For those who find themselves battling a substance use disorder, professional addiction treatment is often necessary to enter recovery. Many people rely on their insurance provider to cover the cost of treatment. For those who carry Health Alliance Insurance, a variety of addiction treatment formats are covered.

About Health Alliance

Health Alliance is an insurance provider offering coverage in Illinois, Iowa, Ohio, Washington, and Indiana. Health Alliance offers plans for a variety of groups, including individuals, families, employer-sponsored plans and state employee plans. Each of these plan types offers addiction treatment coverage, but associated out-of-pocket costs will vary.

Health Alliance Insurance offers three types of insurance plans. These include:

  • Health Maintenance Organization (HMO): Affordable plans that require members to use participating providers
  • Preferred Provider Organization (PPO): These plans offer greater flexibility in choosing providers
  • Point of Service (POS): Plans combine HMO and PPO structures to give flexibility in choosing a provider while providing more incentives for choosing in-network.

Does Health Alliance Cover Drug And Alcohol Detox?

All Health Alliance insurance plans offer coverage for drug and alcohol detox. Detox services are covered under each plan’s behavioral health benefit. Each plan has its own coverage level, with varying deductibles, coinsurance costs and copays that the patient must pay.

Drug and alcohol detox is the process of allowing the body to rid itself of addictive substances, and it is often the first step in addiction treatment. Detox programs provide support as the patient deals with withdrawal symptoms. Patients may require medical support during this process, as some withdrawal symptoms can be life-threatening.

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Does Health Alliance Cover Inpatient Rehab?

Health Alliance insurance covers inpatient rehab, but coverage extends to the facility only, not the provider. Patients on HMO plans will need to choose an in-network provider for inpatient rehab services. Patients pay a coinsurance of 10 to 20 percent, and the rest of the costs go toward the deductible.

For patients with the PPO plan, all inpatient rehab costs go toward the deductible, with a zero to 20 percent coinsurance fee for in-network services and a 20 to 50 percent co-insurance fee for out-of-network services, depending on the plan. POS patients have similar coverage, with a 20 percent coinsurance fee for in-network providers and a 50 percent coinsurance fee for out-of-network providers.

Inpatient rehab, or residential addiction treatment, give individuals struggling with addiction the opportunity to live in a group setting. Therapy and recovery activities are built into each day’s routine, and group support and accountability helps prevent relapse. This is often the second stage of addiction treatment and sets the stage for a life of sobriety.

Does Health Alliance Cover Outpatient Rehab?

Patients who need outpatient rehab will find Health Alliance insurance provides coverage. For HMO plans, outpatient office visits have a $25 copay, while outpatient facility visits go toward the patient’s deductible with a 10 to 20 percent coinsurance cost. Patients on HMO plans must visit a participating in-network provider.

PPO and POS patients who visit an in-network provider for outpatient treatment will pay between 0 and 20 percent coinsurance, while non-participating providers have a 50 percent coinsurance cost. All payments go toward patients’ deductibles.

In outpatient rehab, a patient will live at home while attending treatment sessions at the rehab facility. Some patients may also choose to live in a sober living house to provide a measure of accountability and protect themselves from triggers. Ideally, patients will enter outpatient rehab as a follow-up to inpatient rehab, but some people with mild addictions choose to start with outpatient services instead of spending time in an inpatient facility.

Does Health Alliance Cover Medication-Assisted Treatment?

FDA-approved medications are sometimes combined with behavioral therapies and counseling as part of a medication-assisted treatment plan to improve recovery efforts during addiction treatment.

Health Alliance members may find coverage for a medication-assisted treatment program within their prescription drug benefit. Patients who have HMO coverage through Health Alliance will pay between $7 and $80 for most prescription drugs, with a higher cost for specialty drugs. PPO patients pay toward their deductible for prescriptions, with zero percent coinsurance for in-network services. POS patients pay a 20 percent coinsurance fee while paying toward their deductible for prescriptions.

Medications like Suboxone (buprenorphine and naloxone) can help prevent or reduce withdrawal symptoms when a patient is breaking an addiction to opioids. Some medications can also block the pleasurable effects of drugs and alcohol. For patients with an alcohol addiction, Vivitrol (naltrexone) reduces the desire to drink.

Does Health Alliance Cover Sober Living Houses?

Health Alliance insurance may not cover the cost of a stay in a sober living house. Inpatient rehab would be covered, but the housing costs for sober living houses that do not provide treatment would not be. Patients are responsible for their own housing costs when they enter a sober living house.

Sober living houses can be an excellent final step in the process of breaking free from addiction. These alcohol- and drug-free living environments do not typically include any therapeutic services. However, they do provide a safe, supportive environment for an individual to live in while learning how to navigate life newly sober. Residents are given the opportunity to practice relapse-prevention skills while surrounded by others who are also in recovery.

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In-Network Vs. Out-Of-Network Treatment

Health Alliance has a growing network of over 20,000 doctors and hundreds of hospitals that are participating providers. Participating providers are considered in-network, while non-participating providers are out-of-network.

Patients who have Health Alliance HMO plans must visit a participating provider for coverage benefits to be in effect. PPO and POS patients can visit out-of-network providers, but they will pay higher coinsurance costs than if they used in-network providers.

How To Find Drug And Alcohol Rehab Centers That Accept Health Alliance

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