PacificSource Health Insurance For Addiction Treatment

PacificSource Insurance was founded in 1933 by a group of 21 physicians in Eugene, Oregon. The company’s mission is to help community members improve their health and improve the healthcare experience by offering affordable care. They are a not for profit health insurance company now based in Springfield, Oregon.

They offer various plans, including individual and family employer group plans. They have Medicare options and Medicaid along with helping administer self funded plans. They also provide dental and vision along with other ancillary health benefits.

They focus on four western U.S. states with healthcare partnerships that provide members with a wide network of providers in the area. The company is known for its involvement in the community and commitment to improving health outcomes where it operates.

Does PacificSource Cover Addiction Treatment?

Most PacificSource health plans offer coverage for drug and alcohol addiction treatment as mandated by the 2010 Affordable Care Act (ACA). The ACA defines 10 essential health benefits that plans must cover and the list incudes mental health and addiction treatment.

However, there are exceptions to the law and every insurance plan is different in terms of coverage limits and requirements. It’s essential to verify your insurance coverage before receiving addiction treatment. It’s also helpful to have your doctor create a treatment plan which will help define what types of care are medically necessary in your case.

What Are PacificSource Plans?

PacificSource offers a variety of health insurance plans that are adjusted to meet the community’s diverse needs. Many of their plans include healthcare benefits beyond what’s required by the Affordable Care Act.

You can get individual and family plans in the state’s Insurance Marketplace or through your employer. In the Marketplace Pacific Source offers various coverage levels that are categorized as bronze, silver, and gold under the Affordable Care Act. Each level has different premiums, deductibles, and out of pocket costs. For example a Bronze plan has a lower monthly premium and covers about 60% of the cost of care, while a gold plan has a higher premium and covers about 80% of the cost of care.

PacificSource offers several employer group plan options. Small group plans are designed for businesses that have less than 50 employees. They offer a range of coverage options to help meet employer budgets and employee needs. Large group plans are for businesses with more than 50 employees.

These plans can be customized and include wellness programs and health savings accounts. Larger employers can also choose self funded plans that allow them to pay for employee health claims directly while using PacificSource to administer the program and provide support.

Those who qualify for Medicare plans can also find options with PacificSource. If you have Original Medicare you might choose a Part D prescription drug plan or a Supplement Plan. Medicare Supplement Plans cover out of pocket costs that are not covered by Original Medicare, such as coinsurance and deductibles.

The company also has Medicare Advantage plans which replace Original Medicare while offering at least the same coverage. Many Advantage plans have extra benefits as well such as coverage for vision or dental or hearing care. However you may need to use only in network providers and may also need preauthorization for care.

Finally, PacificSource offers Medicaidplans in certain areas of Oregon. The Medicaid Program is called the Oregon Health Plan. PacificSource Community Solutions coordinates Oregon Health Plan benefits in certain counties in the state.

Where Does PacificSource Offer Coverage?

PacificSource established partnerships with a broad network of healthcare providers in four states along the West Coast. These states include Oregon, Idaho, Montana, and Washington.

PacificSource is based in Oregon where they offer most of their insurance benefits. They provide individual, family, and employer group plans and Medicare plans in Idaho and Montana. Coverage in Washington is more limited.

What Inpatient Addiction Treatment Does PacificSource Cover?

Most PacificSource plans cover inpatient treatment in a hospital or clinic and residential treatment in a more home like setting. Inpatient facilities must provide 24 hour care and have nursing staff on site at least 8 hours per day. The team will record your medical history and give you a treatment plan and toxicology screen. Keep in mind you need to let PacificSource know about your admission to inpatient care within two days.

If your doctor determines you need medical detox you will get medical supervision during the detox process. This may include medication assisted treatment (MAT) to help you manage withdrawal symptoms and stay safe and as comfortable as possible.

After detox residential treatment generally includes evidence based care where you live at the facility for 30 to 90 days. You’ll also have activities and access to holistic treatment like art or music therapy. You may also have outings or recreational activities that help you stay healthy and teaches you to embrace life in a new way.

Not all PacificSource plans will have the same coverage so be sure to verify your insurance plan before you commit to treatment.

What Outpatient Rehab Does PacificSource Cover?

Most PacificSource plans cover outpatient care in compliance with the Affordable Care Act. There are some exceptions to the ACA so be sure you talk to the insurance company before you begin treatment.

There are many types of outpatient care. Partial hospitalization programs (PHPs) provide 20 or more hours of treatment a week scheduled over 4 to 7 days. PHPs generally last up to 30 days.

Intensive outpatient programs (IOPs) provide 9-20 hours of treatment a week and last 4 to 8 weeks. Regular outpatient programs (OPs) meet once or twice a week for 1.5 to 4 hours with program length varying by facility.

As with residential treatment, outpatient care must be provided by certified or licensed professionals. A psychiatric and medication evaluation and a psychosocial assessment must be conducted during admission. A treatment plan must be completed within the first week, using American Association of Addiction Medicine guidelines.

Many outpatient treatment programs also offer aftercare services when you finish them. Services such as additional counseling sessions and 12 step peer group recovery meetings are common. There may also be alumni meetings offering socialization opportunities.

Does PacificSource Cover Methadone & Suboxone (MAT)?

PacificSource plans may cover MAT when it is delivered in a qualified practice setting certified by the Substance Abuse and Mental Health Services Administration (SAMHSA).

For many PacificSource plans no prior authorization is required to access MAT treatment for substance use disorders, including opioid addiction. Treatment can take place in an inpatient setting or in an outpatient facility.

MAT medications being administered must be approved by the FDA. Methadone and Suboxone are both approved for use in MAT treatment. A patient can obtain MAT treatment from one provider and residential or outpatient treatment from another provider so that both treatments are able to be delivered concurrently.

Does PacificSource Cover Other Mental Healthcare?

Most PacificSource plans offer mental healthcare in accordance with the ACA. But remember there are exceptions to the law and every plan is different. So you should always verify your coverage with the insurance company before starting treatment.

Mental health treatment options available include crisis care and counseling and psychotherapy. Both in person and virtual sessions are often available and you may also get medication management. Virtual sessions are conducted over the internet or by phone.

Dual diagnosis or co occurring disorders are where a mental health disorder and addiction are both present at the same time and they are are common. In such cases it is important that both conditions are treated simultaneously using a coordinated care plan. If you have a dual diagnosis, make sure that you inform both your healthcare provider and your insurance company. They can then provide you with integrated services that will assure your long term success.

PacificSource requires that dual diagnosis programs must offer mental health interventions provided by licensed mental health professionals who have appropriate state licenses to provide both mental health and substance use disorder treatment.

How to Verify Coverage With PacificSource

There are several ways to verify your insurance coverage. The first is to read through the documentation that came with your insurance policy. This typically includes lists of healthcare benefits that are covered and that are not covered.

Pacific Source also has a member services number where you can call and ask questions about your policy and you can also log in to your PacificSource account on their website to find coverage details and in network providers.

Another way to determine your insurance coverage is to talk to the addiction treatment center that you’re interested in. They may be able to verify your insurance coverage and determine the documentation that may be needed for prior authorization. They can also answer your questions about rehab and start your admission process.