Health Net Insurance Coverage for Drug Rehab

Health Net was founded in 1977 as part of Blue Cross. In 2015 Centene purchased the company and it operates as a separate subsidiary of Centene. Health Net operates primarily in California where it offers employer plans and Medicaid coverage. In partnership with Wellcare they offer Medicare Advantage in the state. Health Net also offers California individual and family plans in partnership with Ambetter. Health Net Oregon offers employer plans in Oregon.

A Health Net subsidiary known as Managed Health Network used to administer behavioral health benefits for Health Net members but in 2024 this administration was transferred to the main Health Net company.

Health Net has five regional offices and employs more than 5,700 Californians to help deliver high quality coverage to their members.

Does Health Net Cover Addiction Treatment?

In 2010 the Affordable Care Act was passed. Under this law most insurance plans were required to cover alcohol and substance use disorder treatment and mental health care. It is important for individuals to understand their benefits plan and verify coverage before starting any type of treatment.

Insurance plans generally require that any treatment be deemed medically necessary for benefits coverage. In order to determine medical necessity you should contact your primary care provider for assessment and work closely with them to develop a treatment plan to meet your unique recovery needs.

What Are Health Net Plans?

Health Net offers multiple types of insurance in California. They also offer employer plans in Oregon. Because plans differ greatly from one to another, it is important to understand your benefits summary and choose a plan that suits your needs.

Individual and family plans are available on the California insurance marketplace, Covered California. There are plans available for a variety of income levels. You’ll find either health maintenance organization (HMO) or preferred provider organization (PPO) plans. An HMO is less expensive monthly but requires you to use in network providers and have a primary doctor that gives you referrals to specialists. A PPO is more expensive but doesn’t require referrals and has out of network care available — although you’ll pay far more out of pocket.

Wellcare by HealthNet offers individuals Medicare Advantage plans. These plans include the same benefits as Original Medicare and they will usually have a prescription benefit. Advantage plans may also offer vision and dental coverage as well as free fitness memberships and other perks. The HealthNet Advantage plan has added benefits such as a 24 hour nurse phone line where members can receive medical advice and have their questions answered by qualified medical professionals.

With Original Medicare you can get care at any participating Medicare provider or Medicare participating facility in the United States. With Medicare Advantage you may be required to see providers or seek care with in network providers only unless it’s an emergency. You may also need referrals for specialist care and preauthorization for certain kinds of treatment.

HealthNet offers low or no cost insurance coverage for eligible people in California under the Medi Cal program. You may qualify for Medi Cal based on your income or age as well as disabilities or pregnancy or being a caregiver. Individuals do not have to be documented residents to qualify. Plans and benefits differ but most include medical and dental as well as vision coverage. Enrollment can be done in a number of ways: in person at local DHCS offices or on the state website CoveredCa.com. You can also apply by phone or by mailing in an enrollment form.

What Inpatient Addiction Treatment Does Health Net Cover?

Most Health Net Plans cover inpatient addiction treatment but it is important to verify coverage before beginning treatment. In most cases a determination of medical necessity is required for these services to be covered.

Individuals should work with their primary care providers to create a treatment plan. One way to determine the appropriate course of treatment is to have an American Society of Addiction Medicine (ASAM) assessment completed. Factors such as a patient’s needs and obstacles and liabilities along with strengths and assets and support structure are considered when developing an appropriate treatment plan.

For those who meet the criteria for inpatient alcohol and substance use disorder treatment the first step in their recovery journey may be medical detox.

Medical detox can take place in an inpatient hospital or residential treatment facility. This can be especially critical for those with severe addiction especially for alcohol or opiates. Medical detox is helpful for barbiturates and certain stimulants as well. Under 24/7 medical supervision individuals receive FDA approved medications and other treatment to help ease the symptoms of withdrawal and stabilize body functions to help normalize brain chemistry. These medications could include naltrexone and methadone as well as buprenorphine and acamprosate or disulfiram. On average, medical detox lasts between 5 and 14 days but for some it may take weeks. After completing medical detox, most individuals then go to residential or inpatient rehab.

Inpatient or residential rehab involves 24/7 structured care for those in the earliest stages of recovery. Treatment plans often include individual and group therapy using a variety of modalities such as cognitive behavior therapy (CBT) and motivational interviewing as well as Eye movement desensitization reprocessing (EMDR).

You may also receive holistic treatments including meditation and yoga along with nutritional counseling. Some programs offer experiential therapy and recreational therapy which may include art and music therapy and animal therapy as well as exercise. Most programs last anywhere from 30 to 90 days — and 90 day treatment programs have the highest success rates.

What Outpatient Rehab Does Health Net Cover?

