Massachusetts Laborers’ Benefit Funds were created to cover the health, pension and annuity plans of laborers and their dependents. Workers who build everything from roads to bridges in the state of Massachusetts are eligible as long as they apply for membership, pay union dues and meet work requirements.
The Massachusetts Laborers Health and Welfare (MLHW) Fund plan is administered through Blue Cross Blue Shield of Massachusetts, offering access to their expansive provider network.
There are two categories of coverage under the MLHW fund, both of which are based on the number of hours a person works in a 12-month qualifying period.
- Plan A: 1,000 hours in a 12-month qualifying period
- Plan B: 700 hours in a 12-month qualifying period
Plan A has a $250 deductible per individual, with a maximum of $500 per family for in-network PPO coverage. It also has a $750 deductible per individual with a $1,500 maximum per family for out-of-network providers in a PPO coverage area.
Plan B has a $500 deductible per individual, with a maximum of $1,000 per family for in-network PPO coverage. It also has a $1,000 deductible per individual with a $2,000 maximum per family for out-of-network providers in a PPO coverage area.
Member Assistance Program
For those who experience drug or substance abuse and need additional help, the MLHW fund offers a member assistance program (MAP). The MAP helps with any issues that are not covered under a traditional medical plan, including income replacement if the covered person is unable to work as a result of their treatment. Insurance coverage for addiction treatment programs cannot begin until the insured has first contacted the MAP.
Does Massachusetts Laborers Cover Drug And Alcohol Detox?
If a patient participates in inpatient detox at an in-network drug or alcohol rehab facility and is covered under Plan A, the plan will pay 100 percent of the costs until the amount charged reaches $20,000. Once the charges exceed that amount, the patient will be responsible for 15 percent of the cost until they reach an out-of-pocket limit of $2,000. Once they have reached that limit, the plan will begin paying at 100 percent again.
If the patient participates in inpatient detox at an in-network, inpatient drug or alcohol rehab facility under Plan B, the fund pays 100 percent of the first $7,500 charged to their insurance. The patient is then responsible for 15 percent of the cost until they reach an out-of-pocket maximum of $5,000. At that point, the fund will pay at 100 percent again.
Before treatment for the psychological and emotional aspects of addiction can begin, patients must go through a detoxification process where drugs and alcohol are withheld and allowed to leave the body. While detox is often the precursor to more extensive inpatient treatment, it is not usually used as a standalone treatment.
During detox, medical professionals monitor the person going through withdrawal and may administer medication to help with severe symptoms, such as:
- Irregular heartbeat
- Inability to regulate body temperature
Does Massachusetts Laborers Cover Inpatient Rehab?
Anyone covered by MLHW is limited to 25 days of inpatient rehab treatment over their lifetime. This treatment must be pre-authorized by the MAP and is paid with the same limits of Plan A or Plan B inpatient care that apply to detox.
Patients of inpatient rehab, also known as residential addiction treatment, live in a group setting while attending therapy, participating in recovery activities and learning how to live a life of sobriety.
Does Massachusetts Laborers Cover Outpatient Rehab?
Outpatient drug and alcohol rehab is conducted using the same therapies as inpatient rehab, but the patient returns home after treatment each night. Under the MLHW fund, there is a maximum coverage of $1,500 per the calendar year regardless of if the patient is covered under Plan A or Plan B.
Eight outpatient addiction treatment visits are automatically covered under the MAP. After those visits, the fund will pay 100 percent of the first $500 in covered charges. The fund will then pay 80 percent of the remaining covered charges. The patient will be responsible for paying the remaining 20 percent. This continues until the fund reaches the $1,500 maximum payout.
Continuous outpatient rehab for no less than three hours per day and no more than 12 hours per day is considered partial hospitalization. Members are eligible for up to 10 days of partial hospitalization treatment for addiction in a calendar year. If the cost of one of these partial hospitalization sessions is more than half of the cost of inpatient care at the same facility, the coverages will change to inpatient coverage and be subject to the same limitations.
Does Massachusetts Laborers Cover Medication-Assisted Treatment?
The prescriptions used in medication-assisted treatment are considered non-preferred, name-brand drugs. Subscribers must pay a $25 copay for the first prescription and the first refill. After that, members must cover 50 percent of the cost of the medication associated with this treatment.
The medication-assisted treatment combines behavioral therapy with FDA-approved medications to help prevent relapse. These medications often include Suboxone (buprenorphine, naloxone), Diskets (methadone) and Vivitrol (naltrexone), among others. Some of these medications prevent withdrawal, others make the user feel sick if they drink alcohol or use drugs. Some even block the pleasurable effects of opioids, alcohol or even nicotine.
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Does Massachusetts Laborers Cover Sober Living Houses?
Alcohol- and drug-free group living arrangements, known as sober living houses, are frequently recommended by inpatient providers. However, MLHW fund does not cover costs associated with sober living houses. The fund does offer outpatient rehab coverage in addition to inpatient addiction treatment coverage.
In-Network Versus Out-Of-Network
In an effort to reduce costs for all members, MLHW will not provide coverage for any substance use disorder care performed by a provider who is not a part of the Blue Cross Blue Shield of Massachusetts (BCBSMA) network. Even if a facility is considered a part of the network, not all providers may be participants. When looking for a drug and alcohol treatment facility, inquire if all providers are a part of the BCBSMA network.
However, there are instances where treatment can be sought at an out-of-network facility and be covered at an in-network rate. If a doctor prescribes a medically necessary drug or alcohol treatment program and there is not a facility of that type within a certain number of miles of a member’s home, MLHW will cover the cost of treatment at an in-network rate. Treatment under these circumstances must be pre-approved before coverage can begin.
How To Find Drug And Alcohol Rehab Centers That Accept Massachusetts Laborers
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.