Magnacare Health Insurance for Drug & Alcohol Rehab

MagnaCare was founded in 1990 to help labor unions reduce healthcare costs by providing access to a low cost network of diagnostic professionals. They quickly started offering physician networks and hospital access as well. In 2014 the company was acquired by Brighton Health Group and continues to operate as a separate subsidiary.

Today MagnaCare is a third party administrator (TPA) licensed in all 50 states. They help employers and brokers along with self insured plans and other organizations with custom health insurance plans. MagnaCare offers medical networks and health plan management along with add on benefits that plans can offer to members. Clients can also access case management and chronic care services along with wellness programs for their members.

The company focuses on giving patients the best possible care based on their medical needs while supporting healthcare payors with administration and technology solutions to help them manage costs.

Does MagnaCare Cover Rehab?

MagnaCare provides high quality medical networks to insurance plans and organizations. However the insurance plan is the one that determines what services are covered and how much coverage there is so it’s important to talk to your benefits specialist for full details.

Not all employer insurance plans are required to cover the 10 essential health benefits listed in the Affordable Care Act (ACA) but many will offer some coverage for important health concerns such as mental health and addiction treatment. It’s important to understand your plan before you start treatment to ensure you get the coverage you expect and don’t have any surprises.

All insurance plans focus on covering medically necessary care so it’s important to work with your doctor to create a treatment plan to help you break free of substance misuse. The treatment plan will help you know what programs to look for and will serve as proof of medical need for insurance.

What Products and Services Does MagnaCare Offer to Insurance Plans?

MagnaCare offers a variety of services ranging from medical networks to administration services to technology solutions.

One of the primary products is their PPO network. What makes their network unique is that it’s divided into tiers. While members can access any in network provider they can save money on out of pocket costs by using higher value provider options. This helps members make smart decisions about their medical care which saves both them and the insurance plan money.

They also offer ancillary benefitsthat help their clients offer additional benefits to their employees and members. Clients can offer MagnaCare vision and dental coverage as well as affordable pharmacy benefits. They also have an employee assistance program (EAP) that can support members with mental health and work life balance issues along with financial and legal concerns and addiction recovery.

MagnaCare also has medical management programs such as case management and utilization management. They can also help clients with chronic care management and wellness programs. They can also connect employers and organizations with telehealth options that allow better access to care at a lower cost.

What Inpatient Addiction Treatment Does MagnaCare Cover?

When you’re trying to find out what addiction coverage you have, keep in mind that the company that is using MagnaCare’s network has the final say in what’s included in their service offerings. Also, keep in mind that large employers and other self funded plans might not be required by law to cover addiction treatment. That said, many choose to do so despite it not being legally required.

If your company covers addiction treatment then they will want to make sure to match your needs to the right level of care. This will be a major factor in determining what your company will cover. Through MagnaCare they will likely ask to see the level of care assessment that you receive from a clinician before you get referred to treatment.

If you’re at risk of going into withdrawal when you decide to seek treatment then the right level of care for you may be inpatient detox. With medical inpatient detox, staff monitor and treat your withdrawal symptoms to prevent and treat the negative health consequences of coming off certain substances.

Residential rehab is the right level of care for people who are physically healthy enough to attend a full day of group therapy and who can benefit from living in a structured and controlled environment. It’s usually the right intensity of care for people who feel like they can’t stop their addiction despite wanting to and despite the danger it’s putting them in.

What Outpatient Rehab Does MagnaCare Cover?

Depending on your needs, there are different outpatient services that your company may choose to include in their care network. As with inpatient services it’s important to verify your insurance coverage before committing to a program or service to avoid surprises. Also consider checking if your insurance provider imposes any limits on the number of days or sessions you can access.

The most intensive outpatient service type is a partial hospitalization program (PHP). In many ways a PHP is similar to residential rehab but instead of staying overnight you go back to your own home in the evenings and on weekends. This is a good option for people with supportive home or sober living environments who need intensive treatment to help them stop using.

If you’re in early recovery but are still able to keep working you may do well at an intensive outpatient program (IOP). These programs are usually two to three days a week for a few hours each time. During the time you spend there you can expect to attend groups where you learn and practice relapse prevention skills. The sessions generally have morning and evening options so you can fit them around your work or school schedule.

