Drug And Alcohol Rehabs That Accept Prominence Health Plan
One of the most common reasons why a person doesn’t seek treatment for a drug or alcohol addiction is due to financial limitations. Unfortunately, this is a barrier that may in some cases, be more easily overcome than a person thinks. Today, the vast majority of rehab facilities accept a wide variety of insurance plans, providing you or your loved one with a greater number of options that can make your treatment needs a reality. Here, we’ll help you understand how Prominence Health Plan coverage can factor into your ambitions to seek treatment.
Changing Legislation Offers You More Complete Care
Fortunately, the political and social climate surrounding addiction and the subsequent need for treatment has greatly changed over the years. We now understand that an addiction is a disease, one that with proper medical treatment and attention, can be managed in a way that offers you both sobriety and better health.
Due to this shift, insurance companies have adapted to better serve their clients. This is due largely in part to changing legislation surrounding addiction treatment. In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law, and made effective for most plans starting the first of the year in 2010. This provided groundbreaking access to mental health and substance use coverage that was not otherwise mandatorily included within insurance coverage. Specifically, it mandated that coverage had to be equal to that which was offered for medical and surgical care.
These regulations may apply to coverage that you obtain from your employer. According to the United States Department of Labor, “MHPAEA applies to plans sponsored by private and public sector employers with more than 50 employees, including self-insured as well as fully insured arrangements.”
Understanding Your Prominence Health Plan Coverage
Prominence Health Plan, previously called St. Mary’s Health Plans until 2014, is a provider that offers various insurance options for residents of Texas and Nevada. Their insurance coverage may be obtained several ways, including by purchasing it on your own for yourself or your family, or as obtained by an employer that offers Prominence plans.
Originally a Health Maintenance Organization (HMO), Prominence’s services now go beyond this, and in addition, they also offer Preferred Provider Organization (PPO) health plans, and Point of Service (POS) plans, the latter of which offers you the lower out-of-pocket costs associated with a HMO paired with the increased flexibility of choosing a PPO provider. Each of the former has numerous plans that may vary depending on both your state, and your specific location within the state.
Your substance abuse treatment coverage will vary depending on the state you reside in, and if you receive coverage from an employer or an individual plan. The following are examples of information gleaned from the Prominence website that give you ideas of both individual and employer-offered plans.
In example, the lower level Bronze 10 Premier individual plan for the 2017 open enrollment in Northern Nevada, taken from the Premier Network Base Plans, has a $4000 copay for both inpatient withdrawal and inpatient rehabilitation per stay, and outpatient rehab or day treatment has the Calendar Year Deductible (CYD)/0% copay. In comparison, within this same category of plans, the Gold 2 Premier plan has $500 copay per stay for both inpatient withdrawal and rehabilitation, with outpatient rehab or day treatment falling at CYD/30% copay.
In contrast, also for Northern Nevada, the employer offered Premier North HMO Plan, HMO Core 1 Premier North, has a $650 copay per admit for both inpatient withdrawal and rehabilitation, and 10% coinsurance for outpatient rehabilitation/day treatment, whereas their HMO Ded 9 Value Premier North plan has a CYD/30% Coinsurance for all three treatment needs.
These are only some examples, representing only one region within Prominence’s coverage area. In order to get exact representations of what your specific plan covers, or the plan and coverage that is applicable to your area and needs, contact Prominence directly.
Utilizing Resources To Determine The Extent Of Your Coverage
Wading through insurance options, coverage, and the supporting language and forms can be overwhelming and confusing. Due to this, it is helpful to enlist the aid of trained professionals that can help to clarify things and put you on the right path. Depending where you are within the process, there are several ways to go about this. Your primary resources are going to be Prominence and the rehab facilities.
If you currently don’t have insurance, or if you’re looking to change to another provider, and you’re in the process of contemplating drug or alcohol treatment, you should carefully look over your plan options, whether they be through an employer, or on your own accord. If you already have a Prominence plan, you will essentially communicate to these entities in the same way, only with a more directed focus.
First, as you’re assembling a list of facilities that you are interested in, you can contact them individually to see if they accept Prominence Health Plans, and if so, to what extent. Our staff can also assist you during this time, helping you to determine what your coverage options are within specific facilities.
As you’re looking over coverage and copays, it can be helpful to speak to a Prominence representative to help you clarify and compare the information you’re looking at. When you speak to them, it is important to keep a few things in mind that can be helpful to inquire about.
- Is substance abuse treatment covered under this plan?
- Do you have a list of facilities that accept this insurance for substance abuse treatment?
- If I choose inpatient drug rehab, is there a maximum amount that is covered on a daily basis?
- What specific services do you cover during my treatment at a drug rehab center?
- Are medications covered?
- Are aftercare services covered?
After you’ve spoke to these parties, take time to compare your options against the specific needs of your situation. Don’t fret—if your insurance does not cover treatment, or if it doesn’t cover the full amount, you may yet have options. You may be able to access various other resources to help you obtain your treatment needs. Financial aid, financing options, and a variety of scholarships and grants exist to help you stay on track towards sobriety. Your place of employment may also offer an Employee Assistance Program (EAP) to help you with your needs during this time.
Let Us Be Part Of Your Team
You should never have to contend with the process of seeking treatment alone. With so many options and concerns, it can be a daunting process. Let us help you. At RehabCenter.net our staff is well-versed in insurance and other financial concerns, and can offer you a wealth of additional resources on treatment types and locations. We can help you put together a treatment plan that best serves your unique needs. Contact us today to get started.