Answer: Your addiction treatment coverage through Priority will vary based on your insurance policy and how each treatment is coded and billed.
To check what your plan covers, contact Priority Health, log onto the member site, or read through your explanation of benefits (EOB).
Coverage for medical detoxification may depend on how severe your addiction is and whether your doctor considers it necessary. This can include the management of withdrawal symptoms and monitoring vitals.
Whether short-term or ongoing medication management, medication-assisted treatment (MAT) coverage differs by company and plan.
If you’ve purchased your plan through the Health Insurance Marketplace, some of the cost should fall under your plan. The same goes for Medicare and Medicaid.
However, Priority Health plans purchased outside of those companies or offered through an employer have different rules to follow.
Inpatient treatment can get expensive quickly. Most Priority Health insurance plans offer some relief, but ensure that all treatments and providers will be covered by your plan. You may have additional out-of-pocket costs even after you pay a copay and meet your deductible.
Dual Diagnosis Treatment
Mental health disorders and substance use disorders co-occur pretty often. Having a mental health issue can contribute to starting an addiction. Using drugs or alcohol regularly messes with your brain chemistry.
Priority Health insurance companies may separate these diagnoses for coverage, so review your treatment options under mental health coverage and substance use disorder treatment.
Outpatient Treatment Programs
Your Priority Health medical care plan might include intensive outpatient services if your primary care provider (PCP) thinks that you can live at home during treatment but need higher levels of care.
You can receive outpatient treatment as a more cost-effective approach to rehab or possibly because your type and level of addiction aren’t severe enough to require inpatient rehab. Your EOB should have this information listed through your member login.
Counseling & Behavioral Therapy
Priority Health covers counseling and behavioral therapy, two of the most crucial services in addiction treatment programs. You may need a referral from your PCP for insurance to approve certain mental health services.
Standard forms of therapy should have coverage for a few sessions under your Employee Assistance Program (EAP), if nothing else.
However, if you’ve found that alternative treatments offer greater health benefits, your insurance policy might not pay for those sessions. While some companies have begun to embrace more therapy forms, it’s not across the board.
Sober living communities, extended inpatient or outpatient rehab, and residential treatment centers are types of continuing care. Priority Health may offer coverage for continuing care programs depending on your healthcare needs and your plan limits.
You may also join support groups or group therapy and have additional counseling sessions to facilitate your recovery. If that’s the case, converse with your insurance provider about what behavioral health is covered with your plan.