Luminaire (Formerly NGS CoreSource) Insurance Coverage for Drug & Alcohol Rehab

In 2022, NGS Coresource was acquired by Health Care Service Corporation (HCSC) and rebranded as Luminaire.

Luminaire is a third party administrator of health benefits that helps with self funded insurance plans. They work with employers, hospitals and medical systems, indigenous tribes, and other organizations. Your employer may use Luminaire to access medical networks and provide specialized care and case management. Organizations can also get backend tools to help them track the use of services and costs.

As an employee or member of an organization you might see Luminaire’s name when you look for in network providers or have questions about coverage. They can also help when you need help managing a complex health issue or request preauthorization for services.

Does Luminaire Cover Addiction Treatment?

Luminaire provides employers and organizations with connections to doctors and facilities that can provide care. However, they don’t decide what’s covered. Instead, they will help your employer or organization build a unique coverage plan and then help provide the services your organization decides on.

Self funded health insurance plans are not required to offer any specific benefits the way many other insurance plans are. However, if they do decide to offer mental health and substance treatment they have to provide them at the same coverage level as other care according to the 2008 Mental Health Parity Act.

It’s very important to check with your organization’s benefits specialist or to contact Luminaire with your plan’s name to find out what is covered and at what level. That way you won’t have any surprises when you start treatment.

What Insurance Products Does Luminaire Provide?

Every self funded employer or organizational plan is different, and Lumiaire offers a variety of elements that employers can combine to create their own unique insurance coverage. Not every plan will have all the elements described below.

The most important part of Lumiaire’s help is the connection to a medical network. They can offer over 40 different provider networks including options from Aetna and Cigna along with Multiplan and First Health and more. Networks can be national or regional. As an employee or organization member you’ll want to understand the provider network so you can maximize your insurance coverage and keep your out of pocket costs low.

Luminaire also provides healthcare management services such as a phone number for plan members to call and find out details about benefits and a department that approves coverage based on medical necessity criteria.

The company also has case management options to help members navigate difficult health situations and condition specific care for oncology, maternity, and gene therapy. As a health plan member you may get access to a 24/7 nurse line and telehealth care options.

Finally if the employer or organization needs flex spending accounts (FSA) or health savings accounts (HSA) or health reimbursement accounts (HRA) Luminaire can administer them.

What Inpatient Addiction Treatment Does Luminaire Cover?

Self funded plans are not required to cover addiction treatment — however many will. It is important to understand your benefits coverage before starting any type of treatment to ensure it is a covered benefit.

All insurance plans require that services are deemed medically necessary before they cover them. A treatment plan created by you and your primary care provider will help support the need for addiction treatment. These are often required for preauthorization.

A normal part of developing a treatment plan is the ASAM assessment. This takes into consideration factors such as biomedical and psychosocial needs as well as strengths and assets. It also looks at your support system and resources. By assessing how you are affected by their SUD providers are able to determine the appropriate level of care you need.

In some cases you might benefit from inpatient medical detox. Medical detox offers you FDA approved medications during the detoxification process. During this process you are closely monitored by medical professionals to assess your physical and emotional condition. The use of medications decreases withdrawal symptoms and lowers the risk of health related complications. On average, medical detox lasts from 7 to 10 days but this differs from person to person.

While not everyone requires inpatient medical detox those who have undergone this process generally go on to inpatient or residential rehab. For those who do not require medical detox inpatient rehab may be the first step toward recovery.

Inpatient rehab involves 24/7 supervision in a safe and controlled environment with medical and addiction professionals. During inpatient rehab you receive individual and group therapy and you may also participate in experiential and recreational therapy.

Peer support is an important component of inpatient rehab as well. The amount of time an individual remains in inpatient rehab differs from person to person. On average the stay is somewhere between 30 and 90 days. Studies report the best success with the 90 day programing.

It is always important to remember that each recovery journey is unique and that treatment plans differ greatly depending on the needs of individuals.

What Outpatient Rehab Does Luminaire Cover?

Depending on your insurance plan outpatient rehab may be covered. It is extremely important to check with your insurance plan before starting any program to verify if a referral or preauthorization is required before you start treatment.

Outpatient care could include partial hospitalization programs (PHP) and/or intensive outpatient programs (IOP) and/or general outpatient treatment and aftercare programs.

A PHP is an intensive outpatient program for people with alcohol and substance use disorder. For some this is the first step in the process or it could be a second step for those who finished inpatient rehab. This treatment option requires 20 hours per week or more of programming but allows you to return home each night. You get treatment similar to inpatient care.

An IOP is less intensive than a PHP and requires around 9 hours per week. The program usually lasts for 90 days. You can often work the schedule around work or school obligations. This type of treatment is best for people with mild to moderate addiction and those who have a high motivation for recovery. An IOP involves individual and group therapy with a focus on relapse prevention as well as improving coping skills and developing tools to recognize triggers. You’ll also work on support system repair and development.

General outpatient treatment is best for people with mild alcohol and substance use disorder and few psychosocial risk factors. Individuals work one on one with a therapist or addiction specialist to prevent relapse. Learning to recognize triggers and improving coping skills as well as healing from past trauma are integral parts of relapse prevention.

Does Luminaire Cover Methadone & Suboxone (MAT)?

Medication assisted treatment (MAT) may be a covered benefit with your insurance. Before starting any type of program it is important to remember to check with your insurance provider to determine if you need a referral or preauthorization.

MAT uses FDA approved medications to help those with alcohol and substance use disorder during the early recovery period. These medications — such as naltrexone and buprenorphine along with methadone and acamprosate — ease withdrawal symptoms and help to normalize brain chemistry and stabilize body functions. This is especially important during medical detox.

Some individuals only need MAT during the detox process while others need it throughout treatment to help manage cravings to reduce the risk of relapse and decrease the risk of overdose. For most people longer term MAT is combined with inpatient or outpatient treatment to help you establish long term recovery.

Does Luminaire Cover Other Mental Healthcare?

Self funded plans are not required to cover mental health treatment but many plans do. It is important to know what your benefits are and to verify if preauthorization is required before starting any type of mental healthcare.

Mental healthcare is especially important for people with alcohol and substance use disorder. The National Institute on Drug Abuse reports that people with SUD commonly have co occurring mental health diagnoses. These may include anxiety or depression as well as PTSD or bipolar disorder or other diagnoses. It is important to address both mental health and addiction with an integrated plan to treat them together.

Does Addiction Treatment Need to Be In Network?

This differs from one self funded plan to another. Again it is important to understand what your benefits are before starting any type of treatment.

With most self funded plans it is reasonable to assume that most plans will require the use of in network providers. Even if out of network care is covered it’s best to stay in network if you can for the best coverage and the lowest out of pocket expenses.

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

If your employer’s self funded health plan does not cover the cost of rehab there may be other options to help pay for care.

One option is to pay for treatment yourself. Many treatment centers have payment plans available or offer a sliding scale of fees based on income. Others offer scholarships to help pay for the cost of treatment. Another may be to apply for a Care Credit card which will allow repayment over time.

Finally free services can be found in many communities through organizations such as the Salvation Army or YMCA along with homeless shelters or faith based organizations. As with all types of medical and mental health care it is extremely important to verify accreditation and ensure the highest quality of care when seeking free or low cost treatment options.

How to Verify Coverage With Luminaire

With self funded plans the best place to start would be with the benefits manager or contact person within the organization. If there is a member identification card there may be a customer service number on the back of the card to contact.

Self funded insurance plans differ greatly from one to another. Before starting any type of treatment plan you should speak with a representative from Luminaire to fully understand your benefit coverage and need for such things as determination of medical necessity before starting care.