Priority Health Insurance Coverage for Drug Rehab

Priority Health is a nonprofit healthcare company based in Michigan. With more than 1.3 million members, it is the second largest healthcare insurer in Michigan.

Started in 1985 as Lakeshore HMO, in June 2024 Priority Health announced plans to acquire Physicians Health Plan of Northern Indiana, a company that serves 52,000 members. In June 2022, Priority Health also created an alliance with Cigna insurance to allow Cigna members to access Priority Health’s network in Michigan and for Priority Health members to access Cigna’s nationwide network when they are traveling outside of Michigan.

Priority Health also participates in community projects that improve the lives of the underserved residents of Michigan. One such project is a $600,000 Priority Health Foundation grant that helps eight nonprofit organizations provide free vaccines and expand food pantry access to older adults in Detroit, Michigan.

Does Priority Health Cover Addiction Treatment or Rehab?

Most Priority Health plans cover mental health and substance abuse treatment, as required by the 2010 Affordable Care Act (ACA). This law requires most insurance plans to cover 10 essential health benefits which include mental health and addiction treatment. Another law requires that mental health and substance abuse treatment must be available to members at the same level as other medical treatments.

However there are exceptions to the laws and insurance plans differ so you should check with the insurance company to get the details of your specific plan before you commit to a rehab program.

In addition, the type of treatment(s) your insurance covers will be based on your doctor’s assessment and the treatment plan they create. It’s important to work closely with your doctor so you get the care you need.

What Are Priority Health Plans?

Priority Health offers a variety of plans including individual and family plans, plans that employers can offer employees, and coverage for those who qualify for Medicare or Medicaid.

You may have an individual or family plan from the state’s Insurance Marketplace or from your employer. There are two primary types of insurance. A preferred provider organization (PPO) plan lets you choose the doctor and the treatment facility you wish to use without a referral. You may even have some coverage for out of network providers. However the monthly premiums will be higher.

Health maintenance organization (HMO) plans offer the advantage of lower monthly premiums. But that advantage comes with less flexibility. You’ll need to choose a primary care provider to give you referrals to specialty treatment like addiction rehab, and you’ll also need to use an in network provider to get insurance coverage. As long as the network includes the doctors you prefer to use, an HMO can be a great way to save money.

Priority Health also offers Medicare plans for those who qualify. If you have Original Medicare you can get a Medicare Supplement plan to help you cover out of pocket expenses. Priority Health also has Medicare Advantage plans that fully replace Original Medicare. These plans have some additional benefits, such as vision and dental care, but you also will need to choose providers in the Advantage plan’s network.

Finally, Priority Health offers Medicaid plans, including MIChild, Children’s Special Health Care Services, and Healthy Michigan Plan. These plans offer additional benefits as well including help with transportation to medical appointments, care management, and virtual health visits.

What Inpatient Addiction Treatment Does Priority Health Cover?

Priority Health insurance coverage for inpatient addiction treatment will focus on care that is deemed medically necessary. To ensure coverage you should have a comprehensive treatment plan from your doctor.

Inpatient care is particularly important for those undergoing medical detox because it provides the necessary monitoring and safe environment you need as your body clears the drugs and alcohol from your system.

After detox you may move into a residential inpatient care facility to receive ongoing treatment and reduce the risk of a relapse. This treatment includes a very structured environment along with individual and group therapy to help you learn new habits and mindsets for sobriety.

What Outpatient Rehab Does Priority Health Cover?

There are several outpatient program options that your doctor might recommend. Partial hospitalization programs (PHPs) allow you to receive addiction treatment during the day but you return to your home at night. PHPs often involve sessions that last 4 to 8 hours a day for three to four days a week. Thirty to 90 day programs are typical.

Intensive outpatient programs (IOPs) often include 9 to 20 hours of treatment per week that are spread over 3 to 5 days. A total of 90 days of treatment is recommended.

In general outpatient programs (OPs) you might take part in sessions at a rehab facility once or twice a week. Group counseling and education on addiction and relapse prevention will typically be provided. When needed individual sessions may also be offered.

Priority Health also offers Teladoc — virtual mental health support — for free to its members. Formerly called myStrength Teladoc provides resources to help with stress and depression along with sleep problems and other issues that may be related to substance abuse. This service can help you create a personalized plan for mental wellness and provides the tools to help you follow that plan.

Does Priority Health Cover Methadone & Suboxone (MAT)?

Priority Health plans may cover medication-assisted treatment (MAT) plans that use methadone and Suboxone. MAT treats opioid use disorder and alcohol use disorder by curtailing cravings and alleviating withdrawal symptoms which helps prevent relapse.

Along with the medication you’ll receive individual and/or group counseling to help you establish long-term recovery. Eventually you can taper off the medication and live truly substance-free.

Your coverage may vary depending on your specific plan. It’s important to get your full plan details so you can find out if you need a referral or preauthorization before you start treatment.

Does Priority Health Cover Other Mental Healthcare?

Most Priority Health plans cover other mental healthcare services. One program unique to Priority Health is Priority Pups which is a partnership with Canines for Change that places trained therapy dogs in local schools to help alleviate stress and anxiety for kids.

You may be able to get coverage for individual and group coverage to treat mental health issues such as depression or anxiety along with personality disorders and more.

It’s also common to have a mental health disorder alongside addiction concerns. This is known as a dual-diagnosis. If you have a dual-diagnosis it’s essential to get integrated care that addresses both your mental health and addiction. That’s the best way to help you achieve long term recovery.