First Health Network Insurance Coverage for Addiction Treatment

First Health Group is a wholly owned subsidiary of Aetna. They provide national and regional preferred provider organization (PPO) medical networks to national and regional insurance carriers as well as employer groups and more. They also offer a national dental network and have solutions that help insurance plans reduce the cost of non network care.

First Health serves more than 260 clients who pay for healthcare and their 1.4 million members. They are able to use Aetna’s pricing power and credentialing process to provide access to high quality providers at an affordable cost.

Does First Health Cover Drug Rehab?

First Health Group doesn’t provide insurance coverage so they do not decide what services are covered or at what level. However most insurance plans are required to cover mental health and addiction treatment and First Health may provide the medical networks that you use to get care through your insurance provider.

First Health offers access to multiple provider networks, including a primary PPO network that has more than 5,700 hospitals and 52,000 other medical facilities. The networks provided by First Health will have professionals who can help you address addiction and mental health concerns.

Every insurance plan is different so be sure to verify your coverage details before you begin treatment. For example you may need to get a referral or preauthorization depending on your plan.

What Provider Networks Does First Health Group Offer?

First Health offers multiple provider network options to clients. Some are primary networks that can be used as a foundation for care while others are supplements that help improve a plan’s network and fill gaps in care. Along with these national networks, First Health offers regional networks in Michigan and the Midwest.

The main offering is the First Health Primary Network. It’s a PPO network with more than 993,000 professional providers across the country. It can be used by plans that want to have a single high quality network and by plans that have a local network and want to add national coverage through First Health.

They also offer First Health Complementary Network, which is a national network that helps insurance plans expand their primary network while still saving money on care. A plan can pay these providers through an in network arrangement or an out of network setup.

For non-US residents who come to the U.S. for care or are visiting the United States and need healthcare during their visit, the First Health International Network can help. Companies that offer travel insurance most often use this network.

The First Health Limited Benefits Network is available for clients who want to offer limited health coverage that doesn’t include major medical. This network can also be used for minimum essential coverage which only covers preventive services in the Affordable Care Act (ACA) and CMS requirements.

Finally the First Health Share Plan Network is available for cooperative health share plans where members pool money together to help pay for each other’s medical needs. These plans are not insurance and coverage is not guaranteed but the Health Share Plan Network can make it easier to offer members affordable providers.

Does First Health Cover Mental Healthcare?

There are a variety of mental health care options when you are diagnosed with a mental health condition. This can include various behavioral therapies such as cognitive behavioral therapy and dialectical behavior therapy as well as motivational interviewing. Other care options include medication management and lifestyle coaching to address changes like nutrition and mindfulness as well as exercise.

Mental health treatment can be administered as an inpatient or an outpatient and in individual or group therapy settings. Support is typically offered by psychiatrists or psychologist or licensed counselors. Mental health conditions may occur independently or as co occurring disorders. Treatment of co occurring disorders requires integrated and simultaneous care for both conditions to increase the potential for successful treatment.

Most healthcare plans provide coverage for mental health treatment as regulated by the Affordable Care Act. This is for individual mental health conditions or co occurring disorders. However there are exceptions so you must check your insurance coverage with the insurance company to determine your benefits. Since First Health does not provide insurance coverage they also do not make decisions about benefits and limitations.

What Inpatient Addiction Treatment Does First Health Cover?

Many insurance plans offer benefits for inpatient addiction treatment. First Health has a network of providers with whom your insurance plan collaborates to provide care. You must use a provider within the First Health network to receive in network benefits. Some insurance plans offer out of network benefits, but you typically pay more for deductibles and co-payments.

Insurance coverage focuses on providing medically necessary treatment. A treatment plan from your physician or completion of a comprehensive tool from the American Society of Addiction Medicine (ASAM) can help document medical necessity. The ASAM assesses your needs across six factors including emotional and behavioral issues and relapse risk as well as intoxication and withdrawal potential and readiness for change. The assessment helps clinicians determine the appropriate level of care.

Your addiction treatment may begin with medical detoxification. This is often provided in an inpatient or residential care setting where you receive 24/7 supervision and support. Medical detox may be accompanied by medication assisted treatment (MAT), including FDA cleared prescription medications to reduce symptoms of withdrawal.

