Priority Health Insurance Coverage for Rehab

Priority Health was formed in Michigan in 1992 when Lakeshore HMO and Butterworth HMO merged. Its service area has remained in the state, though it has grown.

Policyholders through Priority use their healthcare coverage for a range of health services, including substance use disorder treatment.

Keep reading for information on Priority Health coverage for rehab, including:

• What drug rehab may be covered
• What to do if you live, work, or travel outside of Michigan
• Where to find cost estimates for drug treatment
• How to find a healthcare provider

Answer: Yes, Priority Health offers coverage for drug rehab but it depends on your specific plan. Some treatment services are covered before your deductible has been met, and some will require a copay.

It also depends on your location. Priority Health is only available to Michigan residents receiving care from Michigan treatment providers.

If you’re seeking treatment out of state, you can look into Priority Health’s coinsurance partnership with Cigna PPO.

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).

Medical Detox

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.

Medication-Assisted Treatment

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 Rehab

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.

Continuing Care

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.

Location is one of the most significant factors affecting coverage under Priority Health. This is because different plans are offered in different areas, and also because you may be limited to seeking care with in-network providers.

Other factors can include your age, family size, insurance policy, and levels of care required.

Answer: Priority Health partners with Cigna to allow members who live, work, and travel outside its coverage area to access a more extensive network of providers.

This strategic alliance means that, with specific Priority Health plans, you may be able to receive treatment at a treatment center that would otherwise be considered out-of-network.

However, your plan may only cover in-network providers. Check with your agent or log into your member account to verify coverage for any rehab program you’re interested in.

Priority Health has several plans, even though it’s only available in Michigan. However, you’ll need to input basic information to determine those options. For example, these are the plans available to policyholders with a Lansing zip code:

MyPriority Standard plans include:

• Bronze
• Bronze Travel
• Silver
• Silver Travel
• Gold

Other MyPriority plan options include:

• Value Bronze
• Value Bronze HSA
• Premier Silver Off Marketplace
• Balanced Silver Off Marketplace
• Prime Silver HSA Off Marketplace
• Premier Silver
• Balanced Silver

Medicaid and Medicare plans are also available through Priority Health. The standard Medicaid plan, as well as Health Michigan Plan, MIChild, and Children’s Special Health Care Services, are part of Priority Health’s Medicaid services.

Medicare Advantage Prescription Drug Plans through PriorityMedicare plans include:

• D-SNP (HMO D-SNP)
• D-SNP Advantage (HMO D-SNP)
• Key (HMO-POS)
• Vital (PPO)
• Thrive (PPO)
• Edge (PPO)
• Ideal (PPO)
• Value (HMO-POS)
• PriorityMedicare (HMO-POS)
• Merit (PPO)
• Select (PPO)

Priority Health also offers Medicare Supplement Plans with Medigap Plans A, D, G, and N.

Whatever SUD you have, it may be covered under chronic disease, substance abuse treatment, or mental health.

All plans offered through the Health Insurance Marketplace have to offer some coverage for substance abuse treatment under the Affordable Care Act (ACA).

Remember that your total plan cost can be lower, which often means out-of-pocket expenses like co-pays and deductibles are usually higher.

Finding a high-quality rehab center in your area is a top priority, since where you go for treatment can greatly affect how successful that treatment will be for you.

The following are some ways to find a rehab center that accepts Priority Health:

1. Log into your Priority Health member page on their website to search through in-network treatment facilities.
2. Use the Find a Doctor feature on the website. The Cost Estimator tool will help you figure out approximate costs for treatment for drug and alcohol addiction with your specific plan.
3. Browse our directory of rehab centers by state to find a Michigan rehab center that takes your Priority Health plan.

Navigating the specifics of insurance plans and what they cover can be tricky. RehabNet.com can assist you with figuring out which drug and alcohol rehab programs are covered by your insurance plan with Priority Health.

You can reach us on our helpline or visit our website for more information. We are available 24 hours a day to take your call.