PacificSource Insurance Coverage for Rehab

PacificSource is an insurance company that offers healthcare plans for a range of health conditions, including substance use disorders.

Read on to learn about substance abuse treatment coverage available with PacificSource insurance plans and what you can do to keep your costs low, reasonable, and affordable.

Answer: Yes, PacificSource does cover drug and alcohol rehab, although the level of coverage can vary and prior authorization may be necessary depending on the treatment service.

In fact, all insurance companies offered through the marketplace are required by the Affordable Care Act (ACA) to provide coverage that includes mental health and behavioral health care. And substance abuse treatment falls under behavioral health services..

PacificSource offers many different types of health plans to individuals, low-income families, employees, and older adults. For this reason, it’s important to be aware of the exact addiction coverage offered by your specific plan.

Answer: The following are some addiction treatment services you can find standard in most facilities and which are frequently covered, at least partially, by PacificSource insurance.

Medical Detox

Not everyone in addiction treatment needs medical detoxification, but for those who do it can be a truly life-saving treatment. This type of treatment can allow people to experience minimal withdrawal symptoms and minimize their chances of relapse.

Because medical detox is usually considered medically necessary, this service is covered by PacificSource, at least partially, with each plan.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a type of treatment that is relatively specific to opioid use disorders, as it uses opioid replacement medications to help wean people off opioids safely.

MAT is covered under PacificSource insurance policies, however, some plans may require prior authorization while others do not.

Inpatient Rehab

Inpatient rehab is the most intensive form of substance abuse treatment. It’s also the type which has proven to be the most successful, with people living in a rehab facility for around 30 to 90 days.

Residential treatment can be covered by PacificSource. But prior authorization is required, and inpatient treatment is never considered an emergency service, so it will need to be with an in-network provider.

Dual Diagnosis Treatment

Dual diagnosis treatment is for people who have co-occurring mental health conditions and substance use disorders. It often involves the use of medications such as antidepressants or anti-anxiety medications.

This type of treatment is usually offered in a treatment center that offers both mental health services and substance abuse treatment. It is covered by PacificSource, though prior authorization may be needed.

Outpatient Treatment Programs

Outpatient treatment may be preferred by some people who are seeking addiction help. And outpatient care may be necessary for those who have families at home or jobs that they are unable to take time away from.

Outpatient programs can include both intensive outpatient programs (IOP) and partial hospitalization programs (PHP) for people who need frequent or intensive treatment but do not need to be supervised overnight.

It will depend on the type of outpatient treatment that you are seeking, but as long as it is considered a medical necessity, prior authorization is usually not needed.

Counseling & Behavioral Therapy

Counseling and behavioral therapy are helpful when treating all kinds of mental illness or behavioral health problems, including substance use disorders.

Types of therapy offered can be individual, couples, or family therapy, as well as specific types of therapy like cognitive behavioral therapy (CBT).

Counseling and therapy are always covered to a significant degree by PacficSource, though copays may be required depending on the plan.

Continuing Care

Continuing care is important for anyone who has successfully completed an inpatient rehab program. Aftercare lends to their continued success and sobriety as they transition back into their regular lives.

Some services, like therapy, case management, or medication management, may be covered by PacificSource if they are considered to be medically necessary, but other services, like sober living homes, are not likely to be covered.

The amount of coverage that you have will depend on your specific plan, as well as several other factors.

Having an understanding of these factors in advance can prevent you from experiencing any surprises in costs along the way.

Factors that can affect your PacificSource coverage for alcohol and drug rehab include:

• The state where you live — PacificSource is only available in Washington, Oregon, Montana, and Idaho
• Whether your plan is an HMO, PPO, or POS
• The out-of-pocket maximum for your plan, as well as any copays, deductibles, and coinsurance
• Whether the rehab center you attend is a part of your PacificSource network
• Whether you need inpatient care or outpatient care
• The duration and level of your care
• The specific healthcare provider that you see

You can contact us if you have specific questions about what is included in your coverage or the different factors that could potentially affect it.

Answer: Yes, PacificSource does cover out-of-network providers for rehab care in specific instances, but most plans will only cover medical situations that are considered urgent emergencies.

Members typically have to pay for out-of-network services upfront, and can be reimbursed by PacificSource later as long as they are found eligible. Reimbursement is not guaranteed, however.

If you are interested in an out-of-network service, you can ask for a pre-service organization determination before you follow through with the service.

PacificSource offers a variety of healthcare plans to suit different income levels and situations.

PacificSource for Individuals and Families

PacificSource offers health plans to individuals and families that can cover a range of substance abuse treatment plans.

These plans also cover prescription drug and preventive care services that can be used toward substance abuse treatment.

PacificSource Medicaid

PacificSource offers Medicaid to residents of Oregon under the Oregon Health Plan (OHP) as long as they qualify and are found eligible.

At this time PacificSource does not offer Medicaid plans in any other states, but many of their plans are available at very low cost.

PacificSource Medicare

With Medicare Advantage plans from PacificSource, older adults can enjoy benefits beyond what Original Medicare provides.

These plans also place limits on what members can be charged for health care services in a year, so policyholders can stay within an affordable range.

Addiction can come in many forms and levels of severity, oftentimes largely dependent on the type of substance a person is addicted to.

Most treatment facilities address addiction as a whole, although some services, such as detox and MAT, are more specific to the use of certain substances.

Some of the addictions covered by PacificSource Insurance include:

• Alcohol
• Heroin
• Marijuna
• Opioids
• Prescription medications
• Crystal meth
• Cocaine and crack cocaine

No matter what type of addiction you or your loved one is living with, we can help you find a rehab center in your area that is in-network with PacificSource.

There are a few different ways that people can find treatment for substance abuse if they are members with PacificSource.

Your membership ID card is a valuable resource, with helpful numbers and information for members.

PacificSource also offers an online Provider Directory where members can search for mental health and substance abuse treatment providers or treatment facilities.

It can also be helpful to speak with a medical provider that you trust, such as your primary care physician, to ask for recommendations for addiction treatment providers within your network.

In fact, it may be necessary to speak with your PCP in advance if you need a referral or prior authorization for any type of substance use treatment.

Lastly, you could also browse our list of alcohol and drug treatment centers by state, which provide information about insurance, cost, treatments, and more.

If you need further assistance for yourself or a loved one in finding an alcohol and drug abuse rehab program in your area that is covered by PacificSource, reach out to RehabNet.

Our trained representatives are prepared to answer any questions you have about substance abuse treatment or how to finance your addiction treatment.

Everyone deserves the opportunity to take care of their mental health and behavioral health in an affordable way, and we can help you get started in recovery as soon as you are ready.

Reach out now to learn how we can help jumpstart your recovery journey.