Answer: It depends on the terms of your GuideWell plan type and level.
Examine your coverage information by reading through the Benefits Booklet under your login or by contacting Guidewell to find coverage availability.
Medical Detox
Your GuideWell benefits may cover medical detox, but you’ll need to check your specific plan. GuideWell requires some medications to be pre-approved and may place limits on some treatment options.
Medication-Assisted Treatment
Because medication-assisted treatment may be part of rehab as well as maintenance treatment, you’ll have to check your GuideWell plan. The insurance company places specific limits on some medications, and you’ll need to know that what your doctor prescribes is covered.
For example, you may only be able to receive a 30-day supply of a medication, or you may be able to fill up to 90 days at a time.
If there’s a generic drug available, but you want to go with a brand name, you may be paying out-of-pocket for the price difference, as GuideWell may only cover the cost of the generic.
Inpatient Rehab
Each GuideWell insurance company distributes information differently, so what your GuideWell plan covers will be outlined in your Explanation of Benefits (EOB). You’ll want to ensure that each provider and treatment is in-network and doesn’t require prior authorization.
Utilizing an inpatient treatment center that is part of GuideWell’s healthcare system or one of its partners may help you ensure your treatment providers are in-network for every level of care.
Dual Diagnosis Treatment
Any plan offered through the Health Insurance Marketplace must offer coverage for mental health and substance use disorder treatment.
Because of the ACA, many of GuideWell’s plans will have coverage for co-occurring disorders of mental health conditions and drug or alcohol addiction.
However, plans offered through your employer or before 2010 may not offer that coverage. You may be required to meet a deductible or have a copay for office visits and coinsurance responsibilities for some treatment services.
Outpatient Treatment Programs
For intensive outpatient programs (IOP) and less intense rehab, most GuideWell plans will include coverage. Outpatient rehab may be completely outpatient or a partial hospitalization program (PHP), which means you spend some time receiving inpatient treatment.
Read your EOB to better understand what rehab coverage is included in your plan. You can find it through your member login or request that GuideWell mail a copy to you.
Counseling & Behavioral Therapy
GuideWell plans offer a range of treatment options for mental health disorders and drug and alcohol addiction.
Counseling, family, and group therapy may be covered, but how that works depends on your plan. It may be a part of your general benefits or included under your Employee Assistance Program (EAP).
Because most GuideWell group plans are offered in the state of Florida, they’re subject to Florida law, which requires that they include coverage for mental and nervous disorders.
Continuing Care
Depending on the severity of your addiction and how long you require treatment, GuideWell may limit your insurance benefits for continuing care.
This can include only covering a certain number of days or percentage of treatment costs for the life of your plan or until you’ve met your deductible.
It may also require that you receive prior authorization for any treatment services, prescriptions for maintenance medications, or healthcare providers.
Continuing care can include residential treatment at an accredited treatment center and staying in a sober living community.
