Drug And Alcohol Rehab Centers That Take GEHA Insurance
- 1 Drug And Alcohol Rehab Centers That Take GEHA Insurance
- 2 What is GEHA Insurance?
- 3 General Insurance Terms that Individuals Should Know
- 4 What Percent of Treatment Does my Policy Cover?
- 5 What is the Difference Between In-Network and Out of Network?
- 6 What are the Types of Policies Available?
- 7 What is Meant by Metal Levels?
- 8 Does GEHA Cover Mental Health and Substance Abuse Treatment?
- 9 Addiction treatment covered by GEHA
- 10 Will GEHA Insurance Cover Out of State Rehab?
- 11 How Long Will Insurance Cover Rehab?
- 12 How Much of my treatment Does GEHA Cover?
- 13 How Can I Pay the Cost Not Covered by My Insurance Plan?
- 14 I Just Lost My Job, How do I Know if I am Still Covered?
- 15 GEHA Policy Limitations
- 16 How Do I Know What My GEHA Insurance Will Cover?
- 17 How Can I Get GEHA Coverage for Detox and Rehab?
- 18 Find Addiction Rehabs Using My GEHA Insurance – How to Start?
Are you, or someone you know suffering from addiction to drugs or alcohol? Are you thinking about getting help, but worried that you may not be able to afford it? If you answered yes to these questions, there is no need to suffer alone. Health insurances like GEHA are available to help you cover the cost of rehab and get the help you need. Continue reading to find out all you need to know about GEHA and using it for drug addiction treatment.
First, let’s answer a few questions related to terms and concepts normally used when discussing health insurance to make your understanding of the process better.
What is GEHA Insurance?
GEHA is the acronym for Government Employees Health Association. This insurance company is a non-profit organization that works to provide government employees and retirees with health insurance. It was started in Kansas City, Missouri in 1937 when it was first designed to assist the US Railway Mail Service Clerks with medical expenses. Twenty (20) years later, they expanded their services to include all federal employers. Today, they provide both health and dental insurance for all federal employees, their families, and retirees.
General Insurance Terms that Individuals Should Know
Premium: The premium is the fee that you are required to pay each month to get help from your health insurance when you need it.
Out-of-Pocket Cost: This refers to money that you will have to pay from your funds to cover your medical expenses. This includes the deductible, coinsurance, and copayments.
Deductible: The deductible is the amount of money that you will be required to pay towards your medical expenses before the insurance company begins to assist you with payments. This amount is normally a set figure for the calendar year. For instance, if your insurance plan has a deductible of $350, you will be required to pay all medical expenses obtained until you get to a total of $350. Once this is done, your insurance company will then contribute to your other medical expenses once they are covered by your insurance plan.
Coinsurance: Coinsurance is normally expressed in percentage and this is the portion of the cost of your medical expenses that you will pay after paying your deductible. For example, let’s say you have already paid your deductible, and now have medical expenses totaling $100 with a coinsurance of 20%. You will now be required to pay $20, which is 20% of the $100 and your insurance company will pay the remaining $80
Copayment: Copayment or copay for short is a fixed amount that you are required to contribute as payment towards a medical expense that is covered by your insurance. This fixed amount is all you pay regardless of the total. So, if your copay is $20 for a visit to the primary care physician (PCP), but your total bill for that visit is $200. You pay $20 and then the insurance company would be required to pay the remaining $180.
What Percent of Treatment Does my Policy Cover?
The percentage of treatment covered by your policy is the average proportion or fraction of your medical expenses that the insurance company is likely to cover for the calendar year. If your plan has a 60% coverage, you are then likely to pay an average of 40% of the total of your medical expenses acquired. This 40% is inclusive of your deductible, copays, and coinsurance. This percentage gives you an idea of the amount of coverage a plan will offer you.
What is the Difference Between In-Network and Out of Network?
