For people who suffer from a severe substance abuse problem such as drug addiction or alcoholism, the best option for recovery is rehabilitation. For many, however, the only real thing holding them back from getting the care they need is the cost, as the expense of a rehabilitation program is not cheap. Fortunately, there are options, such as the MHNet behavioral health program, that could help with the matter of insurance coverage for rehabilitation.
The MHNet Drug Rehab Coverage is a health insurance program intended to help people get into a rehabilitation program and aid with the payment as well. The passing and enactment of the Affordable Care Act (ACA) in March 2010 mandated that healthcare providers must cover the cost of addiction treatment, as both drug addiction and alcohol dependence are considered diseases. As such the treatment of these conditions is considered an essential health benefit.
The ACA mandate dictates that all essential health benefits must be covered by insurance, including mental health concerns, behavioral health concerns, and substance abuse problems. Many, however, are concerned that debates and contentions concerning healthcare could put the future of the ACA up in the air, and even suspend the mandated treatment coverage. This situation makes options like the MHNet Drug Rehab Coverage invaluable for those seeking rehabilitation but might not be able to shoulder the cost.
MHNet Behavioral Health has partnered with numerous medical detox centers and institutions offering rehabilitation programs to provide affordable and low-deductible addiction treatment. This is an immense aid for those who cannot afford the expense of a proper rehab or might not have the proper coverage for one.
Just like other institutions, addiction treatment facilities work with a number of insurance providers. Providers who work with a treatment center are said to be “in-network” as they belong to the network of insurance providers that have partnered with the treatment center.
Patients who have insurance through these in-network providers are able to use their plan should they seek treatment at the facility partnered with the provider. These in-network insurance providers have negotiated a standing contract with treatment facilities that ensure mutual benefit, such as paying the treatment facility an agreed-upon rate whenever one of their members enrolls in a treatment program in the facility.
Out-of-network providers, as the name might suggest, are the providers that are not part of the insurance provider network partnered with a particular facility. As such, these providers do not have a pre-negotiated contract with the facility, and if a patient happens to be using an out-of-network provider, the rate will then be determined on the particulars of the treatment they receive, as opposed to the discounted rate offered by in-network providers.
The MHNet drug rehab coverage works similarly to other insurance plans, where a member pays an annual fee for the coverage. This insurance plan is typically offered as one of the perks of employment in a particular company, although some individuals could enroll in a plan of their own choosing which they pay for on their own.
Depending upon the particulars of the insurance taken, MHNet drug rehab coverage could typically cover the entire expense of rehab treatment, although there are also instances where only a portion of the total cost is covered.
While most treatment centers do have their own procedure when facilitating a patient’s rehabilitation, many follow a specific step-by-step process, which includes:
This phase of the process is where the patient meets with an MHNet-authorized primary care physician. The physician will conduct an interview and assess the particulars of the patient’s substance dependencies. This assessment will be the determiner if the patient will need professional addiction treatment.
It should be noted that will medical professionals in the field of addiction treatment are trained and experienced to spot any falsehoods the patient might say about their habit, it would be best if the patient is entirely forthcoming about their dependencies as honesty will go a long way to facilitate a better recovery process.
Once the physician has determined that the patient is indeed in need of medical detox and rehabilitation, they will revert to MHNet to discuss the particulars of the case. The physician will fill out the required documentation such as prior authorization forms and others and then prescribe the most suited best treatment method.
This will usually entail what particular treatment form the patient needs to go through during their rehabilitation and therapy phases. The thorough interview and in-depth assessment done by the physician is also done to ascertain what particular treatment form would work best for the patient, as some patients resonate better with some treatment form than others.
MHNet will also assist the patient in finding the best treatment facility that offers the appropriate treatment for their rehabilitation and therapy. In some cases, the Mental Health Network may recommend a particular facility. Patients are also allowed to find a treatment facility on their own, should this be something they prefer.
It should be noted, however, that MHNet maintains a vast network of partnered treatment centers, and are familiar with the particular specialties of these centers. This knowledge allows MHNet to provide an informed suggestion when they recommend a facility to a patient.
Once a suitable facility has been found that provides the appropriate treatment, the patient will now be able to enroll in it. The treatment usually proceeds as soon as all the needed particulars are attended to, with most enrollees going through medical detox shortly after enrollment.
Currently, insurance providers all over the US are mandated by both The federal Mental Health Parity & Addiction Equity Act of 1996 and the Affordable Care Act of 2010 to offer the same level of benefits for behavioral health issues like addiction as they do for medical and surgical issues. This necessarily includes addiction treatment in all its forms.
Behavioral health treatment would typically include sessions with therapists or psychiatrists, intensive outpatient treatment for addiction (IOP), residential/inpatient addiction treatment, and addiction treatment aftercare. The coverage also necessarily includes alcohol rehab as it falls under the classification of addiction treatment for substance abuse.
The particular treatment form would mostly depend on what the consulting physician would recommend, based on the initial consult done before enrollment. The focus on determining the most suited and appropriate treatment is so that there is a greater likelihood of treatment success and less likelihood of a relapse.
Mental health professionals are looking at behavioral health as the foundation and determiner of a person’s ability to react positively or negatively to most of life’s experiences. It is believed that positive behavioral health helps a person cope better with everyday stress, achieve a healthier and better quality of life, and foster overall healthier habits.
There are many things in life that are practically unavoidable, such as exposure to negative or intense experiences that could induce trauma, or affect a person to the point that they develop a negative reaction or perception to certain things. This is often the root cause of many anxiety-related issues, which in turn, directly affect the behavior and thinking of a person.
Addressing behavioral health issues and ensuring that a person’s behavioral health is capable of helping a person cope with adverse experiences is one way to avoid the negative effects of going through such as experience. This is the case with people who suffer from post-traumatic stress disorder (PTSD). This behavioral health issue is held to be responsible for the development of a substance abuse disorder in most servicemen and in people who went suffered significant trauma in life.
Apart from addiction treatment and rehabilitation, the company offers medicare programs, disease management, quality assurance, claims administration, and case management services. For behavioral health coverage, it necessarily includes atypical mental conditions or behavioral problems, apart from substance abuse.
The inclusion is mostly because of the fact that many who have a substance abuse disorder also suffer from a concurrent mental health issue as well. In most cases, both of these conditions need to be addressed simultaneously as neglect or prioritization of one condition could actually hinder the treatment of the other.
The initial consult also helps to determine if the patient is potentially suffering from a concurrent mental health issue apart from the substance abuse concern. In most cases, the patient is either not aware that they do have a concurrent mental health issue alongside the substance abuse disorder, or they are not inclined to admit that they do have it.
A strong foundation in mental and behavioral health is always important to ensuring one is ready for the challenges in life. This is why the professionals at Magnolia City make a point to work hard toward helping a person achieve full mental and behavioral health.
The recovery process might not be easy or cheap, but Magnolia City is staffed by professionals with years of experience in the matter, and also partnered with insurance providers to make the process more affordable for everyone. Please give us a call for more information or to learn more about the cost of detox and treatment.
Dr. Olaniyi O. Osuntokun is a Neurology & Psychiatry Specialist based in Conroe, Texas, and Lafayette, Indiana. He has extensive experience in treating Individuals with substance use disorders and addiction. He earned his medical degree from University of Ibadan College of Medicine and has been in practice for more than 20 years.