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WPS Health Solutions Insurance Coverage For Drug And Alcohol Rehab

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WPS Health Solutions offers insurance for individuals, families and employers throughout the state of Wisconsin. Someone seeking alcohol or drug rehab may find that many treatment options are covered by their WPS insurance plan.

Specific coverages and limitations will depend on the particular policy a person has. For instance, someone with catastrophic individual insurance through WPS Health Solutions will likely find that treatment is not covered. On the other hand, someone who has an individual bronze plan or a group plan through their employer will find that at least some treatment options are covered with insurance.

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Does WPS Health Solutions Cover Drug and Alcohol Detox?

Drug or alcohol detox is a preliminary step before treatment begins. Because of the dangers of withdrawal, detox should occur in a medically supervised setting. Medically supervised detox may involve the use of medications that can help alleviate the discomfort and address some of the dangers of withdrawal, depending on the needs of the individual patient.

Most WPS insurance policies will cover medically supported inpatient detox. The patient may be required to seek prior approval from WPS before receiving care.

Does WPS Health Solutions Cover Inpatient Rehab?

Inpatient drug and alcohol rehab, also known as residential addiction treatment, is covered by most ACA-compliant health insurance policies, including those offered by WPS. Deductible and coinsurance payments will apply. The insured will need to seek prior authorization from WPS for any elective inpatient stays.

An inpatient facility offers a space away from the stresses of daily life for a patient to concentrate on treatment and recovery. Residents live in a group setting with others who are in recovery. Treatment can include group and individual counseling, dietary and health counseling and other therapies as appropriate to the individual.

Does WPS Health Solutions Cover Outpatient Rehab?

Outpatient addiction treatment is an effective option for many who are struggling with substance use. Those who have milder addiction symptoms, for instance, may be able to attend treatment at an outpatient facility while continuing to live at home, allowing them to attend to work and family obligations.

Most of the therapies associated with outpatient rehab are the same as those offered in an inpatient setting. The patient just visits each day for treatment instead of living on-site.

Outpatient treatment can also be a more affordable option for those who have insurance policies with lower coverage levels. Someone with a low-cost insurance policy may find an outpatient facility to be a more financially manageable option. The choice between inpatient and outpatient treatment should be made by each individual depending on their prior treatment history, their environment at home and other factors.

How much outpatient treatment will cost will depend, in part, on whether the facility is in-network or out-of-network. At an in-network facility, the patient may only be responsible for a copay. However, at an out-of-network facility, a deductible and coinsurance payment may be required, or the patient may be responsible for the entire cost of treatment.

Does WPS Health Solutions Cover Medication-Assisted Treatment?

Sometimes medication can be used alongside counseling to help improve treatment outcomes. Medications like Diskets (methadone), Suboxone (buprenorphine and naloxone) and others can help decrease opiate cravings and prevent withdrawal symptoms during treatment. In other cases, medications can help reduce cravings for alcohol by making the patient sick if they consume alcoholic beverages. All medications used in MAT programs help reduce the chances of relapse during treatment.

Individuals who have insurance through WPS Health Solutions should contact their provider to learn which medications are covered by their specific plan. WPS’s preferred drug guide can give more information about the medications, dosages and medication forms that are covered.

Most medications that are used in medication-assisted therapy (MAT) come in a number of forms and dosages. For instance, some medications are available in chewable, liquid or sublingual forms. Checking to ensure that the dosage and form desired is covered can help ensure that medications are both affordable and readily available throughout treatment.

Does WPS Health Solutions Cover Sober Living Houses?

The Affordable Care Act requires that qualifying health insurance policies cover drug and alcohol treatment. However, since sober living houses are not considered treatment, they are unlikely to be covered by WPS Health Insurance. Additionally, many states require that sober living houses be financially independent and function without the support of payments from insurers.

Sober living houses are safe residential facilities for people who no longer need to be in a residential treatment program but who are not ready to return to the stresses of regular life. They are places to avoid environmental triggers that could lead to a relapse. They also offer an environment where people recovering from addiction can support one another and offer understanding and fellowship that can help build a lasting recovery.

In-Network Vs. Out-Of-Network: What’s The Difference?

Healthcare costs will vary significantly depending on whether a provider is one of WPS Health Solution’s preferred providers or whether services are provided out of network.
In-network treatment centers have an agreement with their insurance provider. While WPS Health Solutions will often cover some level of out-of-network care, a patient’s out-of-pocket costs are likely to be much higher.

Depending on the type of policy the insured has with WPS Health Solutions, in-network and out-of-network treatment centers can vary thousands of dollars in out-of-pocket costs. The patient may only be responsible for a copay during outpatient treatment with an in-network provider. A deductible and coinsurance may apply during treatment with an out-of-network provider.

How To Find Drug And Alcohol Rehab Centers That Accept WPS Health Solutions

1) 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.

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.