In accessing health insurance, you will find that the terms in-network and out-of-network are mentioned from time to time. In-network refers to those physicians or hospitals that have a contract with your health insurance to provide health care services to members of the insurance company at a discounted rate. As a result, assessing services from these facilities will result in cheaper out-of-pocket prices for you. Out of network, on the other hand, refers to those physicians or health care facilities that do not have a contract with your health insurance company. Using these services may cost you more and depending on your health plan, accessing services from these physicians and facilities may not be covered by your plan.
What are the Types of Policies Available?
Now that you should have a fair understanding of the terms used when discussing medical insurance, let’s consider the various policies available:
HMO – The HMO or the Health Maintenance Organization plan is one of the cheapest plans available. It offers low premiums and deductibles and fixed copays for visits to the doctor. It is best suited for individuals on a tight budget with minimal medical problems. Persons with this plan must choose a primary care physician (PCP) whom they will see for regular checkups. If the services of a specialist doctor, such as the dermatologist or skin doctor are required, they would need a referral for the PCP. All doctors and facilities visited under this plan must be in-network physicians and facilities.
POS – The POS or Point of Service plan is more expensive than the HMO plan with higher premiums. However, it offers more freedom as it also covers out-of-network doctors. The cost to access care from out-of-network doctors will however be greater than that for an in-network doctor. Similar to the HMO plan, a referral from your PCP will be required to visit the specialist doctor. This plan would therefore be a good option for those who use the services of an out-of-network doctor to manage a particular condition.
EPO – The EPO or Exclusive Provider Organization is similar to the HMO plan in that they only cover in-network care. However, with the EPO the networks are larger than those for HMO. Also, a referral from your PCP is not always necessary when visiting a specialist. The premium for these plans is less than that for PPO but higher than that for the HMO.
PPO – The plan providing the most freedom is the PPO or the Preferred Provider Organization plan. With this plan, an individual can see out-of-network doctors and specialists without a referral. However, the coinsurance and copays for in-network doctors are lower. The premium for a plan of this nature is higher than the ones mentioned before.
If you are looking for a plan with good coverage for addiction treatment, a PPO plan would be best. This is because, with a policy like this, you would have access to many different treatment facilities. This would include facilities in-network and out-of-network and facilities in and out of state. As a result, the likelihood of success in treatment for your addiction would be much higher as you would have the freedom to find the center that suits you best. GEHA is a PPO policy and therefore an excellent option in this regard.
What is Meant by Metal Levels?
If you buy insurance on the marketplace, you may find plans being represented as four levels these being bronze, silver, gold, and platinum. Plans are grouped this way to make it easier for persons to shop for insurance. The levels represent the proportion of your health care bill that the insurance company will cover.
Bronze – This is the most basic of the options where the insurance company pays 60% of your medical bills and you pay the remaining 40%. Plans in this category tend to have the lowest monthly premiums but high deductibles. They are good if you are looking for an affordable way to protect yourself from possible serious medical events. However, if you seek routine care a lot it will cost you more in the long run.
Silver – Plans at the silver level provide you with more coverage at 70%. The premiums are moderate and the deductible less than that for bronze. They make a good choice if you would like to have more coverage for routine care.
Gold – Gold plans provide 80% coverage. Premiums are high, but deductibles and the cost of care are normally low. This is a great plan for persons who require a lot of care.
Platinum – Platinum plans provide the most coverage at 90%. As you can imagine these premiums are the highest, however, the deductibles are very low and with this plan, the cost of care is the lowest.
Now that you have a much better understanding of the terms used to discuss health insurance, let’s now answer questions popularly asked about GEHA and drug addiction treatment.
Does GEHA Cover Mental Health and Substance Abuse Treatment?
Yes, GEHA does cover mental health and substance abuse treatment once the service is being offered by licensed professionals acting legally. They therefore cover services offered by licensed psychiatrists, psychologists, professional counselors, family therapists, and clinical social workers to just name a few. They also cover the following services:
- Diagnostic evaluation
- Diagnosis and treatment of alcoholism and drug misuse
- Intervention and stabilization of persons having acute episodes
- Treatment and counseling including group, individual, or in-home therapy visits
- Medication evaluation and management
- Intensive day treatment
- Inpatient rehab and outpatient rehab.
