Health New England is a non-profit insurance provider serving the residents of Massachusetts. Initially formed by a small group of physicians and two community hospitals, Health New England now consists of a network of 23 hospitals and medical centers along with almost 11,000 healthcare providers. The organization offers a comprehensive portfolio of plans that include coverage for drug and alcohol rehab.

This insurance provider offers both HMO and PPO plans, along with individual, small and large group coverage. Within each group of plans are many policy choices that fall under different brand names, such as:

  • Wise
  • Essential
  • Premium

Families who are looking for a suitable drug and alcohol rehab often contact their insurance company first. What can families expect Health New England to pay for drug and alcohol rehab?

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Does Health New England Cover Drug and Alcohol Detox?

Health New England may cover at least part of the cost of drug and alcohol detox. How much will depend on the type of insurance plan the patient has.

Detox programs provide medical support when a person stops using drugs or drinking alcohol. This period can be difficult, because withdrawal brings with it some unpleasant and even dangerous side effects, such as:

  • Nausea
  • Vomiting
  • Muscle cramps
  • Chills
  • Fever
  • Mood changes
  • Paranoia
  • Seizures

Through a medically managed detox program, healthcare providers can help manage these symptoms in a safe, structured environment.

Does Health New England Cover Inpatient Rehab?

Health New England covers inpatient rehab but will most likely require a copay or coinsurance payment from the insured. How much depends on the plan each person purchases.

Each of Health New England’s programs pays a different amount toward residential addiction treatment. For example, the HMO Wise 3000/10% HDHP LG policy requires a 10 percent coinsurance fee after the deductible is met. In other words, the insured is responsible for 10 percent of the total bill but must meet the deductible before Health New England pays anything.

The PPO Essential 2000 LG plan for in-network providers pays the full amount after the deductible is met. Like most PPOs, the policy does offer out-of-network benefits that include a 20 percent coinsurance fee after the deductible is met and up to a $500 reduction of benefit. Reduction of benefit means Health New England reserves the right to reduce their payment further by up to $500 and the insured might be responsible for that additional amount.

Health New England also has a Connector group program in the Massachusetts health insurance exchange. Categorization of these plans is by metal level, and these plans could have different benefits than employer group plans.

For example, the HMO Silver A Connector plan requires a $1,000 copay per admission, after deductible. A copay is a flat fee that the insured pays, as opposed to a percentage of the cost as in the case of coinsurance. In this instance, the only out-of-pocket expense is $1,000 as long as the deductible is met.

In general, HMO policies require the insured to use in-network providers, while PPO plans may be more flexible. It is possible that any facility could come to an arrangement with Health New England for billing and payment.

Since Health New England has an extensive selection of plans available, it’s important to check the policy to see what they will pay toward inpatient drug and alcohol rehab.

Does Health New England Cover Outpatient Rehab?

Health New England does cover outpatient drug and alcohol rehab, but, coverage levels depend on the policy. There are many variations among the different insurance offerings from health New England. For instance:

  • HMO Wise 3000/10% HDHP LG has a $25 copay per office visit after the deductible.
  • PPO Essential 2000 LG requires a $20 copay per visit for in-network providers and a 20 percent coinsurance fee after the deductible is met for out-of-network care.
  • HMO Silver A Connector plan specifies a $30 copay per visit.

As with inpatient rehab benefits, expect to stay in-network for HMO plans if possible. The PPO plans do provide benefits of out-of-network facilities, however. None of these policies require preauthorization for care.

Does Health New England Cover Medication-Assisted Treatment?

Health New England may pay for at least part of the costs associated with medication-assisted treatment (MAT). MAT uses different kinds of FDA-approved drugs as part of the treatment process, decreasing the risk of relapse by combining these medications with behavioral therapy. Medications used in MAT may include:

  • Suboxone, Zubsolv, Bunavail (buprenorphine, naloxone)
  • Diskets (methadone)
  • ReVia, Vivitrol (naltrexone)

Does Health New England Cover Sober Living Houses?

Aftercare options like sober living houses may be covered by insurance providers, although Health New England does not list them individually in benefit documents. Often residential treatment facilities include sober living homes in their treatment plans because aftercare is a fundamental part of preventing relapse.

Sober living homes involve staying in a group living environment after leaving an inpatient treatment facility. It’s an essential step for many who are transitioning back to a healthy life in sobriety.

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What Is The Difference Between In-Network And Out-Of-Network?

Health New England differentiates between in-network and out-of-network treatment in PPO plans. In-network refers to a facility that partners with Health New England as part of their network. In-network care providers charge agreed-upon rates and usually bill the insurance company directly.

Out-of-network facilities do not have such an arrangement with Health New England, and out-of-pocket costs will be higher than an in-network provider. Families shouldn’t automatically pass on a treatment provider that appears to be out-of-network, though. All treatment providers perform a verification of insurance benefits as part of the admissions process, and results may vary.

How To Find Drug And Alcohol Rehab Centers That Accept Health New England

1) Contact 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.