Health Net covers outpatient rehab when medically necessary. It is important to understand your plan benefits before starting any programs to ensure coverage.

Outpatient treatment varies from intensive and highly structured programs to general outpatient treatment.

Partial hospitalization programs (PHP) are best for people who are at the beginning of their recovery journey. Individuals in these programs may or may not have participated in inpatient treatment. One advantage to a PHP is that you get to go home each night.

However, there is still a significant time commitment, on average 20 hours per week of programming. Another advantage to PHP is that it offers participants consistent access to peer and recovery support, including individual and group counseling, with the end goal of relapse prevention.

A PHP is not for everyone and it is critical that you work with your primary care provider to assess which options are best for your unique circumstances.

An Intensive Outpatient Program (IOP) continues to offer highly structured treatment for those with alcohol and substance use disorder who do not require medical detox and have mild to moderate addiction or have finished a more intensive program.

You participate in IOP for an average of 9 to 12 hours per week with most programs lasting 90 days. Group therapy is an integral part of IOP with the goal of preventing relapse through behavioral change and the development of positive coping strategies along with repairing and building of support systems and addressing psychosocial needs such as employment and housing issues.

IOPs also include individual therapy. You work with counselors and addiction specialists to address your emotional and psychological needs and learn to develop healthy coping mechanisms to aid in your recovery. Counselors and addiction specialists use a variety of approaches to meet their clients’ unique needs. This includes but is not limited to the use of cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) as well as motivational interviewing and eye movement desensitization and reprocessing (EMDR).

Aftercare is the support you receive after you finish formal treatment. Recognizing that relapse prevention and recovery is a lifelong process these programs provide continued resources for those with alcohol and substance use disorder. This may include continued individual and group therapy along with peer support and education. You may also get resources that help with employment and housing as well as other psychosocial needs.

Does Health Net Cover Methadone & Suboxone (MAT)?

Medication assisted treatment (MAT) may be a covered service with HealthNet. A determination of medical necessity is often required so it is important to understand your insurance requirements before starting treatment.

MAT has been proven to decrease relapse and lessen withdrawal symptoms and cravings while stabilizing brain chemistry and body functions. This reduces the risk of drug overdose death and the risk of infectious disease transmission such as hepatitis and HIV/AIDS.

MAT uses FDA approved medications such as methadone and suboxone along with buprenorphine and naltrexone prescribed by qualified medical professionals to help in the early stages of detox and recovery. However, for some, medication assisted treatment can be used for weeks or months or even years, depending on each person’s unique recovery needs.

Does Health Net Cover Other Mental Healthcare?

Under the ACA mental healthcare is considered an essential health benefit and should be covered by most Health Net plans. However, this can depend on the type of plan and should be verified before starting any treatment program to ensure coverage.

For many with addiction there is also a co occuring mental health condition such as depression or anxiety. You might also have PTSD or bi-polar disorder alongside addiction. Comprehensive treatment recognizes that successful recovery not only means sobriety but that underlying conditions are also addressed. For individuals with co occurring conditions integrated care is essential to address mental health and substance use disorder at the same time.

Mental health care can include both inpatient and outpatient care which may include therapy and medication management along with other evidence based practices.

How Long Will Health Net Cover Rehab?

The amount of time Health Net will cover rehab depends on a number of factors. This includes determination of medical necessity and proper assessment and treatment plan development. This is why it is crucial that you work with your primary care provider to assess your recovery needs. One way to do this is to complete the ASAM assessment which helps to determine the level of care that is appropriate.

Most residential treatment programs last anywhere from 30 to 90 days and evidence shows the best outcomes with 90 day programming. Intensive outpatient programs (IOP) are similar to residential treatment programs in that most last 90 days or more. It is critical to remember that every person has unique needs and that recovery must truly be worked one day at a time.

Can I Travel Out of State For Treatment With Health Net?

Because Health Net offers many plan options it is important to understand what type of plan you have.

In some cases where the plan is an individual or family PPO, out of network coverage is allowed within the state of California only. For those with a Medicare Advantage HMO or PPO the rules can be different. HMOs typically do not allow out of network coverage. For Medi Cal members there is no out of state coverage. This could be waived during an emergency but this must be verified with each plan.

The best course of action would be to verify coverage with your benefit plan before obtaining any care out of state. You can maximize your insurance benefits and save money by choosing an in network provider which will likely be in California.

How to Verify Coverage With Health Net

There are a number of ways to verify coverage with Health Net. One way to do this is by calling the customer service center; most times this number is located on the back of your ID card. Health Net also has an online site where you can verify benefits and find a provider along with health related education.

In some cases, the treatment center or healthcare facility can help verify benefits coverage. When doing this it is important to have all of the plan information including the plan name as well as your ID number and group information in order to get the correct information.