HealthLink Insurance Coverage for Alcohol & Drug Rehab

HealthLink was founded in 1984 and serves employers in Missouri and Illinois and surrounding states. They offer regional medical provider networks to self funded employer plans.

They also provide a medical management program that helps employers provide appropriate high quality care while keeping costs lower. These services include utilization management and case management along with comprehensive behavioral health services.

Finally employers can also take advantage of a telemedicine program and 24 hour nurse line to help their employees get the care they need more affordably without needing to leave home.

Does HealthLink Cover Addiction Treatment?

HealthLink does have behavioral health services available to their clients but not all plans will choose to use them. Self funded employer health insurance plans are not required to cover mental healthcare or substance use treatment but many will.

To find out what your specific plan includes reach out to your benefits coordinator. They can help you contact in network providers and give you information about coverage for behavioral health services.

All insurance plans focus on covering medically necessary care and directing members toward evidence based programs. To ensure you get the right care be sure to work with your doctor to get a treatment plan that meets your needs. This will guide you toward the right rehab programs while also proving what services are medically necessary for you.

What Insurance Products Does HealthLink Offer?

Employers can get a few different insurance options for their self funded plans. The primary service HealthLink offers is a medical network that covers a small regional area. This will be more affordable than a national network for employers located in this area.

Many of the medical networks have multiple tiers available. This allows an employer to reward employees who choose lower cost providers while still offering freedom and a good choice of providers.

HealthLink also has a variety of medical management services. This includes precertification services and notification of emergency hospital admission. They also have case management to support those with chronic or severe medical conditions to help improve health outcomes.

Finally they also help connect employers to behavioral health services such as outpatient treatment and day treatment programs along with residential treatment centers.

One of the things that can save employers and their employees a lot of money is getting care at home instead of incurring the time and cost of visiting a hospital or clinic. HealthLink can provide health and wellness solutions such as a 24/7 nurse line and virtual medical care to serve as a low cost first line of treatment for members.

What Perks Come With HealthLink Plans?

Within HealthLink’s provider networks to self funded employers there are additional benefits to help members make healthy lifestyle choices. This benefits everyone since healthier employees are more productive and take fewer sick days. It’s important to discuss these benefits with your employer since not all plans have them.

Inside the member toolbox is a program called The Last Cigarette which gives members the tools and support they need to quit smoking. This includes tips to help you get started and tools you need once you’ve quit.

HealthLink provides members with resources to find an emergency room alternative to reduce costs but still receive quality care. That helps you save money while still ensuring you get the emergency care you need.

HealthLink also provides an Employee Assistance Program that employers can include in their insurance offering. EAP services include legal and financial information and mental health resources as well as tips on learning how to improve work/life balance. Finally the Crown Vision benefit offers discounts on eye exams as well as frames and contact lenses for your whole family.

What Inpatient Addiction Treatment Does HealthLink Cover?

While self funded insurance plans are not required to cover addiction treatment many do offer some coverage. Coverage for inpatient addiction treatment is based on medically necessary care. Medical necessity means the insurance company deems the treatment or service to be essential to the diagnosis, prevention or treatment of a condition.

To prove medical necessity your doctor might provide a treatment plan or recommendations from therapists. They might also give you an assessment from the American Society of Addiction Medicine (ASAM). This is a multidimensional tool that helps clinicians determine the level of care required for treatment. It’s a structured approach to ensure you get individualized and appropriate care.

Inpatient addiction treatment typically begins with medical detoxification. This is a process in which you are supported through withdrawal which may include the use of FDA approved drugs to reduce withdrawal symptoms and prevent adverse complications.

Once your body has detoxified from the addictive substance, you may move into inpatient or residential care using evidence based therapies that address addiction triggers and teach coping strategies along with life skills that help you establish long term recovery and avoid relapse.

What Outpatient Rehab Does HealthLink Cover?

Treatment centers typically use a comprehensive assessment to determine the level of care required in your initial treatment. Be sure to verify your insurance coverage details before entering treatment so you are not surprised by the cost. Self funded plans can vary widely in terms of coverage and limitations as well as requirements including prior authorization.

