HealthSmart Insurance for Drug & Alcohol Rehab

HealthSmart provides medical network options to employers who choose to self fund their health coverage for employees or organization members. They serve health insurance brokers who need custom solutions for clients as well as employers and Native tribes and anyone else who pays for health insurance coverage for an organization.

Clients can get ready made health benefit plans or simply opt for a medical network solution. The company also offers care management services and claims processing technology along with robust reporting so clients can understand their health care coverage and spend.

HealthSmart focuses on not only saving clients money and providing efficient solutions but also on treating health plan members with dignity and respect.

Does HealthSmart Cover Addiction Treatment?

HealthSmart helps employers and other organizations build health solutions but they don’t determine what services are covered or what level of coverage is available. That is up to the employer or organization.

Self funded health plans don’t have to offer the 10 essential health benefits listed in the Affordable Care Act (ACA) although many plans do. If self funded plans offer mental health or addiction coverage they are required to provide them at the same level of coverage as other medical care in accordance with the 2008 Mental Health Parity Act.

Because self funded plans vary widely it’s especially important to check with your organization’s benefits specialist to get the full details on your coverage. That way there won’t be any unexpected challenges when you start treatment.

What Insurance Solutions Does HealthSmart Offer?

HealthSmart offers organizations benefits solutions and care management along with provider network options. The primary focus of HealthSmart’s business is their medical provider networks. These options are flexible and customizable which means every insurance plan is unique. The primary network is HealthSmart Preferred and is a preferred provider organization.

With a PPO you don’t need a doctor’s referral to see in network specialists and you will likely have access to out of network coverage. However out of network coverage is much more expensive for you — you’ll have much higher deductibles and copayments or coinsurance.

HealthSmart also offers ancillary networks that can help organizations fill care gaps or flesh out more limited primary networks.

Along with their medical networks HealthSmart offers benefits solutions such as health plan design and claims processing along with help administering flex spending accounts and more. As a member you’re unlikely to see these behind the scenes operations but they can help your organization offer health coverage more effectively.

Finally HealthSmart has care management available for clients as well. This helps your company or organization point you toward the right care at the right time based on your needs. The company helps clients focus on improving every member’s health because that’s the best way to take care of people and the best way to ensure a cost effective health plan.

What Inpatient Addiction Treatment Does HealthSmart Cover?

Addiction treatment is not a legally mandated obligation for self funded plans. Nevertheless many will offer some form of coverage. You’ll want to talk to your benefits administrator to get the full details of your plan.

Insurance’s main goal is to provide medically essential care so make sure to get a treatment plan formulated by your doctor. Clinicians utilize frameworks like the American Society of Addiction Medicine (ASAM) Criteria to decide the appropriate level of care you need. Your doctor will use the assessment to evaluate parameters such as health status and withdrawal risk to determine if your situation demands residential care.

Medically supervised detox is the initial step of inpatient treatment for many people. 24/7 onsite clinical support helps you manage the withdrawal symptoms that come with stopping using a drug.

Residential care is often the next stage of an individual’s recovery journey. In this phase you’ll be in a highly structured environment with 24/7 support. This allows you to focus fully on your recovery and avoid temptations and triggers that might lead to relapse.

What does a day in the life of a participant in an inpatient program look like? Individual counseling and group activities are frequent. You’ll get workshops on how to manage abstinence and reenter the workplace as well as reduce relapse risks. These classes are critical components of residential care to equip you with the skills needed for long term recovery.

What Outpatient Rehab Does HealthSmart Cover?

Your insurance plans may use HealthSmart to offer three classes of outpatient rehabilitation: Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) along with general outpatient care.

PHP is the most intensive outpatient treatment form. You attend almost full time for 5 to 6 days a week but go home at night and on weekends. People tend not to work during treatment due to the time commitment.

An IOP has a much more flexible schedule — many require 9 hours of treatment over three days. You can often choose between morning and evening treatment so you can manage work or school obligations. General outpatient care meets for one or two hours a week to help you sustain long term outcomes.

Outpatient programs aim to help solidify the habits that are foundational to long term recovery and prevent relapse through targeted therapies that empower you to establish yourself in an independent and productive life. Aftercare services are intended to strengthen your support networks and connect you to essential services like housing support.

