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Published: January 6, 2024
If you have MVP Health Care insurance coverage and are interested in entering substance abuse treatment, it is important that you have an understanding of what is covered by your plan.
Without a good understanding of your coverage, you may find yourself paying more than you expected and more than you can afford for your addiction treatment.
Read on to learn what kind of substance abuse coverage you can expect with MVP Health Care insurance, and the different factors that can affect your level of coverage.
Answer: Yes, MVP Health Care insurance does cover drug and alcohol rehab, though the amount of coverage can vary depending on the individual and their health plan.
This follows standards set by the Affordable Care Act (ACA), which requires that insurance companies provide coverage for mental health and behavioral health services. And these services often include treatment of substance use disorders.
In order to find a drug rehab center that’s mostly covered with insurance from MVP Health Care, it is best to choose a health care provider or facility that is in your network. This way, you will avoid any additional costs or payments.
This insurance provider currently provides coverage to individuals in New York, New Hampshire, Vermont, Maine, and select areas of Pennsylvania.
Answer: While your specific coverage will depend on your individual plan, the following are some of the treatment services commonly covered at least partially by MVP Health Care.
Medical detoxification is a type of treatment covered by MVP Health Care insurance when considered medically necessary and when prior authorization has been obtained.
Medical detox is often necessary for people with life-threatening withdrawal symptoms or for those who have a high risk of relapse. It involves detoxing a person off drugs or alcohol under medical supervision and with the assistance of medication.
This type of treatment is usually ongoing and offered in an outpatient setting while combined with therapy, and is typically covered by MVP Health Care with a small copay per visit.
Medication-assisted treatment (MAT) is similar to medical detox but is almost exclusively used when treating opioid use disorders and is performed over a more extended period of time.
Inpatient rehab is covered by MVP Health Care, however, people must obtain prior authorization and their residential stay must be considered medically necessary.
One of the most effective and successful forms of substance abuse treatment, during residential treatment people stay onsite and attend therapy, group sessions, and detox if needed.
Dual diagnosis co-occurring disorder treatment can be at least partially covered by some MVP Health Care plans, though the level of coverage may depend on whether it is in an inpatient or outpatient setting.
Dual diagnosis treatment can be a highly beneficial form of treatment for people who are experiencing a co-occuring disorder involving their mental health at the same time as their addiction.
Outpatient treatment is much less intensive than residential treatment, and can come in regular outpatient treatment, intensive outpatient programs (IOP), and partial hospitalization programs (PHP).
Depending on the type of outpatient treatment, prior authorization is not usually required for MVP Health Care, although it should still be considered medically necessary.
Counseling and therapy play a large role in addiction treatment, and are important components for preventing relapse.
This type of treatment is almost always covered at least partially by most MVP Health Care plans, although people may have to pay copays depending on their individual plan.
Continuing care, or aftercare, is treatment that people receive after their initial rehab program has finished and they leave residential treatment. It can include both transitional housing as well as therapy, support groups, and case management.
Continuing care treatments, such as counseling, may be covered by MVP Health Care if they are deemed to be medically necessary. But sober living homes or halfway homes are not usually considered medically necessary and therefore not covered.
It is a good idea to be aware of the following factors which can affect your level of coverage for drug rehab with MVP Health Care.
Factors that can affect your MVP Health Care coverage for alcohol and drug rehab:
As long as you understand your MVP Health Care plan and stay within your network, the majority of substance abuse services can be affordable regardless of the above factors.
Answer: Some MVP Health Care plans do cover out-of-network providers and rehab programs, however, not all of them do, which is why it’s important to understand your specific plan.
Those plans which do cover out-of-network care may only do so for emergency care, and people may still be responsible for a large portion of their final bill.
For people who are looking to have the largest portion of their care covered, in-network providers are almost always considered the best option.
MVP Health Care offers plans for a variety of situations, depending on a person’s income level and their other needs.
These types of plans come in a variety of options and include prescription benefits, preventive care, and pregnancy and family care.
Health plans within this group can be HMO, POS, or PPO depending on the specific plan a person chooses or has available to them.
MVP Health Care provides a few different options to people who need free or low-cost coverage, including Medicaid Managed Care and Harmonious Health Care Plan, which provides additional mental health support services.
There are also Medicare plans available through MVP Health Care for older adults over the age of 65 or for others who may qualify due to disability.
People who qualify for both Medicaid and Medicare may also fit best with the DualAccess plan offered by MVP Health Care.
This plan is available to people who do not qualify for Medicaid or Medicare, and is available with no deductibles and $0 premiums each month.
These plans cover a variety of essential services, including mental health care services and substance abuse treatment services.
Addiction can happen to anyone, and there are numerous types of substance addiction that can become difficult to manage and require the help of addiction professionals.
Fortunately, drug and alcohol addiction are highly treatable no matter what the specific substance is that a person is addicted to.
Some of the addictions covered by MVP Health Care Insurance include:
You can also contact us if you would like more information about a specific addiction or if you have questions about whether your addiction is covered by MVP Health Care.
Because it is so important to find a treatment facility that is within your insurance network, it can be helpful to know where to find centers that accept MVP Health Care in your area.
Your first option is to follow the instructions on the back of your membership ID card, call the number for members or beneficiaries, and ask for assistance locating a health care facility.
You can also use the members portal on the MVP Health Care website to search for health care providers within the network for your insurance plan, including doctors and specialists.
In addition to these options, you can also speak with your primary care physician (PCP) for a recommendation or referral to a treatment center nearby.
Finally, you can locate treatment facilities using our list of rehab centers by state, which gives information on insurance options, cost, treatment services, and much more.
No one should have to worry about financial barriers when it comes to their well-being and seeking treatment for a substance use disorder.
Contact us today if you need help in understanding your substance abuse treatment options with MVP Health Care, or if you have other questions about how to pay for your treatment.
No matter what kind of health insurance policy or payments you are using to cover your addiction recovery, we can help you or your loved one get started today.
Healthcare.gov. “Affordable Care Act (ACA).”
Healthcare.gov. “Health benefits & coverage.”
Healthcare.gov. “Mental health & substance abuse coverage.”
MVP Health Care. “MVP Essentials Plan.”
MVP Health Care. “In-Network Benefits Summary.”
MVP Health Care. “Individual and Family Plans.”
MVP Health Care. “Medicaid.”
MVP Health Care. “Medicare Advantage Plans.”
MVP Health Care. “Services that Require Prior Authorization: A Guide for Members.”
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