Addiction treatment covered by GEHA
GEHA has different plans, all of which cover many of the treatment and services available for drug addiction. In addition, the plans give you access to both in-network and out-of-network facilities. Here are a few of the services covered:
Detox – Normally the first step in the treatment of addiction is detoxification. This process serves to rid your body of the unwanted substances that may still be in your system. The process can be vigorous and sometimes require medication to assist in the process. It is therefore recommended that persons undergo medical detox in a licensed detox facility under the supervision of medical professionals.
Residential Rehab – Here patients are given 24-hour care in a non-hospital setting in a therapeutic community. This program tends to be highly structured with activities to help residents examine damaging beliefs, destructive patterns of behaviors and adopt new ones. This is especially great for persons who feel like continuing their everyday lives at home might pose too much temptation to start using again.
Outpatient Rehab – Outpatient rehab is available at different intensities and suits persons with jobs and a lot of support. This option is also good for persons suffering from minor addictions. However, before enrolling in an outpatient facility it is highly recommended that you first enroll in an inpatient facility to lay a good foundation for long term recovery.
Sober Living – Sober living homes are residencies where persons trying to recover from addiction live together. Persons living in these homes have to follow the rules of the home, remain sober for the duration of their stay and take part in chores. These homes normally charge rent per month and operate to help individuals reintegrate into society with the support of a sober community. They may however not be covered by the GEHA high and standard plans.
Will GEHA Insurance Cover Out of State Rehab?
After deciding to enter recovery, the next big step is to choose the right facility to suit you. Many states have rehab centers, however, there are times when persons would prefer to travel to a different state for treatment. A different state may seem expensive and inconvenient, but it gives individuals the opportunity to start over as they remove themselves from negative influences and triggers present in their environment. This will allow them to focus more, giving them a better shot at recovery. Health insurance is not limited to treatment programs that are in the state. There are GEHA health insurance plans that will cover out-of-state facilities. The amount of coverage you have access to will however depend on the nature of your plan.
How Long Will Insurance Cover Rehab?
The duration for which your insurance will cover your treatment is heavily dependent on which plan you have. In some cases, plans will cover the treatment for a specific amount of time, while in other cases it will cover a certain proportion of the cost irrespective of the length of the treatment. In other cases, your insurance may even cover all the costs of your plan. The final answer is therefore dependent on your policy.
How Much of my treatment Does GEHA Cover?
The proportion of your mental health or substance abuse treatment that will be covered by GEHA will be dependent on various factors. These factors include the specific type of treatment you may require and your insurance plan. In addition, using an in-network vs out-of-network provider will also affect the fraction of the fee covered by GEHA. Depending on the treatment service being accessed you may or may not be required to pay the deductible fee.
How Can I Pay the Cost Not Covered by My Insurance Plan?
If your health insurance policy does not cover the full cost of your treatment program, all hope is not lost. There are still other ways to cover the remaining cost. Here are a few:
Payment Plans – It is important to make your financial status clear to the rehab center from the beginning. These places were designed to help persons overcome addiction and so many are flexible and have payment options to suit the needs of their patients. In many cases, centers offer payment plans where patients are given the option of lower monthly payments instead of having to pay all the costs upfront.
Loans – Healthcare loans can be assessed from several financial institutions to cover healthcare-related issues such as treatment for substance abuse. These loans tend to have a lower than the normal interest rate and can be used to cover a part or even all of the cost of your treatment. Your credit score may have a big impact on the amount of money you can access via this medium. You could even try reaching out to your bank to see if they provide loans of this nature.
Low-interest Credit Card – Another option is to find a credit card with a low-interest rate and use this to pay the difference in cost. You would then repay the balance over time as you can.
