For those who struggle with addiction, finding the right treatment program can mean the difference between years of struggle and a successful life in recovery. Therapy is not often cheap, and many find themselves wondering how they will be able to pay for this service. Providence Health Plan offers addiction treatment coverage options for patients in Oregon and Washington.

Providence Health Plan has several different levels of insurance coverage that are broken down based on metal levels. Members can choose from:

Gold health plans: These plans have a high monthly premium and a low deductible. They are a good match for people who need frequent medical care.

Silver health plans: Silver plans have a middle-of-the-road premium and deductible. They work well for people who need to control their monthly costs but want decent coverage when needed.

Bronze health plans: These plans have a low monthly premium and a high deductible. They work well for people looking for catastrophic insurance coverage.

In addition, Providence Health Plan breaks down its insurance plans based on the provider network. Plans fall into one of three different networks, and the network a person chooses affects the cost of the policy. These networks are:

  • Providence Signature Network – This is the largest network, with close to one million providers across the nation.
  • Providence Choice Network – This network requires the member to choose a medical home from one of over 230 primary care clinics in the region.
  • Providence Connect Network – This network is limited to the greater Portland area, offering lower cost but a limited network of just over 70 primary care clinics in Clackamas, Hood River, Multnomah, Washington and Yamhill counties.

No matter which plan an individual has, it will include behavioral health services, which includes addiction treatment. Behavioral health coverage is a requirement of the Affordable Care Act.

About Providence Health Plan

Providence Health Plan provides health insurance in Oregon and parts of Southwest Washington. Although it is one of the country’s smaller health insurance providers, it has a strong focus on helping people take better care of their health, both physical and mental. Providence Health Plan is a locally owned, not-for-profit health plan that has been serving the region for over 160 years.

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Does Providence Health Plan Cover Drug And Alcohol Detox?

Providence Health Plan insurance policies cover drug and alcohol detox as part of the plan’s behavioral health services. These services require prior authorization before the first visit. Because detox is typically handled on an inpatient basis, members are responsible for their deductible and a coinsurance amount, which for silver plans is 30 percent.

Detox is the process of allowing the addictive substance to leave the body. For those who are physically dependent on drugs or alcohol, withholding a substance leads to intense, uncomfortable withdrawal symptoms.

Alcohol and drug detox programs take place under close supervision to ensure the patient is safe and as comfortable as possible. During detox, medical care is provided and therapy can start, but the main focus is on managing withdrawal symptoms and preventing the patient from having any access to the addictive substance.

Does Providence Health Plan Cover Inpatient Rehab?

Yes, Providence Health Plan insurance covers inpatient services. Patients must meet their deductible before the insurance coverage will kick in, and then the plan requires payment of a coinsurance fee. For silver plans, this is 30 percent. Providence Health Plan also requires members to get prior authorization from the insurance company for their inpatient addiction treatment services.

Inpatient programs provide residential addiction treatment that offers counseling and other therapeutic services while the patient lives in a monitored environment. Inpatient treatment helps set the stage for success in other areas of addiction treatment.

Does Providence Health Plan Cover Outpatient Rehab?

Outpatient treatment is covered under Providence Health Plan insurance programs. Provider office visits do not require prior authorization. For silver plan members, a $25 copay per office visit or a 30 percent coinsurance fee is required for outpatient addiction treatment services, and patients will also need to meet their deductible.

Outpatient treatment can be an effective way to treat minor addictions. It also serves as the next level of care after an inpatient treatment program. During outpatient treatment, patients live at home and are able to maintain most aspects of daily life, but they attend therapy regularly.

Outpatient treatment can be intensive, requiring a patient to be in therapy full time except for time spent at home at night, or they can be less intensive. Each patient’s doctor will determine the best course of treatment for their individual addiction treatment plan.

Does Providence Health Plan Cover Medication-Assisted Treatment?

When a patient’s doctor feels that medication-assisted treatment will help reduce the chance of relapse, Providence Health Plan covers the cost of that medication under its prescription drug coverage. This coverage requires the member to pay a copay or deductible before coverage will kick in.

For generic prescriptions, the copay is $0 to $15. For preferred brand prescriptions, gold plan members pay a $30 copay, silver plan members pay a $60 copay and bronze plan members pay nothing after meeting the deductible. For specialty brand medications, gold and silver plan members pay 50 percent coinsurance, while bronze plan members are fully covered after meeting deductibles.

Prescription drugs can help make addiction treatment more successful by preventing withdrawal or blocking the pleasurable effects of substance use. Some common prescriptions used in MAT programs include ReVia (naltrexone), Suboxone (buprenorphine, naloxone) and Diskets (methadone).

Does Providence Health Plan Cover Sober Living Houses?

Sober living houses are not a covered service with Providence Health Plan insurance programs. These facilities offer a group living arrangement where people who are new to recovery can live in a drug- and alcohol-free environment. Because no treatment or therapy is typically included, these programs are not covered.

Many people will enter sober living houses after completing inpatient or outpatient treatment. Some will live in these homes while attending outpatient treatment at a separate facility.

In-Network Versus Out-Of-Network Coverage

Providence Health Plan’s robust provider networks allow them to provide access to treatment across all medical disciplines, including addiction treatment. The company has three different networks that its various plans belong to, which means there are an extensive number of treatment options for members.

Providence Health Plan coverage extends to in-network facilities only. Patients would be responsible for the full cost of treatment provided at facilities that are not in-network.

Most people struggling with addiction find that selecting the right treatment facility is critical to their success in recovery. Patients can call their preferred treatment facility and request a verification of benefits. This is often the fastest way to find out whether a facility is included in the Providence Health Plan network.

How To Find Drug And Alcohol Rehab Centers That Accept Providence Health Plan

1) 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.

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.