Rehab Centers That Accept QualCare Insurance

Many people struggling with a drug or alcohol addiction find that seeking treatment through a rehab program offers crucial support on their path to recovery. However, the cost of these services can prevent people from pursuing this route. Some insurance providers, like QualCare, provide coverage for drug and alcohol rehab and other addiction treatment options to help ease the financial burden.

If you have a QualCare healthcare plan, understanding your substance abuse and mental health treatment benefits can ensure you find a facility that meets both your needs and budget. In this guide, we explore different QualCare insurance plans, commonly covered SUD treatment options, and the best ways to find an in-network substance abuse treatment center in your area.

QualCare, a subsidiary of Cigna, is a managed care organization providing a variety of health insurance plans to residents of New Jersey, Pennsylvania, and New York. They offer several services in addition to healthcare policies, such as care management services, consultation services, and third-party administration (TPA) services.

Common QualCare insurance plans available to individuals, families, and employers in the New Jersey and tri-state area include:

• Preferred Provider Organization (PPO) Plans: This plan offers a wide range of in-network healthcare providers and may cover out-of-network services as well. PPO QualCare plans often require a higher monthly premium compared to other policies.
• Health Maintenance Organization (HMO): QualCare HMO plans offer in-network coverage with lower monthly premiums. Many HMO plans require individuals to have a primary care physician (PCP) who coordinates their care and provides referrals for specialist treatment services.
• Open Access Plus (OAP) Plans: OAP plans, offered on behalf of Cigna, provide healthcare coverage for services within the Cigna Open Access Plus network.
• Open Access Plans: This type of plan offers flexibility in terms of coverage for both in-network and out-of-network providers.
• Medicare Advantage: While QualCare does not offer direct Medicare Advantage plans, you can seek coverage from other providers under QualCare. For example, QualCare collaborates with insurance companies such as Anthem, WellCare, and Aetna to deliver these services.
• Self-funded Employer Plans: QualCare offers TPA services for companies wishing to offer self-funded employer insurance policies to their employees.

For specific details on QualCare addiction behavioral health plan benefits, reach out to a QualCare representative or contact RehabNet today.

Yes, many QualCare plans offer coverage for behavioral and addiction services based on determinants like medical necessity. This section explores specific factors that can impact how much your plan may cover for inpatient or outpatient treatment.

Some plans require proven medical necessity before providing coverage for certain types of treatment.

QualCare’s medical necessity guidelines include:

• Analyzing specific factors such as the individual’s condition and unique needs, the effectiveness of a treatment, and the treatment’s cost compared to other options.
• Reviewing documentation made by your healthcare provider to ensure an appropriate decision is made.
• Referencing medical standards from up-to-date and proven medical establishments.
• Obtaining pre-authorization based on the individual’s needs to determine insurance coverage.

Most QualCare insurance plans abide by the mandates set forth by the Mental Health Parity and Addiction Equity Act. This act requires insurance providers to offer coverage for both mental health and addiction services, such as drug addiction rehabilitation at a treatment facility. The MHPAEA also requires providers to honor parity between these services and other medical treatments, meaning you should receive the same level of coverage for evidence-based addiction treatment that you would for another medical service.

Some plans use levels of care to determine eligibility coverage. Examples of levels of care that may be part of your plan include:

• Primary Care: This includes basic care such as visits to a PCP.
• Secondary Care: This level of care includes services from specialists and may require a referral from your PCP.
• Tertiary Care: This is a more intense care level that is highly specialized and is typically offered at hospitals or other inpatient facilities.

For example, seeing a therapist for a co-occurring disorder may be considered secondary care, while drug and alcohol inpatient treatment is often considered tertiary care. A QualCare representative can help you better understand your level of care needs and explain your plan’s benefits concerning that level.

Different types of addiction treatment options may be covered by your QualCare healthcare plan. Common SUD rehabilitation services that insurance covers include:

Detoxification is an important step for many people seeking recovery from addiction. A detox program includes an inpatient stay at a medical facility where patients receive continuous care from experienced medical providers to ensure safety and comfort through the withdrawal process.

Inpatient rehab requires individuals to live on-site at a treatment center for a period of time, such as 30 or 60 days. Patients receive various types of services for recovery, such as therapy and medication management.

IOPs are structured treatment programs for addiction and/or mental health issues. They offer flexibility in terms of days and times treatment is provided and allow patients to return home each day. IOPs are considered a step down from residential treatment and partial hospitalization programs and are a good option for those needing less intensive recovery care.

PHPs are often day-long programs that offer intensive SUD treatment for you or your loved one. Unlike residential treatment, patients can go home after completing each day. PHP may be a good option for those graduating from a residential recovery center or those who cannot commit to an inpatient program due to responsibilities like family.

Therapy may be obtained outside of a structured program or offered as part of inpatient or outpatient treatment. Evidence-based addiction therapy approaches include cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), experiential therapy, and family therapy.

