Medical Mutual of Ohio Coverage for Drug Rehab

Medical Mutual is a family of companies associated with the parent company Medical Mutual of Ohio. Most Medical Mutual health insurance plans are located in Ohio but there are some in certain counties of Kentucky, Florida, and Indiana.

Medical Mutual of Ohio, where the company started and is headquartered (in Cleveland), serves 1.6 million customers throughout Ohio. They have more than 43,000 primary care and specialty providers in their HMO network, located in every Ohio county. Medical Mutual of Ohio is a mutual health insurance company, which means that it is owned by its policyholders. Insurance coverage is provided to members at or near cost and profits and investments are shared with members.

Does Medical Mutual Cover Drug and Alcohol Rehab?

The 2010 Affordable Care Act requires most health insurance plans to cover mental healthcare and addiction treatment. Therefore, most Medical Mutual plans should cover some forms of drug and alcohol treatment.

There are exceptions to the law, however, and services will vary according to the policy you have. Before starting rehab, it is important that you verify with your insurance company the details of your coverage and the treatment options available to you.

It’s important to note that insurance coverage is based on medically necessary care which usually means that a primary care physician has diagnosed you with an alcohol use disorder (AUD) or a substance use disorder (SUD) and has created a treatment plan for you to address it. You will want to work closely with your doctor to ensure the treatment plan meets your needs.

What Are Medical Mutual Plans?

Medical Mutual offers a variety of plans. They offer individual and family plans through the Ohio Insurance Marketplace. You might also have one of these plans through your employer. Medical Mutual plans are Health Maintance Organizations (HMOs), which means you’ll need to get care within the provider network. You’ll also need a primary care doctor that will give you referrals to specialists such as addiction counselors.

If you qualify for Medicare, you can also get Medicare plans through Medical Mutual. If you have Original Medicare, you can get a Part D prescription plan and/or a Medicare Supplement plan. Another option is to replace Original Medicare with a Medicare Advantage plan. Advantage plans offer the same coverage as Original Medicare but generally include additional benefits as well, such as vision, dental, and hearing coverage. However, you will likely need to use the plan’s network providers and you might need preauthorization as well.

Finally, Medical Mutual offers add on plans such as separate dental, vision, accident, and life insurance.

What Inpatient Addiction Treatment Does Medical Mutual Cover?

Medical Mutual will usually cover inpatient addiction treatment if it is a medically necessary part of your treatment plan. You may need preauthorization and/or a referral from your primary care physician, depending on your insurance plan.

Inpatient treatment often takes place in a hospital or clinic. But sometimes it is provided in a residential facility that offers a more home like setting. Inpatient care provides around the clock monitoring in a structured environment. Treatment is provided by credentialed staff and living accommodations and food are included. Inpatient or residential care removes you from the temptations faced in everyday life and allows you to fully focus on your treatment. In cases of a severe addiction or a dual diagnosis or another health issue requiring close monitoring inpatient or residential rehab provides a good option.

During inpatient treatment medical detox is often available. This process gives you medical care to manage withdrawal, including medication-assisted treatment (MAT). During MAT FDA approved medications aid withdrawal and reduce physical symptoms that are associated with it helping you be safer and more comfortable while going through detox treatment.

What Outpatient Rehab Does Medical Mutual Cover?

Addiction treatment delivered in an outpatient setting is covered by most Medical Mutual plans in line with ACA requirements. Your insurance company can verify details about your plan’s specific outpatient addiction treatment coverage.

Outpatient treatment does not provide overnight care. You return home following your treatment sessions. This allows for more flexible scheduling so that you can accommodate work or family obligations. But since you will still be in an outside environment you’ll still face the stressors and temptations that are present there. An outpatient treatment program works best for people with mild to moderate addiction or those who have recently completed an inpatient or residential program. Outpatient detox can also be helpful for those who have a low risk of experiencing severe withdrawal symptoms.

Outpatient treatment can include a partial hospitalization program (PHP) with at least 20 hours of treatment per week that is scheduled over 4 to 7 days and lasts 3 to 4 weeks. Or it can involve an intensive outpatient program (IOP) that provides between 9 and 20 hours of programming a week and lasts 4 to 8 weeks.

The least intensive option is a regular outpatient program (OP) that meets once or twice a week for one to 1.5 hours, or up to 3 to 4 hours, each day. The length of outpatient programs differs by facility but 30 days is a typical program length.

Does Medical Mutual Cover Suboxone & Methadone (MAT)?

Medication assisted treatment (MAT) involves prescribing medications such as Suboxone and methadone to treat withdrawal symptoms during detox and to manage cravings during rehab.

Longer term MAT is for those who struggle with opioid or alcohol misuse. It’s generally paired with evidence based treatment so you can build a strong foundation for ongoing recovery. Managing cravings helps lower the risk or relapse and overdose. Over time you’ll taper off the medication support so you can live truly substance free.

MAT may be covered by your Medical Mutual plan. However, it’s important to verify your coverage before you get your medication. You may need a referral or preauthorization to ensure you get the coverage you need.

Done Medical Mutual Cover Other Mental Health?

Mental health treatment is covered by Medical Mutual health plans. It’s important to find an in network provider to take advantage of this coverage. Medical Mutual members can visit the company’s website to find appropriate mental health care professionals who are covered by their plan.

Mental and behavioral health services are covered by Medical Mutual plans. These services include treatment for substance use disorders as well as anxiety, depression, and other mental health concerns. Both inpatient and outpatient treatment are covered by Medical Mutual plans, as well as telehealth options. Copays may be required. Members should refer to their Summary of Benefits and Coverage to learn more.

Does Addiction Treatment Need to Be In Network?

Most Medical Mutual plans are HMO plans that do not offer out of network coverage. A few Medical Mutual plans may offer an out of network option. But these plans would usually involve greater out of pocket expenses such as higher costs for deductibles and copayments.

Using an in network provider will likely be your most cost effective option. But if you choose to go outside of your network carefully review the details of your insurance policy to compare the service options and expenses involved.

How to Verify Coverage With Medical Mutual

You can verify your healthcare coverage by calling the customer service line at Medical Mutual or by logging onto your online Medical Mutual account. This will give you details about your coverage and help you find in network providers.

You could also call the addiction treatment center that you’re thinking about attending and ask if they accept your specific insurance plan. In that case you’d need to make sure that you correctly state the exact name of your plan. There are many different plans and some may have similar names.

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

If your insurance plan doesn’t cover the cost of your rehab, you still have options. There are ways to pay for treatment without using insurance.

Many treatment centers have reduced fee payments based on a sliding scale. This allows you to pay less depending on your income and household size. Using this sort of treatment center can make rehab much more affordable. However you will want to make sure they are properly accredited and have licensed clinical staff.

Affordable government funded substance abuse treatment programs are available in almost every state. Some addiction treatment programs are run by county governments as well. You can find information about these programs by visiting the official government web pages for your state or county. You can also visit your state or county’s Mental Health Department’s website. Addiction treatment offered by government subsidized rehab facilities may be free or at least available at a very low cost.

Another free option is the Salvation Army Rehabilitation program which allows you to exchange work in one of their facilities for the cost of treatment in their addiction program. Visit the Salvation Army website to find links to their rehabilitation centers which are located in many states.

Other options include applying for a grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA addiction treatment grants are available in all states. Financial assistance may also be available through scholarships or grants offered by some advocacy groups or churches.

Finally, you might consider using a credit card to pay for your rehab treatment. CareCredit is a company that markets credit cards for specific use for healthcare needs. Or you might borrow money from your family or friends. What’s most important is to get the rehab you need so be diligent when searching for funding options.