Answer: Centene covers all types of substance use disorder treatment. However, your specific insurance plan may not cover all of your addiction treatment.
It may cover a lower percentage of the total cost of inpatient treatment plans but a higher percentage of outpatient programs, as those can cost significantly less. It may not cover detox unless your healthcare providers submit a referral.
If your plan was purchased by March 23, 2010, and has not changed significantly, offering the same coverage as later insurance plans isn’t required.
Centene may cover medical detox, but you must check your specific plan. Even if it’s generally covered, you may negate that coverage if you’re treated at an out-of-network facility or fail to gain pre-approval.
Your insurance plan may cover medication-assisted treatment (MAT), but there may be restrictions on that coverage. Sometimes, health insurance will only cover a portion of a prescription, so you may have out-of-pocket costs even if your medication is covered.
MAT can refer to medication used to help you through initial withdrawal symptoms in drug addiction treatment. It can also apply to medication that you take to maintain your sobriety.
Centene’s Medicare Part A covers inpatient rehab. Before the ACA, Medicaid did not cover substance abuse treatment for minors or childless adults. However, some states now offer coverage for those individuals.
This type of treatment falls under the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires insurance coverage for substance use disorder (SUD) treatment to be equivalent to any other medical and surgical benefits.
Additionally, any plan purchased from Centene health insurance companies through the Health Insurance Marketplace will include some coverage for inpatient rehab.
Dual Diagnosis Treatment
A dual diagnosis is given when a patient has co-occurring disorders of substance abuse and mental health. You’ll need to check your specific Centene health plan or contact your insurance provider to determine what benefits might apply to your dual diagnosis.
Outpatient Treatment Programs
Medicare, Medicaid Part B, and any ACA plans through Centene will cover some outpatient treatment programs.
Your explanation of benefits (EOB) will tell you what percentage of treatment will be paid through insurance and what portion will be your responsibility.
You may have copays and a remaining balance if you haven’t met your deductibles.
Counseling & Behavioral Therapy
Behavioral health services are considered Essential Benefits under the Affordable Care Act and, therefore, are covered by Centene plans. Medicare and Medicaid also cover mental health services.
Even if your insurance plan was grandfathered in before the ACA took effect, you may have some sort of Employee Assistance Program (EAP) benefits that offer a few behavioral health counseling sessions for free.
Behavioral health treatment is evidence-based and shown to heavily contribute to your overall wellness and relapse prevention.
Check with the Centene provider in your area to find out what types of continuing care are covered under your plan.
Coverage may apply to additional inpatient or outpatient treatment, residential treatment, or sober living communities.
Verify that these treatment services are in-network and whether you need a referral. It’s important that you (or your loved one) receive the right type of treatment for substance use disorder.