Once addictive substances have cleared your body you transition into evidence based therapies that address addiction triggers and negative thought patterns as well as help you develop healthier coping strategies. These can include cognitive behavioral therapy and motivational interviewing as well as patient centered therapy. Your highly structured and customized treatment programs provide you with long term benefits that promote sobriety and sustainable recovery.

What Outpatient Rehab Does First Health Cover?

First Health offers a comprehensive network of providers for outpatient care. Using a provider within the First Health network helps maximize your insurance benefits but it’s important to contact your insurance company to get full details before starting treatment.

Outpatient therapy may begin with a partial hospitalization program (PHP) that provides a highly structured and intensive therapeutic environment during the day but allows you to return home in the evening. Many PHPs offer the same level of care as you receive as an inpatient and are ideal when you do not need 24/7 support and supervision.

An intensive outpatient program (IOP) has more flexibility than a PHP. Some centers offer IOPs during the morning or afternoon or evening hours to allow you to meet other family and work or school obligations. After a comprehensive evaluation to determine the necessary level of care you may be admitted into a PHP or an IOP to start your outpatient rehab.

As you progress through the program you usually graduate to a general outpatient treatment program that provides care once or twice weekly. Aftercare programs help provide support in your recovery journey. Aftercare can include weekly or bi monthly therapy along with 12 step community programs, vocational training and educational support.

Does First Health Cover Methadone & Suboxone (MAT)?

MAT is an effective strategy for both medical detoxification and ongoing treatment of opioid and alcohol use disorders. In the initial medical detoxification FDA cleared prescription drugs can help reduce withdrawal symptoms and prevent some life threatening complications associated with detoxification from certain drugs. MAT is also useful for ongoing treatment to reduce the risk of relapse and the risk of overdose.

Typical medications are methadone and buprenorphine as well as naltrexone and Suboxone. Methadone and buprenorphine are prescribed solely in opioid use disorder. They are opioid agonists — activating the same receptors as opioids without producing the euphoric high. Naltrexone is used in opioid use and alcohol use disorders to reduce the risk of relapse. Suboxone is a combination drug of buprenorphine and naltrexone.

MAT is generally combined with evidence based treatment to help you establish a solid foundation for long term recovery and then you can slowly stop using the medication support and live a fully substance free life.

Does Addiction Treatment Need to Be In Network?

The First Health network is a preferred provider organization (PPO). When your plan uses First Health providers you may also have coverage for out of network care as well. However using out of network providers increases your out of pocket expenses and will cost you far more than using an in network provider.

Most out of network providers do not file insurance paperwork. This means you pay the cost of care up front and must file the paperwork to your insurance plan to be a reimbursed at a lower rate. When you receive care from an in network provider you pay the co-payment up front and the provider completes the rest of the paperwork. You can maximize your insurance coverage by finding high quality in network providers for inpatient and outpatient addiction treatment.

How Long Will First Health Cover Rehab?

Your insurance provider limits the duration of your coverage for drug and alcohol abuse treatment based on medical necessity. First Health does not determine coverage benefits. An initial comprehensive assessment that includes the substance and severity of addiction as well as your home environment and any co occurring mental health conditions helps determine medical necessity. This information may also be used to determine if inpatient or outpatient care is required.

Most treatment centers have residential care programs that last 30 or 60 or 90 days. Outpatient treatment programs can last for a similar time. The length of your program is determined by your initial evaluation and by ongoing assessments to determine your progress. It’s important to embrace your treatment program and complete all the steps. This gives you the best chance at achieving sustainable long term recovery.

How to Verify Coverage With First Health

There are several ways to verify your coverage for drug and alcohol addiction treatment. First Health does not make decisions about insurance coverage so it’s important to verify your benefits and limitations directly with the insurance plan. You can contact their customer service or member services phone number or login to your online insurance account. These resources can provide you with information about what your insurance plan does and does not cover.

You also want to identify the healthcare providers and treatment centers that are in your plan’s specific network. Each insurance provider decides how they use the First Health network.

Most treatment centers can verify your insurance coverage and determine your estimated out of pocket expenses by speaking with your insurance provider. The treatment center requires the insurance provider’s name and the specific plan as well as your member or group plan numbers for accurate information.