Outpatient treatment programs may be offered on three levels. A Partial Hospitalization Program (PHP) is the most intensive treatment available as an outpatient. Many programs offer treatment for several hours each day over at least five days each week. The program is beneficial for you when you have a stable and supportive home environment so you can receive therapy during the day and return home in the evening.

An Intensive Outpatient Program (IOP) provides many of the evidence based therapy treatments available in a PHP but over fewer hours each week and with greater flexibility. Some treatment centers offer programs in the morning hours and evening hours to accommodate your work and school schedule.

Finally a traditional outpatient program offers therapy one to two days per week and may include individual and group therapy options. After completing an inpatient or outpatient program you may be eligible for an aftercare program during which you may have access to vocational training and additional group and individual therapy along with community support groups and educational help.

Does HealthLink Cover Methadone & Suboxone (MAT)?

If Medication Assisted Treatment (MAT) is covered by your insurance plan it can be a helpful treatment. MAT can be used during medical detox to reduce withdrawal symptoms during your initial treatment.

MAT can also be used in ongoing treatment for opioid and alcohol use disorders. The FDA approved medications help reduce cravings and the risk of overdose. Methadone and Suboxone are just two of the medications that may be chosen for treatment depending on the substance and the severity of your addiction.

Does HealthLink Cover Other Mental Healthcare?

Self funded plans are not required by federal law to include coverage for mental health disorders. However many of them do as it helps protect the employee and the business. It’s important to check your insurance coverage before beginning care so you do not receive a surprise bill.

Mental health care options are varied and depend on your immediate and long term needs. For example your insurance provider may cover the cost of crisis support that provides immediate assistance when you’re experiencing severe emotional distress or suicidal thoughts or other mental health emergencies. Your coverage may also include evidence based therapies to address your mental health needs.

Co occurring mental health disorders are commonly diagnosed in people with a substance use disorder or addiction. This is called a dual diagnosis and requires integrated care that’s offered simultaneously for addiction and mental health. Specialized dual diagnosis treatment supports long term and sustainable recovery.

Does Addiction Treatment Need to Be In Network?

The determination if you can receive treatment in network or out of network is not made by HealthLink but rather by your employer’s self funded plan. Some programs allow you to receive care out of network. Your employer may offer a full three tiered plan which may include a health maintenance organization (HMO) and preferred provider organization (PPO) along with out of network services.

When out of network services are available, they are usually at a higher cost to you. These costs include a higher deductible and co payment or coinsurance. When you stay in network you can maximize your insurance coverage and receive more therapy for less out of pocket cost. It’s important to review your plan carefully so you can make an informed decision about using an out of network provider.

What to Do if HealthLink Won’t Cover the Cost of Rehab

There may be instances when your insurance provider covers addiction treatment but it is limited. If you have a lack of coverage it’s still important to get the care you need to break the cycle of addiction and improve your mental health. There are several ways of accomplishing this.

Many treatment centers will work with you to help cover at least some of the cost by guiding you in finding financial assistance within the community. For example some community or nonprofit organizations offer grants and scholarships for addiction treatment. You might consider a personal loan so you can pay the cost over time or crowdfunding to get help from friends and family as well as a wider online network.

Some treatment centers also have sliding scale fees and payment plans when you qualify. Treatment centers that accept Substance Use And Mental Health Block Grants from the Substance Abuse and Mental Health Services Administration may also offer grants and scholarships.

You might also consider low cost rehab facilities such as the Salvation Army which allows you to work for them instead of paying for services. State and county run programs are also typically inexpensive for local residents.

How to Verify Coverage With HealthLink

Before beginning treatment it’s important to verify your coverage with your insurance plan and HealthLink. Start with the benefits manager within your organization. They may give you the customer service or member services number for HealthLink.

Member services for HealthLink or your insurance provider can give you benefit advice and help determine what is and is not covered.

It’s important to speak with your insurance company and HealthLink to get the best information since self funded plans are typically one of a kind. The member services department will have the most accurate information about your insurance plan.