TriWest Health Insurance Coverage For Drug Rehab

Triwest is a part of the VA health system’s Community Care Network (CCN). The CCN is divided into five regions and Triwest is the third party administrator for regions 4 and 5.

The Community Care Network enables veterans to obtain healthcare outside of a VA facility when certain eligibility requirements are met. This is especially important when individuals do not live near a VA facility or need care that their VA facility does not provide. It’s also helpful for specialized care or when the wait is too long for a needed appointment.

Referrals must be obtained from the veteran’s primary care provider within the VA system for care with a CCN to be covered. Failure to obtain a referral could result in non payment.

Does TriWest Cover Addiction Rehab?

Yes, TriWest will provide addiction rehab for those who are approved by the VA for this type of care. TriWest has providers for inpatient and outpatient services such as residential care and various outpatient treatment programs. You can also get medication assisted treatment (MAT) including detox and long term maintenance if it’s appropriate for your individual needs.

Prior to any type of alcohol and substance use disorder treatment you will go through an assessment process to determine the best starting point for your unique circumstance. The American Society of Addiction Medicine has created an assessment tool that the VA may use to help to determine the level of care that is appropriate for your specific recovery needs.

If you need to obtain services outside of a VA facility TriWest will help to locate a community provider that meets VA quality standards. A referral from a VA healthcare provider will be necessary before starting any treatment programs.

In What States Does TriWest Provide Coverage?

TriWest administers the Community Care Networks in Regions 4 and 5. This includes the western and southwestern portions of the United States along with Alaska and Guam. It also includes the Northern Mariana Islands and American Samoa.

For example, you would use TriWest for Community Care in Texas or California along with Oregon or Colorado.

When Would TriWest Provide Care Instead of the VA?

Under certain circumstances when a veteran is unable to obtain the services they need at a VA facility they may seek care through the Community Care Network.

For example, you may not have a VA facility within the defined standard for driving (which is 30 minutes from an individual’s home) or appointments can not be made in a timely manner (within 20 days of need). Perhaps the type of care needed is not provided by your VA facility or more specialized care is required.

You can find the CCN provider yourself or ask your VA medical team to find one for you. Then you’ll ask for a referral from your VA primary care provider which can take 14 days to process. Once you have the referral you can schedule your appointment. When the appointment is scheduled the VA will send you an authorization letter for CCN care which will tell you what kind of care you can get and how long you can get treatment before you need another referral.

What Type of Inpatient Addiction Treatment Does TriWest Cover?

TriWest administers CCN care for inpatient rehab when inpatient care is approved by the VA. This can include medical detox and residential treatment. There are many factors your doctor will consider when determining the appropriate level of care. They will look at your support system and willingness to work the program along with your physical and financial condition.

While not everyone requires medical detox there are many benefits to this first step in recovery. Medical detox allows for slow and safe withdrawal from substances such as alcohol and benzodiazepines along with stimulants and opioids in a closely monitored environment. Medical professionals assess and treat the symptoms of physical dependence. This may include the use of FDA approved medications such as methadone or disulfiram. Naltrexone and buprenorphine are other options. Medical professionals can also provide care to help stabilize any other conditions that may be affected by the withdrawal process such as hypertension and diabetes.

On average the medical detox lasts between 7 and 10 days but each person’s experience is different. Continued medical support may be needed for weeks or months.

Residential treatment is often recommended after medical detox and for some it may be the first step in their recovery journey. During this time you’ll be at an inpatient treatment facility and receive 24/7 care. Treatment generally includes individual and group therapy along with nutritional counseling and life skills education. You’ll also get recreational and experiential therapy and in some cases holistic therapies such as meditation and yoga and art therapy.

Recognizing that the first phases of recovery are difficult residential treatment provides a structured environment where individualized treatment plans are created to meet the unique needs of each person. This may include ongoing MAT to help reduce the cravings that can be a tremendous obstacle in recovery.

Residential treatment times can vary. Programs can range from 30 to 90 days and in some cases longer depending on the needs of the individual. The 90 day treatment programs have been shown to have the highest success rates.

What Type of Outpatient Rehab Does TriWest Cover?

Outpatient rehab services are provided by TriWest when approved by the VA. As with other types of care a referral is required before obtaining any treatment outside of the VA system. The facility and provider must be a part of the CCN system for coverage.

