What can people with Samaritan Choice Plans insurance expect when paying for drug and alcohol rehab?
Does Samaritan Choice Plans Cover Detox?
It is likely that all Samaritan Choice insurance policies will cover some portion of the bill for drug and alcohol detox. All detox services require preauthorization, and how much the policy pays depends on which plan the insured carries.
Samaritan Choice insurance works under two distinct groups for all services:
- Samaritan Choice
- InterCommunity Health Network CCO
Samaritan Choice offers two insurance plans: high deductible and wellness. Each plan has its own coverage criteria for services, including detox.
The InterCommunity Health Network CCO plan may cover detox in full, as long as services are preauthorized and the insured uses a contracted provider. The Samaritan Choice plan may also pay for detox but would require a copayment or a coinsurance fee.
What Are Copayments And Coinsurance?
Copayments are flat fees one pays for a service such as medically managed detox. If the plan lists a $100 per day copay, the insured is responsible for $300 if the detox takes three days. There can be a cap on daily copayments, too, such as five days, meaning the most the insured pays is $500.
Coinsurance is a percentage of the total bill. If the plan lists a 30 percent coinsurance fee, the insured must pay 30 percent of the final bill. In some situations, there may be separate benefits for facility fees and physicians fees that also apply to detox care.
Withdrawal occurs within a few hours to a few days after a person stops using a substance or drinking alcohol. During this time, they can experience potentially dangerous withdrawal symptoms, such as:
- Dehydration
- Vomiting
- Muscle cramps
- Fever
- Hallucinations
- Mood changes
- Depression
- Seizures
Detox offers management of these withdrawal symptoms using both support and medication. Medically managed detox provides a smoother transition into rehab.
Does Samaritan Choice Plans Cover Inpatient Rehab?
Samaritan Choice Plans covers inpatient drug and alcohol rehab either in part or in full. Inpatient addiction treatment allows the insured to live in a residential facility while participating in therapy, typically for 30 days to 120 days or longer if necessary. This puts them in a protected environment during treatment, living with others who are also recovering from substance use disorders.
For inpatient rehab, Samaritan Choice Plans most likely covers:
- Screening and dual diagnosis assessment
- Medical exam
- Inpatient residential costs for housing and food
- Medication
- Therapy
The InterCommunity Health Network CCO plan may pay 100 percent for inpatient rehab with prior approval, based on the Oregon Health Plan (OHP) guidelines. OHP is a state-sponsored insurance program.
Coverage levels are different for those with insurance under the Samaritan Choice plan. Out-of-pocket expenses will depend on if treatment occurs in a Samaritan Health Services facility, an in-network center or out-of-network. The amounts may change from year to year and preauthorization is required regardless of a facility, but in general, patients can expect to pay:
- A per-day copay ranging from $100 to $175 for SHS services, up to five days
- A per-day copay up to $300 for in-network, non-SHS services, up to five days
- 30 percent coinsurance fee for out-of-network facilities
Dual Diagnoses And Co-occurring Disorders
Individuals with a drug or alcohol use disorder often have an underlying mental health condition such as bipolar disorder or major depressive disorder. Getting dual-diagnosis treatment for both the addiction and the underlying mental health problem offers the best hope of a full recovery.
Does Samaritan Choice Plans Cover Outpatient Rehab?
Samaritan Choice Plans covers outpatient rehab, but how much depends on the patient’s specific plan. Samaritan Choice Plans may not include every type of outpatient program, however.
Outpatient rehab comes in different types of treatment programs, including:
- Day programs: also known as partial hospitalization programs; individuals spend daytime hours at a facility participating in treatment but return home at night with a friend or family member
- Outpatient counseling and therapy: usually private and group
- Continuing care: peer groups like AA or NA
Samaritan Choice Plans policies require a copay ranging from $35 to $40 for in-network providers and a coinsurance fee of 30 percent for out-of-network treatment. There is no preauthorization necessary, but the wellness insurance plan does differentiate between mental health counseling and chemical dependency outpatient services.
The InterCommunity Health Network CCO program covers outpatient therapy in full as long as it’s offered by a contracted provider and preauthorized. The plan may not include other outpatient services, however.
Does Samaritan Choice Plans Cover Medication-Assisted Treatment?
Medication-assisted treatment (MAT) may be covered under Samaritan Choice Plans insurance if the treatment is medically recommended and preapproved. Samaritan Choice takes a wellness approach to treatment and offers a comprehensive pharmacy benefit for FDA-approved drugs.
Prescription coverage could include:
- Suboxone, Zubsolv, Bunavail (buprenorphine, naloxone)
- ReVia, Vivitrol (naltrexone)
Does Samaritan Choice Plans Cover Sober Living Houses?
Sober living houses provide a safe environment for those who are transitioning from inpatient rehab back to independent life in sobriety. Insurance companies like Samaritan Choice do often cover aftercare treatments, if only in part, because they reduce the risk of relapse.
Samaritan Choice Plans may require the use of a contracted provider for aftercare services like sober living. Patients should assume preauthorization will be necessary for any insurance coverage to apply.
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What’s The Difference Between In-Network And Out-Of-Network?
In-network facilities have a billing arrangement with Samaritan Choice Plans. An in-network treatment center will send bills charged at agreed-upon rates directly to Samaritan Choice for payment.
Samaritan Choice Plans offers two types of in-network facilities. The SHS treatment center is part of the Samaritan Health Services group, which means the facility is owned and operated by Samaritan. In-network, non-SHS facilities are treatment partners that are outside the Samaritan Health group.
Out-of-network providers have no prior business relationship with Samaritan Choice Plans. Families may still be able to use addiction treatment centers that are out-of-network. The out-of-network center may be able to work out a billing plan with Samaritan Choice Plans, or the insured can file claims themselves.
How To Find Drug And Alcohol Rehab Centers That Accept Samaritan Choice Plans
- Contact Vertava Health for 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.
- 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.
