Guidewell Insurance Coverage for Rehab

GuideWell insurance plans cover rehab treatment options for substance use disorders as part of the Blue Cross Blue Shield family of companies.

GuideWell Insurance began in Jacksonville, Florida in 1994. Its insurance companies cover members in Florida and Puerto Rico, though it also has healthcare centers all over the U.S.

Continue reading to learn:

• What recovery healthcare services may be covered by your GuideWell plan
• How to determine which addiction treatment facilities are in-network
• How to locate recovery centers near you
• What factors affect your plan coverage

Answer: Yes, but drug and alcohol rehab coverage under your GuideWell insurance benefits may vary by your plan.

While the Mental Health Parity and Addiction Equity Act (MHPAEA) requires that coverage for mental health and substance use disorder treatment be on par with coverage for other medical and surgical procedures, it does not require that all types of treatment be covered.

Your plan may not fall under the Affordable Care Act (ACA) guidelines and, therefore, not be subject to offering coverage for mental health and substance use disorders.

State guidelines may also affect levels of coverage for GuideWell, as some of those differ from the federal guidelines.

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.

The two main factors that determine whether GuideWell will cover your drug addiction treatment are the type of plan you have and where you’re located.

While you must live in Florida or Puerto Rico to get a plan through GuideWell, some plans include the option to be treated at one of GuideWell’s provider partner facilities in other states.

You can log into your member site to find out if your plan covers rehab facilities outside your location. Of course, emergency care is handled differently, and it is more likely to receive coverage on most plans.

Other factors that may affect your coverage include being treated by out-of-network providers and whether you’ve met your deductible and pre-authorization requirements.

Answer: Possibly. Some GuideWell plans will cover out-of-network rehab programs, but you have to verify that you have a plan that offers coverage outside of your area.

You will also have to ensure that you are receiving care from providers who are on one of GuideWell’s approved provider lists.

You can check your Benefits Book online to find out what health plan you have and what providers and treatments are covered.

Know that choosing a provider not in GuideWell’s network can result in more expensive out-of-pocket costs for coinsurance and penalties, depending on your specific plan.

Also, some treatment services or prescriptions may be covered under your plan but require prior approval. You may be responsible for obtaining that prior approval by contacting your GuideWell insurance provider.

GuideWell insurance plans are available in Florida and Puerto Rico. You can visit their website to find out if you live in their coverage area.

If you already have GuideWell, you’ll want to log into your member site or call the number on the back of your insurance card to determine your rehab treatment coverage limits.

Florida GuideWell insurance plans options are:

Florida Blue (HMO and PPO)

• Medicare
• Individual & Family
• Businesses

Truli for Health

• Business Only

Florida Health Care Plans

• Medicare
• Individual & Family
• Employer

Capital Health Plan

• Medicare
• Individual & Family
• Employer

Puerto Rico GuideWell insurance plans are:

Triple-S Salud

• Individual, Couple, and Family
• Medicare
• Medicaid
• Federal government employees and retirees
• Businesses with 50 employees or fewer
• Businesses with 51 employees or more

Most types of addiction are covered by GuideWell insurance, but it depends on what plan you have.

Logging into your member site or calling the number on your insurance card will help you learn if treatment services offered for your addiction will be covered by your GuideWell plan.

Because GuideWell is the parent company with BCBS licensed companies and has multiple partnerships, there are a number of options for accredited rehab centers.

Rehab centers that are covered by GuideWell can be found by:

1. Logging onto your insurance company’s member site and performing a search query.
2. Using your insurance company’s Find a Doctor or Locate a Provider search tool.
3. Calling the number on your insurance card.
4. Speaking to the benefits coordinator at your work, if your coverage is provided by your employer.
5. Directing your browser to RehabNet.com for our comprehensive, pre-vetted database of rehab centers.

With so many choices and different websites to visit, it’s easy to get lost in all that GuideWell insurance has to offer.

When you need information on the drug and alcohol addiction treatment centers nearby, contact RehabNet. We’re always available on our helpline or website, and our list of providers goes through rigorous assessments to determine eligibility.