MVP Health Insurance Coverage for Addiction Treatment

MVP Health Care is a non profit insurance company whose headquarters are in Schenectady, New York. They’re a regional company, so you’ll see their insurance plans in New York State and Vermont.

Many of their plans are offered through area employers, but they also have Medicare Advantage plans and a managed Medicaid plan. They have individual and family plans too. You can sign up for MVP directly through them or through the New York and Vermont health insurance exchanges.

Does MVP Health Care Cover Addiction Treatment?

Most MVP plans do cover substance use treatment. They focus on covering medically necessary treatment and you may need to get a referral and/or preauthorization before you begin rehab.

Because every plan is different, it’s important to verify your coverage details and understand what requirements and limits there may be. That will allow you to get a treatment plan from your doctor that shows what’s medically needed in your case. You’ll also be able to find in network providers on their website and get any referrals or preauthorization you may need.

MVP Health Care Available Plans

MVP offers a wide variety of plans. You may have an individual or family plan from the Insurance Marketplace or through your employer. They also have Medicare and Medicaid for those who qualify and specialty plans.

The individual and family plans have different types. The most common are health maintenance organizations (HMOs), exclusive provider organizations (EPOs), and preferred provider organizations (PPOs).

An HMO is less expensive each month but you need to use in network providers. An HMO also requires you to have a primary care provider who can give referrals to specialists like addiction counselors. An EPO also requires you to get in network care but you don’t need referrals to get specialist care. Finally, a PPO has the highest monthly premium but gives you the freedom to get out of network care and you can see specialists without referrals.

How Much Does Rehab Cost with Health Insurance From MVP?

The most important numbers to take note of are your deductible and your total out of pocket limit. Another important number is how much cost sharing you’re expected to do. It may be a defined copayment or a percentage of the cost, which is known as coinsurance. These are annual figures and reset each year.

You’ll want to make sure you choose an in network provider to maximize your insurance coverage, and if you need preauthorization be sure to get it so you have the coverage you need.

What Special Features Does MVP Health Care Have?

One thing that makes MVP Health Care stand out is the Essential Plan that’s available in New York. It has a $0 monthly premium and $0 deductible. It’s available to those within certain income limits — people and families who don’t qualify for Medicaid but are still lower income.

The Essential Plan includes dental and vision care along with low cost prescriptions. You’ll also get inpatient and outpatient services and primary care including virtual care. There is also coverage for mental health and addiction treatment along with emergency and maternity services.

What Inpatient Addiction Treatment Does MVP Health Care Cover?

Although the benefits and limitations between MVP Health Care plans may differ they all focus on delivering medically necessary care. It is crucial to have a treatment plan from your physician that documents the care required to treat your symptoms or diagnosis. This information will also be used to pre authorize treatment and helps ensure insurance coverage.

Addiction treatment is highly specialized and typically begins with medical detoxification. These programs provide FDA cleared prescription drugs to reduce withdrawal symptoms and help prevent life threatening complications that can occur during withdrawal from certain medications and drugs. Many times medical detox happens in an inpatient or residential care facility.

Once the substances have cleared your body you may transition into an inpatient or residential evidence based treatment program in the same facility. Evidence based programs can include approaches like cognitive behavioral therapy (CBT) and dialectical behavior therapy along with motivational interviewing.

These strategies help to identify addiction triggers and negative thought patterns that support addictive behavior. By changing your thought patterns you can change the results. Evidence based therapies also help develop healthier coping strategies and teach you how to care for your body and mind along with your emotions.

What Outpatient Rehab Does MVP Health Care Cover?

Outpatient drug and alcohol treatment may be the initial treatment strategy determined by your doctor. Your treatment program is typically customized based on a comprehensive evaluation and assessment of your physical and mental and emotional status. Outpatient programs can include a partial hospitalization program (PHP) or intensive outpatient program (IOP). There is also general outpatient treatment.

A PHP provides intensive and highly structured evidence based treatments. These treatments are typically similar to those you would receive in an inpatient or residential care facility but you can return home in the evening. Your customized treatment program may include an IOP that provides treatment for a few hours each day for several days each week.

Some IOPs offer treatment in the morning or evening hours. This allows you to maintain your work or school obligations while attending therapy. After completing an intensive program you may be transitioned to a general outpatient treatment program. These typically include therapy once or twice a week and make plans for relapse prevention programs and aftercare.

The structure of your aftercare program depends on your needs and the community resources the treatment center connects you to. Some options may include weekly therapy and community support groups. There are also relapse prevention programs and drug and alcohol testing and monitoring along with vocational training. Some treatment programs have alumni groups during which you can network with others who have graduated from the program.

Does MVP Health Care Cover Methadone & Suboxone (MAT)?

MVP Health Care plans may cover methadone and Suboxone during medication assisted treatment (MAT). Medication assisted treatment is useful during medical detoxification and for ongoing treatment of opioid and alcohol use disorders. During medical detoxification you may receive FDA cleared prescription medications that reduce symptoms of withdrawal and help reduce cravings.

These medications can be used on an ongoing basis to help maintain your sobriety. Commonly prescribed drugs are methadone and buprenorphine along with naltrexone and Suboxone.

Does MVP Health Care Cover Other Mental Healthcare?

Two federal laws regulate how insurance providers cover essential health services such as treatment for mental health conditions and substance use disorders. Most MVP Health Care plans meet those regulations and offer at least some coverage for mental health care. However there are exceptions to these regulations so you must confirm your insurance policy’s coverage and limits.

Some of the common mental conditions include post traumatic stress disorder and depression. People may also struggle with anxiety disorders and bipolar disorder and borderline personality disorder. MVP Health Care policies may also cover crisis support when you need immediate mental health care.

Mental health conditions are commonly diagnosed alongside substance use disorders. Co occurring disorders are also called dual diagnosis. When your insurance company offers coverage for mental health conditions they typically also offer integrated care for dual diagnosis that covers treatment for both mental health and substance use disorders. This integrated care sets you up for long term and sustainable recovery.

Does Addiction Treatment Need to Be In Network?

Most MVP Health Care plans do not cover out of network treatment but some plans do. This is why it’s important to understand the benefits and limits of your particular plan. When you receive care out of network your out of pocket costs will typically be higher. Even if the insurance plan covers some costs you will likely have higher deductibles and co payments.

You can maximize your insurance coverage and receive the care you need by getting treatment for mental health conditions and substance use disorders within the insurance provider’s network whenever possible. Carefully review your insurance benefits and limitations before deciding on an out of network provider so you are well informed of the costs you might incur.

How to Verify Coverage With MVP Health Care

There are several ways to verify your insurance details with MVP Health Care. The first is to contact the insurance company’s customer service line or login to your online insurance account. The Gia app by MVP gives you an overview of your coverage including how much you’ve paid on your deductibles. It also tells you your plan limits and can help you find in network providers.

Another option to verify your coverage is to work with the treatment center of your choice. They can tell you if they’re in network with your insurance plan and many will help verify your insurance coverage and estimate your out of pocket costs. There are a wide variety of plans within MVP Health Care so the treatment center or your insurance provider will need the exact name of the plan and your member number.