Partial Hospitalization programs (PHPs) provide you with similar intensive treatment plans as residential treatment but allow you to return home each night. These programs are known as day programs and provide an average of 20 hours per week of addiction treatment. Participants receive individual and group therapy as well as medical care if needed.

Intensive Outpatient Programs (IOPs) are another treatment option for people who do not need residential treatment. These programs require a time commitment of several days per week but allow for more flexibility to accommodate work and allow for a return to home each night. On average you’ll attend treatment for 9 to 12 hours per week. Typically these programs last for 90 days but depending on your unique recovery needs this could be extended.

IOPs consist of individual and group therapy and may include case management programs along with vocational and education support and family therapy. Often a 12 step recovery program is also a part of this type of treatment.

An aftercare program’s main goal is to help you establish long term recovery and avoid relapse. Recognizing that recovery is a lifelong commitment these programs help to equip you with the support and tools you need to meet the day to day challenges you’ll face. Ongoing therapy and programs geared toward strengthening coping skills and recognizing triggers are common and you’ll learn to build your support system. You may also have access to peer support groups along with vocational and education support and case management services.

Does TriWest Cover Methadone & Suboxone (MAT)?

Yes, TriWest has CCN providers that offer MAT if this treatment is approved for you by the VA.

MAT refers to the use of FDA approved medications such as methadone or buprenorphine or naltrexone and others to help those with alcohol or substance use disorder in the recovery process.

In the early stages of recovery MAT can be used during medical detox to help decrease withdrawal symptoms and normalize brain chemistry. Medical detox on average lasts 7 to 10 days. For some this is where the use of medication assisted treatment ends.

For others MAT may be used for weeks or months or for an even longer term. For those who struggle with opioids or alcohol MAT has been shown to greatly reduce the risk of relapse and decrease the number of overdose deaths. When the medication is paired with evidence based treatment you have a better chance of establishing long term recovery and eventually living a fully substance free life.

Does TriWest Cover Other Mental Healthcare?

TriWest has CCN providers that can offer mental healthcare when approved by the VA as well. TriWest and the VA offer a wide range of options when it comes to mental health care including individual and group therapy involving modalities such as cognitive behavioral therapy (CBT) and Dialectical behavioral therapy (DBT). You can also get couples and family therapy along with readjustment counseling and grief counseling. The VA offers military sexual trauma therapy as well. Treatment with medication is also a part of mental healthcare through the VA system

According to the Substance Abuse and Mental Health Services Administration SAMHSA) 1 in 4 people with a mental illness also experience alcohol or substance use disorder. When mental illness and SUD occur at the same time it is referred to as a cooccuring disorder. Because of this mental health care is an extremely important part of the recovery process. It’s very important to get integrated care that addresses both mental health and addiction to give yourself the best chance at long term recovery.

Does Addiction Treatment Need to Be In Network?

If you want the VA to cover addiction treatment you will need to obtain care in a VA facility or through an approved CCN provider. It is important to remember that a referral is needed from a VA primary care provider before obtaining care outside of a VA facility.

Failure to get a referral or use a CNN authorized provider could result in nonpayment of services. Emergency and urgent care do not require a referral prior to receiving care.

If you have other health insurance and your addiction or mental health concerns are not service connected you may be able to use your other insurance to get treatment outside the VA and CCN system. You will want to check with that insurance plan to see what coverage is available.

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

If you cannot find a provider within the VA system or CCN network there may be other options to help pay for care.

You might be able to get non VA health insurance and get coverage for non service connected addiction or mental healthcare. That insurance plan will have its own provider network and coverage requirements so be sure to understand the full details of the plan before you commit to treatment.

You might also qualify for Medicaid in your state if you’re lower income. Medicaid coverage will allow you to get free or low cost care for addiction and mental health through state and county facilities.

Another option is to pay for treatment yourself. Many treatment centers have payment plans available or offer a sliding scale of fees based on income. Others offer scholarships to help pay for the cost of treatment.

Finally free services can be found in many communities through organizations such as the Salvation Army or YMCA along with homeless shelters or faith based organizations. As with all types of medical and mental health care it is extremely important to verify accreditation and ensure the highest quality of care when seeking free or low cost treatment options.