Providence St. Joseph Health Plan Coverage for Addiction Treatment

Providence St. Joseph Health was formed in July 2016 when two nonprofit Catholic healthcare organizations–Providence Health & Services and St. Joseph Health–merged to create a new company.

This company became known as Providence St. Joseph Health. In 2019 the company rebranded under the Providence Health & Services name although St. Jospeh’s is still a hospital within their system.

The different providers within the Providence St. Joseph Health family operate as a healthcare collective which means that they utilize their own network of providers and partners to serve their patients.

The insurance arm of Providence St. Joseph Health–Providence Health Plan–operates mostly in Oregon and southwest Washington but they also collaborate with network partners in other states such as California. In 2000 Providence Health Plan provided insurance for 326,000 members. In 2024 they insure about 375,000 members.

Does Providence Health Plan Cover Addiction Treatment?

Maintaining compliance with the 2010 Affordable Care Act (ACA) most Providence Health insurance plans do offer mental health and substance abuse treatment as well as other medical care. The ACA defined 10 essential health benefits that insurance plans need to cover and the list includes mental health and substance use treatment.

However there are exceptions to the law so it’s very important to verify your insurance details before you commit to treatment. You may also need to get a referral or preauthorization before rehab is covered. Work closely with your doctor to set up a treatment plan that fits your needs so you know what kind of addiction treatment to look for.

Where Does Providence Health Plan Operate?

Providence Health Plan utilizes the Providence St. Joseph Health network of more than one million hospitals and doctors along with mental health providers and pharmacies to deliver care. There are three networks: Providence Connect and Providence Choice as well as Providence Signature.

Insured members have a “medical home” which includes access to their primary care provider at a clinic or hospital. Providence Connect and Providence Choice are available in specific counties within Oregon. The ProvidenceSignature network is a nationwide provider network.

Some services are available in California and Montana along with Texas and New Mexico through collaborating providers. They also have collaborating providers in Alaska.

Types of Insurance Plans Offered by Providence Health Plan

Providence Health Plan offers individual and family plans in Oregon and Washington. They also have insurance plans that employers can use to provide coverage to employees and they have Medicare and Medicaid plans.

Individual and family plans are available directly from the company and on the Insurance Marketplace. They offer all the benefits required by the ACA including mental health and addiction treatment coverage. Many of the plans will pay a percentage of the cost of inpatient and intensive rehab — such as 70% — and then you pay the remainder. The individual and family plans require you to use in network providers unless there’s an emergency or need for urgent care.

Providence Health’s Medicaid plan is called the “Providence Orgeon Standard Plan.” It’s available for lower income individuals and families that qualify for Oregon Medicaid. This plan also covers addiction treatment and mental health and you may be able to get free or low cost care.

Finally Providence Health Plan has two different Medicare plan options. If you have Original Medicare and need help covering your out of pocket costs you can get a Medicare Supplement plans from Providence. Providence also offers Medicare Advantage plans which replace Original Medicare and often have additional benefits such as vision and dental coverage. However you will need to use the Advantage plan’s provider network to receive coverage.

What Inpatient Rehab Does Providence Health Plan Cover?

Your insurance plan will focus on covering medically necessary care. Not everyone needs inpatient or residential rehab but if you do most Providence Health plans will cover at least part of the cost. Addiction treatment is covered as a behavioral health service.

Many people will start with medical detox. This process allows substances to leave your body while you are monitored by doctors and nurses who can help treat withdrawal symptoms. Medication assisted treatment (MAT) is commonly part of medical detox. MAT uses FDA approved medication to manage withdrawal symptoms so that detox is safe and as comfortable as possible.

Inpatient treatment takes place in a clinic or hospital and residential treatment takes place in a facility with a more home like setting. Both provide 24/7 supervision and care.

Inpatient treatment is often for more acute needs and typically lasts one or two weeks. Residential treatment is longer and often lasts 28 to 30 days or more. People experiencing both addiction and a mental health diagnosis—which is known as a dual diagnosis—often require inpatient treatment.

During inpatient or residential treatment you’ll get individual and group therapy along with recreation options. Many programs also offer holistic treatment options like art and music therapy along with yoga and meditation.

What Outpatient Addiction Treatment Does Providence Health Cover?

Most Providence Health Plan insurance covers a variety of outpatient addiction treatment services, including partial hospitalization programs (PHP) and intensive outpatient programs (IOP). Its Charlie Health program is a virtual intensive outpatient program (vIOP) designed specifically for teens and young adults, ages 11 – 30, who are struggling with addiction and other mental health issues.

There is also an outpatient substance use disorder treatment program for adults age 18 and older available through Providence St. Vincent Outpatient Behavioral Health. This 90-day program includes assessment, personalized treatment planning, group therapy, and individual therapy sessions (both in-person and virtual).

Does Providence Health Plans Cover Methadone & Suboxone (MAT)?

Yes, most Providence Health Plans coverage does include MAT programs if it’s medically necessary for you, including Methadone and Suboxone. However, checking your coverage to get the full details and see whether you need prior authorization is always wise.

Methadone and Suboxone are MAT treatments used to treat opioid addiction and help alleviate withdrawal symptoms and cravings. The treatment programs usually involve regular visits for medication management and weekly or bi-weekly therapy visits. One MAT program available in the Providence Health Plan network is at St. Joseph Hospital in Orange, California.

Does Providence Health Plans Cover Other Mental Healthcare?

Providence Health Plans coverage generally offers a variety of behavioral health services and programs to meet your personal needs. This may include inpatient, outpatient, and substance use treatment programs. Also Providence Health Plans provides care management and crisis support, self-management and mindfulness tools, and other resources for improving overall well-being.

The insurer’s Behavioral Health Concierge offers direct access to Providence Health providers who can help with mental health and addiction issues and co-occurring disorders. This service is available to eligible Providence Health Plan members who live in Oregon, Washington, Idaho, California, Montana, and Texas.

As with all insurance plans, coverage will vary so be sure to get the full details on your plan before you start treatment.

Are There Additional Perks Available With Providence Health Plans?

Yes, Providence Health Plans provide additional perks for policyholders besides behavioral health services, including:

Travel assistance, in case you need emergency medical help when traveling internationally or more than 100 miles from your home
LifeBalance discounts on recreational, cultural, and travel-related activities
One Pass Select access to gym memberships, digital fitness apps, grocery home delivery services, and more
One-on-one health coaching to help you reduce stress, quit smoking, eat healthier, or lose weight
Identity theft protection and fraud monitoring