MAT is often used in opioid use disorders to help manage withdrawal symptoms and cut back on cravings. In fact, MAT can reduce opioid deaths by over 50%, yet only an estimated 25% of adults with opioid use disorder receive this type of treatment. Medication is provided in combination with other therapies like CBT. Not all insurance plans cover this option, so speak with a representative to learn if MAT is covered by your QualCare policy.

Other substance abuse disorder treatments that may or may not be covered by your plan include aftercare options like sober living facilities. If you’re unsure about your coverage or which treatment is best for you, a RehabNet expert can answer your questions and make the process of finding the best recovery route for your needs as easy as possible.

Several factors can impact a QualCare insurance plan’s coverage for addiction. Understanding these factors can help empower you to choose the treatment option that meets both your needs and budget.

Common things to consider when searching for a recovery program include:

• Whether a service or facility is in or out-of-network with your plan
• If your plan requires you to first submit a prior authorization or obtain a referral to receive coverage
• Your policy’s specific requirements for copays and coinsurance, as well as any deductibles that must be met before coverage is provided
• The out-of-pocket maximum your plan specifies
• Any coverage limitations related to the geographical location of your intended treatment program
• Employer-specific plan customizations that may impact your coverage if you have a self-funded employer plan through QualCare

For example, if your plan has a $5,000 deductible, you may be responsible for any costs until that threshold is met.

You can contact your insurance representative to learn more about any QualCare rehab pre-authorization requirements, drug treatment coverage limits, and other factors that may impact your policy’s addiction treatment coverage.

Some QualCare insurance plans may cover some of the cost for out-of-network rehab programs. For example, a PPO or Open Access Plan typically offers out-of-network coverage for policyholders. However, you may be responsible for higher out-of-pocket costs.

Other plans, like HMO QualCare insurance, often don’t provide coverage for out-of-network services unless it’s an emergency. In emergencies, you may need to obtain out-of-network authorization for coverage. However, if your plan follows the Affordable Care Act (ACA) stipulations, emergency medical treatment must be covered regardless of authorization or the use of out-of-network services or providers. If your treatment is not considered an emergency, you’ll likely be responsible for the full cost of treatment.

There are a few ways you can find out if a treatment center is in or out-of-network with your QualCare plan, including by:

• Contacting the treatment facility directly. Most rehab centers have on-site verification specialists in their financial or insurance departments who can inform you of your coverage options.
• Calling a Qualcare representative. To reach a representative, call the number on the back of your insurance card or use the contact information provided through your member portal.
• Working with RehabNet. Our experts have insurance verification abilities that allow us to confirm whether a center is in your policy’s network. You can give us a call or simply use the rehab search tool located on our website.

QualCare and other insurance plans typically provide coverage for addictions that are diagnosable with the DSM-5.

Substance use disorders include:

• Alcohol use disorder
• Opioid use disorder
• Stimulant use disorder
• Cannabis use disorder
• Other Hallucinogen Use Disorder
• Sedative, Hypnotic, and Anxiolytic Use Disorder
• Inhalant Use Disorder
• Phencyclidine (PCP) Use Disorder

Other addictions and conditions that may be covered include:

• Gambling addiction
• Internet addiction
• Porn addiction
• Dual Diagnosis or co-occurring mental health and addiction diagnoses

An insurance representative can answer any questions you have related to addiction types covered by QualCare policies.

Finding an accredited and trusted rehab center is a crucial part of receiving quality and long-lasting recovery services. Here are a few ways to search for drug and alcohol addiction programs that accept QualCare insurance in your area:

• Use your QualCare member portal to access the provider directory and search for providers and centers within your plan. You may also have access to other customer service tools, such as a representative chat service to further assist you in your search.
• Contact the rehab facility’s admissions team to verify your QualCare coverage and your eligibility for the program.
• Utilize RehabNet services either via phone or through our website. A RehabNet expert can assist you with the confirmation of insurance benefits and the location of in-network programs near you.

Here are a few commonly asked questions about QualCare insurance coverage for addiction treatment:

Learning about your addiction treatment options and insurance coverage can be an overwhelming process. RehabNet is dedicated to helping individuals and families find the resources they need to get started on their road to recovery, and our experts are available 24/7 to best meet your needs.

A few ways that RehabNet can help you on this journey include:

• Performing an insurance verification of your QualCare plan and explaining exactly what’s covered, including covered treatments and your financial responsibility.
• Helping you locate facilities that treat the SUD you’re struggling with, as well as any co-occurring disorders you’re experiencing.
• Helping you throughout the admissions process, including setting up any required pre-admissions assessments and arranging your intake date.
• Providing a searchable network of extensively vetted addiction centers and providers right on our site to ensure you receive the highest level of care possible.

Whether you’re calling for yourself or a loved one, everything you share is completely confidential and free of charge. Reach out to one of our experts today to get started on your path to recovery.