A normal first step when seeking help for an addiction is to research insurance benefits for drug or alcohol rehab. Insurance is often a vital part of paying for those services, and each provider offers different levels of coverage for substance abuse.
Johns Hopkins in one of the leading providers of comprehensive healthcare. The Johns Hopkins Employee Health Program takes a unique approach to how it provides health care to members, and it does include coverage for drug and alcohol rehab.
Plans vary by employer, and the Johns Hopkins EHP includes custom plans for each employer in its system. Plans are separated into two categories: union employees and non-represented employees. Some plans may be broken down by union or nonunion while others have one policy for both.
What can individuals who are part of the Johns Hopkins EHP program expect when it comes to drug and alcohol rehab?
Does Johns Hopkins EHP Cover Drug and Alcohol Detox?
Johns Hopkins EHP includes medically supervised detox for opioid or alcohol addiction. These two substance use disorders often lead to uncomfortable and potentially dangerous withdrawal symptoms during detox, such as:
- Muscle cramps
Medical support during detox frequently incorporates medications to help control or prevent withdrawal symptoms and cravings. These medications, such as Suboxone (buprenorphine, naloxone) and Diskets (methadone), may be covered as part of the plan’s prescription medication benefits or may be evaluated on a case-by-case basis.
Johns Hopkins EHP plans require preauthorization for most services, and without it, the plans may not pay for the cost of detox. There will likely be some out-of-pocket expenses for detox services.
Most of the Johns Hopkins EHP plans require either a copayment or a coinsurance fee based on the employer and plan, and deductibles may also apply. Copayment means paying a set amount, and coinsurance means paying a percentage of the bill.
Does Johns Hopkins EHP Cover Inpatient Rehab?
Johns Hopkins EHP plans include coverage for inpatient drug and alcohol rehab. How much the plan pays toward inpatient services will depend on the plan. Each one varies by employer and according to union or nonunion benefits.
Both union and nonunion employees can expect a copay for inpatient programs that ranges from $10 per day to $150 per admission, or patients may be responsible for a coinsurance percentage. In some plans, the deductible also applies.
The Broadway Services policy pays 100 percent for in-network residential costs but requires a $15 copay for professional fees and mental health testing and procedures. This plan pays the entire bill for residential expenses, but patients owe a copay for the actual treatment.
The Johns Hopkins University benefits plan, on the other hand, requires a $250 copay per admission and covers 80 percent of the professional fees for services.
Both employers allow for out-of-network care, but out-of-pocket expenses go up. The insured is responsible for a $100 copayment per admission, along with 70 percent of reasonable and customary charges. The University plan increases the copayment to $250 per admission for out-of-network facility fees and pays 70 percent of charges for other services.
For both in-network and out-of-network treatment, preauthorization is necessary to be eligible for the full benefit. The coverage differences are from employer to employer, so looking at the insured’s specific policy is helpful.
Inpatient or residential rehab refers to a program that requires the patient to live in the facility while participating in treatment. Programs typically last at least 30 days, but some may run 120 days or longer depending on the needs of the patient.
Does Johns Hopkins EHP Cover Outpatient Rehab?
Outpatient services allow the insured to participate in addiction treatment without living in a treatment facility. The specific services and therapies provided will vary based on the needs of the patient.
Some common outpatient treatment options include:
- Day programs, sometimes called partial hospitalization programs. The insured stays at the facility during the day and goes home at night with a family member or friend.
- Outpatient counseling
- Continuing care via peer groups
As with inpatient benefits, outpatient coverage depends on the employer and the policy. On average, both union and nonunion employees can expect Johns Hopkins EHP to cover at least part of the cost of outpatient care. The plans range from a $10 to $150 copay. Some policies pay 90 percent of the allowable coverage amount, leaving the insured responsible for the difference.
Employer Broadway Services covers 80 percent of the allowed amount for all fees. The Johns Hopkins University plan will include 100 percent of the allotted amount for facility fees and requires a $15 copay for professional expenses including day programs.
Both of these employers offer coverage for out-of-network facilities that will pay 70 percent of reasonable and customary charges for both facility and professional fees. With each, the deductible applies. Preauthorization is necessary for any outpatient treatment.
Does Johns Hopkins EHP Cover Medication-Assisted Treatment?
Johns Hopkins EHP includes coverage for medication-assisted treatment in most employer plans. Medication-assisted treatment (MAT) combines FDA-approved drugs such as Diskets (methadone) or Suboxone (buprenorphine, naloxone) with behavioral therapy to increase success in recovery.
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Johns Hopkins EHP plans may pay for MAT for alcohol addiction as well. With alcohol MAT, the insured takes a medication such as Antabuse (disulfiram) to block an enzyme that metabolizes alcohol. Without this enzyme, drinking produces an unpleasant reaction and discourages relapse.
Plans for the Broadway Services Inc. and Johns Hopkins University both list MAT as a benefit, but the amount paid will vary by each employer.
Does Johns Hopkins EHP Cover Sober Living Houses?
Aftercare services like sober-living houses are not mentioned in the benefits plans, but the outpatient programs covered by Johns Hopkins EHP plans are extensive. Plans mayl pay for this service if pre-authorized and medically necessary.
Sober living houses offer those leaving an inpatient facility a safe living environment while they continue their outpatient treatment or work further on developing their relapse-prevention skills.
What Is The Difference Between In-Network And Out-Of-Network Coverage?
Johns Hopkins EHP partners with care facilities to establish a network of providers who agree to charge specific rates for healthcare services. This arrangement also allows the in-network treatment center or healthcare professional to file claims directly with the insurance company.
Out-of-network facilities do not have this partnership with Johns Hopkins EHP. Some plans include lower coverage rates for out-of-network providers, or no coverage at all. In some cases, the insured may file claims with Johns Hopkins EHP themselves to get reimbursement.
All treatment centers verify coverage before providing care. This verification process provides both the facility and the insured a complete understanding of the coverage allowances before treatment begins. The verification process is different for each facility and may allow for payment arrangements.
How To Find Drug And Alcohol Rehab Centers That Accept Johns Hopkins EHP
- 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.
- 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.