Scholarships – Scholarship programs are available for persons who want to enter a treatment program but are having financial difficulties. As addiction treatment becomes more recognized as important healthcare services, scholarships are being more abundant. The admissions office at the rehab center you are considering is a good place to check for available scholarships
Personal Fundraising and Crowdfunding – You could reach out to family and friends for help and suggest that payments be made directly to the facility. This way, persons can be certain as the intent of the funds. Friends may also be able to help you raise funds via crowdfunding sites such as GoFundMe.
I Just Lost My Job, How do I Know if I am Still Covered?
Under the Consolidated Omnibus Budget Reconciliation Act or COBRA for short, employees and their dependents can continue to enjoy the benefits of their health insurance even after losing their jobs. If your employer has more than 20 full-time employees, they are required to offer this coverage. It extends the coverage of your insurance for additional 18 –36 months after losing your job. During this time the employee is however required to pay the full premium. Federal employees also have a similar benefit under the Federal Employees Health Benefit Program known as the Temporary Continuation of Coverage or TCC.
As a federal employee, once you lose your job, there is a 31-day temporary extension of your coverage at no cost. Under the Temporary Continuing Coverage (TCC), your coverage can continue for as much as 18 months from the date of losing your job once you are eligible. If you were fired from your job because of gross misconduct, you will not be entitled to this benefit. Your Human Resource Department (HRD) will determine what is gross misconduct and whether or not it applies to your dismissal. If this is the reason for which you were let go, your HRD is required to notify you and you can then appeal this decision.
Once you are eligible for TCC you will have 60 days in which to apply for it. It is therefore advisable that you ask your HRD for your TCC information on the last day of work to facilitate early submission of the required form. During the time of your TCC, you will be required to pay the full premium of the plan. Hence you will have to pay both your share and the government’s share of the plan. There is also a 2% administrative charge that you will need to cover.
GEHA Policy Limitations
All substance abuse and mental health services are not be covered under health insurance plans. Some of the services not covered include pastoral, marital, educational counseling, and training services. Plans also do not cover services that are offered by an unlicensed provider. Services that are considered to not be medically necessary are not covered, in addition to those services offered by sober homes and halfway houses.
While many persons may be desirous of luxury rehab centers, some of the perks and amenities offered by these centers may not be covered. This is because they are not considered necessary for your health and safety. As a result, you would have to pay for these extra services yourself if you choose to use a treatment center with luxury services or personal comfort items such as telephone, television, beauty, and barber services.
How Do I Know What My GEHA Insurance Will Cover?
It’s understandable if you are worried as to whether or not your plan will cover the aspect of treatment that you may be interested in or the facility you may be considering. For this information, you can simply call Find Addiction Rehabs, and in five (5) minutes they can verify your GEHA policy and provide you with the information you need. They will be able to inform you of what treatment options are covered by your plan and the amount of coverage you will receive.
How Can I Get GEHA Coverage for Detox and Rehab?
There are many different ways in which you can obtain GEHA coverage, these include:
From Health Insurance Marketplace – You can apply for coverage on the marketplace online, you can also apply by phone or in-person by visiting a trained counselor in your community for information. You can also complete a paper application and mail it in.
Through your Work – You can also contact your agency’s personnel office and inform them of the plan you are interested in. They may then direct you to enroll online using the company’s preferred method.
Buy it yourself privately – If you are a retiree or would like to purchase privately, this can also be done online, via phone, or regular mail.
Individuals under 26 may still be covered under their parents’ GEHA coverage – Natural, adopted, and stepchildren of federal employers are covered under the plans of their parents until their 26th birthday.
Find Addiction Rehabs Using My GEHA Insurance – How to Start?
Once you have decided to get help, the first thing you need to do is determine what benefits are available to you based on your insurance plan. You can contact us today via phone or by filling out the form to let us help you get the process started. No one should ignore receiving treatment for alcohol and drug addiction, or mental health disorders because of financial reasons; not when GEHA has plans and benefits to help you get the help you need.