Standard outpatient treatment involves seeing an addiction counselor on a recurring schedule and sometimes a psychiatric medication prescriber if it’s needed. This can be a good place to start when you need addiction treatment. If you need more intensive treatment, they can refer you to the right place.

Does MagnaCare Cover Methadone & Suboxone (MAT)?

MAT refers to medications that can treat substance use disorders. Methadone and Suboxone are the most well known medications in this class but there are a few others. If your insurance covers these treatments they can be very effective in getting you to recovery. If it doesn’t, you may be able to find affordable cash based options.

Both Suboxone and methadone are commonly used as maintenance treatments for opioid use disorder. These medications take the place of the opioids that you may be dependent on. You remain physically dependent on opioids with these medications but they don’t get you high and you can safely obtain them — thereby avoiding the dangers associated with drug use. Many primary care and psychiatric providers now prescribe Suboxone so if your insurance covers these services you may be able to get Suboxone that way. Methadone can only be obtained at specialty clinics but many offer affordable services.

Suboxone can also be used to help you detox from opioids completely. People who choose a full detox are more vulnerable to death by overdose if they relapse because they often use the same amount they did before but their body isn’t used to it anymore. Therefore this approach is usually best used in a secure setting and with a patient who is fully committed to abstinence. People who are in professions where they cannot test positive for methadone or Suboxone may sometimes choose this strategy.

Medical detox usually happens in a residential setting. If your insurance covers detox then it is likely to cover the medications they would be using such as Suboxone.

Does MagnaCare Cover Other Mental Healthcare?

Your company determines if your plan offers mental health coverage. Many do but not all. It’s important to verify your coverage — including maximum limits on treatment length — ahead of time to keep from getting surprised about costs. These are some of the treatments a plan that offers mental health coverage may provide.

Inpatient psychiatric hospitalization is sometimes necessary for people with acute mental illness. The average length of stay is between three days and a week.

Some emergency departments include a partitioned area called a crisis unit. There is a lot of variety in how these look and function, but generally, they function as a mental health emergency department within the general emergency department.

You can often get one on one mental health treatment with a therapist to address issues like depression and anxiety along with trauma and other issues.

PHPs and IOPs are options for both mental health and substance use treatment. They can often help people who are dealing with both problems at the same time, which is known as a co occurring disorder.

More and more mental health and addiction services are becoming better able to treat people with co occurring disorders. It’s very common to suffer from mental health disorders and addiction at the same time. Treating co occurring disorders together dramatically increases your chances of success.

Does Addiction Treatment Need to Be In Network?

You may be able to go out of network for care if your insurance provider uses MagnaCare’s network. However, it’s important to be aware of the extra costs you might incur if you do. These costs can be very high in some cases. Take careful note of the differences in your deductible and copay when you go out of network before deciding on this option.

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

If your insurance plan doesn’t cover addiction services you still have options. You may be able to get addiction treatment that’s part of another covered service or through an Employee Assistance Program (EAP). You may also be able to find affordable treatment options where nobody is turned away for lack of funds. Some services exist that are free of charge.

Many primary care clinics have integrated addiction treatment into their services. If your insurance covers primary care services at such a clinic you may be able to get outpatient addiction treatment covered under your primary care coverage. Your primary care clinic may also have case managers who are familiar with local resources that are low cost or free so this is often a good place to start.

Many states have programs that help make substance use treatment services accessible for people who don’t have insurance coverage. It may be worthwhile to look at your state’s addiction treatment plan. Some states offer resources at the county level so also consider doing research into what your county offers for substance use treatment.

Many addiction treatment centers have non profit foundations that fund treatment for people who can’t afford it. You can find out if an addiction treatment center you’re interested in takes people who can’t afford treatment by looking at their webpage. If it doesn’t keep looking. You may have to try several times before you find one, but they’re out there.

You may also want to consider organizations that offer a faith based approach to addiction recovery. Many times these organizations will help you for free. The Salvation Army has many free faith based addiction recovery centers throughout the country.

How to Verify Coverage With MagnaCare

If your plan is through your employer your first point of contact would usually be your benefits manager. This person is often someone in the human resources department. If you have received a customer service number for MagnaCare you can try calling that number as well. They may be able to help advise you about what treatments your plan covers.

Keep in mind that employer plans with MagnaCare are unique so a treatment center won’t be able to easily verify your coverage. It’s best to stick with your benefits manager or call Magnacare directly.