Before starting an outpatient treatment, double check your insurance coverage. Self funded plans may vary widely in benefits and limits as well as requirements for outpatient rehab.

Does HealthSmart Cover Methadone & Suboxone (MAT)?

If your insurance plan covers medication assisted treatment (MAT) it can be a valuable therapeutic resource for overcoming alcohol and opioid abuse disorders.

Once someone becomes opioid dependent specialized management by a licensed clinic may be required for safe addiction recovery. Methadone or buprenorphine are medications that assist in managing cravings to help you avoid relapse during treatment. Other medications available may include naltrexone and Suboxone.

Alcohol dependence is also a viable candidate for MAT as clinicians utilize medication in the initial detox phase to counteract withdrawal symptoms from stopping consumption. Acamprosate and naltrexone are therapeutic alternatives for supporting long term sobriety due to their craving reducing properties against alcohol.

MAT does not replace counseling. It is most effective as part of a holistic recovery program that endows individuals with the skills to prevent relapse.

Before starting treatment verify your insurance coverage as you may need a referral or preauthorization. Plans offer different benefits and vary in the type of medication they cover and for how long.

Does HealthSmart Cover Other Mental Healthcare?

Self funded plans are not legally required to provide mental health benefits but many do. Verify your insurance coverage before commencing treatment to avoid unexpected expenses.

Successful mental health interventions take into account each person’s unique characteristics. Treatment tends to start with assessments given by qualified professionals to determine the best type of care for every person. Some individuals may struggle with mental health issues alone and others may have addiction and mental health needs at the same time — which is known as co occuring disorders.

Substance abuse tends to happen simultaneously with mental health concerns. One million children and 22 million adults in the US are diagnosed with anxiety, depression, or mood disorders while they battle an addiction. Successful treatment in these cases requires tackling mental health and addictive behaviors at the same time to give each person the best chance of long term recovery.

The difficulties that mental health conditions cause—like sadness and mental anguish—may stimulate addictive behaviors as an escape. Substance abuse can aggravate a preexisting mental health concern or predispose someone to a mental health diagnosis. That’s why medical professionals address them together.

How Long Will HealthSmart Cover Rehab?

Your insurance plan will determine coverage limits and requirements for specific benefits so check with your benefits specialist or plan paperwork to find out if there are specific limits on addiction treatment.

Care length is not predetermined but rather depends on your individual medical needs and what parts of the continuum of care you need.

Typically residential care provides 24 hour supervision, and patients stay for a few days to a few weeks. Care averages 30 days but some people stay for as many as 90 days. An IOP provides 9 hours of treatment divided over 3 days each week for 30 to 90 days.

General outpatient programs are most successful when a person commits to them for at least 90 days but they can last 6 months or even a year if a medical professional considers it necessary.

Long term recovery depends on embracing each step of your treatment journey. Enjoy each step of the process and complete them with diligence—they will increase your chances of creating the life you dream of.

Does Addiction Treatment Need to Be In Network?

Self funded plans vary in their benefits much more than standard plans. However if they use HealthSmart the network will be a preferred provider organization (PPO). A PPO does provide some coverage for out of network care so your plan may include some coverage for non network providers.

Nevertheless, even if coverage is included you’ll pay far more out of pocket. You’ll have much higher deductibles and coinsurance or copayments.

Always verify with HealthSmart coverage and network status before starting any treatment. In network providers will always be the best way to get the most out of your insurance’s benefits and keep your expenses under control.

What to Do if HealthSmart Won't Cover the Cost of Rehab

Your addiction treatment options may be more limited in a self funded plan and you might encounter less comprehensive benefits — but do not let these circumstances be a reason to avoid seeking the care you need.

Some treatment centers award scholarships or offer sliding scales of fees based on income or payment plans to facilitate treatment. You can proactively reach out to them and ask.

Another option is to get creative. Low cost and even free rehabs exist. The Salvation Army runs programs where you can work instead of paying and your county or state may also operate free or low cost alternatives.

The investment you make today in recovery can become the stepping stone to building a better future.