coventry Health Care Insurance to provide services at an agreed-upon rate. Out-of-network providers do not have this business relationship with Coventry Health.

Patients have the option of selecting in-network or out-of-network providers for their health care. However, if a person chooses an out-of-network provider, the cost of services can be higher. If a person’s preferred treatment center does not appear to be in-network, requesting verification of insurance benefits can provide a definitive answer about coverage.

How To Find Drug And Alcohol Rehab Centers That Accept Coventry Health Care

1) Contact Addiction Campuses for 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.