UniCare Insurance Coverage for Drug & Alcohol Addiction

UniCare is an insurance company that’s a subsidiary of Anthem. Recently, they have paired down their offerings and eliminated most of their medical health insurance plans. They have one medical plan left in West Virginia, where they offer a managed Medicaid plan.

Most of their business now comes from working with employers to offer dental, vision, and employee assistance programs to their employees.

Does UniCare Insurance Cover Addiction Treatment?

If you have a UniCare managed Medicaid in West Virginia, that plan covers the full spectrum of addiction treatment, including drug rehab and addiction treatment with medications. So, to answer the question, “Does UniCare Mountain Health Trust cover drug rehab?” the answer is, yes, they do.

If you have the UniCare employee assistance program or EAP, be aware that it’s not a medical plan. While it may cover some outpatient therapy visits, it usually covers no other types of addiction treatment.

What Types of Plans Does UniCare Offer?

While UniCare only offers one pure health plan, they do have other products that can help you address your mental health and move toward the treatment you need.

UniCare offers a comprehensive Employee Assistance Program. These programs aren’t medical insurance. They’re a benefit your employer may provide in addition to health insurance. As a result, they don’t cover things like alcohol and drug rehab, or medications that treat substance use disorders.

The purpose of this benefit is usually to connect you with resources that might help you in different areas of your life. These resources may include counseling sessions, legal help, financial help, and child or elder care assistance.

West Virginia’s Medicaid Program is called Mountain Health Trust. UniCare is one of the insurance providers that you can choose to manage your Mountain Health Trust plan. These plans are intended for people who have low income. To get a UniCare Mountain Health Trust plan, you first need to qualify for Medicaid through the West Virginia online human services portal.

UniCare Mountain Health Trust is an HMO plan. This means that you must get care from the providers in their network, otherwise they won’t pay for it—unless it’s an emergency. If you’re thinking of signing up for an HMO type plan like this one, it’s a good idea to verify that the providers you’re used to seeing are in their network.

You may also want to check that they have care available near to you so that you don’t have to travel too far to get to it. Fortunately, this plan is accredited by the NCQA, which provides assurance that they have enough coverage for services to meet the needs of their members—needs such as drug rehab.

UniCare also allows employers to offer vision benefits that include eye exams and access to major retail locations where employees can buy glasses or contacts. Members get discounts if they choose options that go above the allowance for frames or other materials.

Finally, UniCare provides life insurance and disability insurance plans for employers to offer their employees. This gives employees and their families financial support if unforeseen circumstances cause injury or even death.

What Does it Mean that UniCare Has NCQA Accreditation?

When a health insurance plan has NCQA accreditation, it means that they’ve been evaluated by a third party to ensure they meet certain standards. To evaluate a plan, they look at the overall quality of care that plan members get. They also drill down and look at a number of specific areas including behavioral health.

Additionally, they check on how satisfied plan members are with the plan. While it’s still a good idea to look at the network yourself, an accreditation from NCQA usually means the plan has done well in these important areas and can likely meet your needs.

Who Does UniCare Mountain Health Trust Serve?

As a managed Medicaid plan, UniCare Mountain Health Trust serves West Virginia residents who have a low income. For most people, low income means that your household income is no more than 138% of the federal poverty line.

Children and pregnant women can get Medicaid with higher household incomes. West Virginia doesn’t have a work requirement for Medicaid at the time of this writing.

Does UniCare Cover Mental Healthcare?

Medicaid is the single largest payer for mental health treatment. UniCare managed Medicaid in West Virginia also covers mental health treatments and treatment for co occurring mental health conditions. A co occurring condition is also called a dual diagnosis. This is the term used to describe when you simultaneously have symptoms of more than one condition. Treatment for dual diagnosis is specialized and mental health and addiction need to be treated together to achieve the best results.

Congress enacted several laws designed to ensure you have access to mental health treatment including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act. State administered Medicaid programs must follow these regulations.

However, each state can cover mental health services differently. Behavioral health services for mental health conditions can include counseling and psychotherapy which is also known as talk therapy. Treatments are conducted by trained mental health professionals such as psychologists and therapists along with counselors and clinical social workers.

UniCare also has an employee assistance program product. EAPs are purchased by employers and provide care at no cost to employees. An EAP helps maintain a healthy work environment. This benefits you and your employer.

An EAP can help you address various issues including legal concerns and financial issues and even help with aging parents. They also offer support for mental health such as stress and anxiety along with other mental health conditions. The EAP can help you with life events and relationship issues along with traumatic events and addiction. You have access to trained representatives 24/7/365. These are all mental health stressors that can increase the potential for drug or alcohol addiction.

The UniCare EAP program also offers resources to help with tobacco use and adoption. They have resources for education and identity theft recovery. Legal and financial consultations can help you with budgeting and debt along with credit counseling and estate planning. They offer education on their website about credit monitoring and workplace issues.

What Types of Inpatient Rehab Does UniCare’s Medicaid Plan Cover?

Under UniCare managed Medicaid services you have access to inpatient substance use disorder treatment. You don’t need a referral but care must be medically necessary and you might need preauthorizaton. Your physician can help create a treatment plan for inpatient or residential care to address your substance use disorder. This plan is an integral part of receiving insurance approval for the care you need.

Medical detoxification and residential care can help lay the foundation for long term recovery. Medical detoxification allows you to be supported through the detox process with FDA approved medications and other treatment to reduce withdrawal symptoms. This allows you to detox safely and as comfortably as possible so you can start fresh in rehab.

In residential treatment you’ll be able to focus entirely on your recovery without outside distractions. Customized treatment plans typically include evidence based therapies like cognitive behavioral therapy or motivational interviewing. You may also receive individual and group counseling and peer recovery support services. These approaches help identify addiction triggers and change negative thought patterns. Your thoughts create emotions and feelings which often drive actions.

By changing your negative thought patterns you can change your actions and reduce the potential for relapse. Changing negative thought patterns also helps improve decision making and increases emotional regulation. Each of these steps lays a strong foundation for you to achieve sobriety and sustainable recovery.

What Types of Outpatient Addiction Treatment Does UniCare’s Medicaid Plan Cover?

There are several types of outpatient addiction treatment that UniCare Medicaid plan covers. However, you might have to get prior authorization before being admitted into an outpatient program even if you transition from residential to outpatient at the same facility.

Outpatient care allows you to live at home or in sober living while attending treatment during the day. There are several different levels of outpatient rehab.

A partial hospitalization program provides a highly structured and intensive outpatient treatment. These programs usually provide you with the same level of treatment as you received as an inpatient, but you can go home in the evening. A partial hospitalization program may be the first step in your treatment or it may be used as a transition out of residential care and into the community.

An intensive outpatient program is a step down from a partial hospitalization program. You receive therapy for several hours each week, which generally includes individual and group and even family therapy sessions. You continue to receive evidence based treatments but have greater flexibility in your schedule. Some treatment centers offer IOPs at different times of day so you can accommodate work or school obligations.

A general outpatient treatment program typically includes therapy once or twice a week and may also include group therapy and family therapy sessions. These outpatient programs often include plans for an aftercare program which continues to provide you with support in group and individual settings.

Aftercare programs may or may not be administered by the treatment center, but are usually developed as part of your discharge plan. Your aftercare program is developed depending on your needs and may include community support meetings and alumni programs along with medication management and family and individual therapies.