WellCare Insurance Coverage For Rehab

Most major insurance companies offer some level of coverage for alcohol and drug addiction treatment services, and WellCare Insurance is one of these providers. WellCare Insurance is a private insurance company that offers Medicare and Medicaid plans.

If you are curious about the types of addiction treatment covered by WellCare Insurance, or finding addiction programs covered by your health plan, keep reading below.

Yes, WellCare insurance offers coverage for drug rehab through its various health plans.

According to the Mental Health Parity and Addiction Equity Act of 2008, mental health treatment must be treated the same as any other medical treatment by insurance companies, and they must provide the same amount of coverage for treatment programs.

The MHPAEA was amended by the Affordable Care Act (ACA), a law created to make health insurance available to people who may not have been able to afford or access health insurance. The change made addiction and mental health disorder treatments more widely available in the U.S.

Substance use disorders fall under the category of mental health disorders, which means WellCare Insurance is required by law to provide coverage for addiction treatment. However, the amount of coverage you receive will depend on the type of plan you have.

When you or a loved one are looking for addiction treatment centers, a key factor is what kind of programs your insurance provider covers.

There are several different evidence-based treatment programs for treating substance abuse that WellCare covers. These programs include inpatient and outpatient treatment programs, as well as medical detox and medication-assisted treatment.

Medical Detox

WellCare Insurance provides at least partial coverage for medical detox with their insurance plans, a crucial first step in addiction recovery.

When you first enter a drug and alcohol rehab program, they will have you begin a medical detox. During this time, you will be kept under supervision by a doctor, nurse, or other medical provider. They will monitor your vitals, including blood pressure, temperature, and heart rate.

To be certain that your insurance policy covers medical detox, you will need to look over your insurance plan and call your agent with any questions.

Medication-Assisted Treatment

Most medication-assisted treatment (MAT) programs are covered at least in part by WellCare insurance plans.

MAT is one of the most successful methods for treating substance use disorders. Medications help lessen the intensity and feelings of withdrawal and increase the likelihood of successfully quitting an addiction.

The following common MAT medications may be at least partially covered by your WellCare insurance plan:

• Methadone
• Suboxone (buprenorphine)
• Vivitrol (naltrexone)

For a full list of covered treatment options, you will need to read your policy. You may be required to have prior authorization in some plans.

Inpatient Rehab

WellCare Insurance covers inpatient treatment programs — at least partially — for people who need more intensive care while battling their substance use disorder. Inpatient treatment (also known as residential treatment) is usually the first step after medical detox.

Whether it is long or short-term, inpatient treatment consists of frequent monitoring by a doctor or medical provider, group and individual therapy, and other evidence-based treatments.

WellCare Insurance follows the guidelines for treating alcohol and drug addiction set by the National Institution on Alcohol Abuse and Alcoholism. These guidelines recommend starting an addiction treatment program by spending at least two weeks in an inpatient treatment facility.

In order to be certain how much your plan will cover, you will need to contact your insurance representative.

Dual Diagnosis Treatment

WellCare policies do cover dual diagnosis treatment. However, the amount of coverage will depend on whether or not the treatment provider is in or out-of-network.

Dual diagnosis treatment is for people facing both drug and alcohol abuse and mental health conditions. These programs treat both disorders together.

The Affordable Care Act (ACA) has deemed mental and behavioral health care essential health benefits that have to be provided in some form by insurance providers.

If you have a WellCare HMO plan, you will need a referral from your primary care physician to see an addiction specialist.

Outpatient Treatment Programs

Most WellCare Insurance policies offer partial to full payment for outpatient treatment programs.

Outpatient treatment programs are designed for people who have successfully completed an inpatient treatment program and for people who do not require a higher level of care.

Outpatient programs are meant to be utilized in a step-down manner, with the intensity of treatment lessening as you move through the levels. Outpatient programs include partial hospitalization programs (PHP), intensive outpatient programs (IOP), and general outpatient programs.

Payment for outpatient treatment programs usually occurs each time you go in the form of a copayment instead of a one-time lump sum payment.

WellCare insurance copays for outpatient rehab programs are as follows:

• WellCare HMO plans have a $20-$30 copay for outpatient opioid treatment programs.
• WellCare PPO plans will charge a $30-$35 copay for in-network opioid treatment and a $50 copay for out-of-network treatment.

Counseling & Behavioral Therapy

Most WellCare Insurance policies offer some form of coverage for behavioral therapy and counseling. Often, this coverage is extended to the inpatient or outpatient program that offers the therapy.

Therapy and counseling are important parts of long-lasting recovery. Sobriety can be more successful when the underlying problems and trauma have been treated.

Some of the most commonly used forms of therapy include:

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Motivational interviewing (MI)
• Individual therapy
• Family therapy
• Group therapy

Continuing Care

WellCare provides coverage for a variety of aftercare programs, or a form of continuing care for people who have finished their initial treatment program.

For many people who have completed inpatient and outpatient addiction treatment, re-entering their lives can be a daunting idea. Sober living was designed to give extra support to those who have successfully completed a substance abuse treatment plan.

These programs are able to assist people as they acclimate to their new lives without drugs and alcohol. The best way to find out if WellCare insurance will cover sober living is to contact your WellCare insurance agent.

When you are looking at and comparing the many different WellCare Insurance plans, you will need to keep in mind that there are different factors that can affect your insurance coverage.

Factors that can affect your WellCare insurance coverage for drug and alcohol rehab:

• Your specific diagnosis
• The type of health care services you will need
• Your plan’s copay and deductibles
• Referral requirements to see a specialist
• The type of health care provider you need
• Your specific insurance benefits

Yes, there are WellCare insurance policies that do cover out-of-network rehab programs. However, you will most likely need a referral or prior authorization before WellCare will cover an out-of-network rehab program.

According to the Non-participating Provider Reimbursement Policy of WellCare HealthPlans, members can receive medically necessary treatment and health services from a provider not in their network.

In-network means that the doctors and treatment centers work directly with WellCare Insurance and have agreed to certain payment rates for their clients.

Generally, choosing an in-network provider is a much cheaper choice for people due to the fact that out-of-network programs require you to pay more out-of-pocket.

If you or a family member are interested in enrolling in a WellCare Insurance plan, you have many options to choose from.

These plans are required to provide the same coverage as Original Medicare, which includes Medicare Part A (hospital) and Part B (medical) coverage. They also provide HMO and PPO plans.

Each WellCare Insurance plan will offer a varying amount of coverage for different needs, such as prescription drug coverage and telehealth services, so be sure to review each plan thoroughly.

WellCare Insurance provides the following types of plans:

• Family health insurance
• Individual health insurance
• Medicaid
• Medicare

Right now, there are two different types of WellCare Insurance plans available for enrollment on HealthCare.gov:

• Participating Provider Option (PPO) — Patients with a PPO plan have the ability to choose where they go for care without needing a referral from their doctor or prior authorization. Patients with a PPO do not even need to see a doctor in-network.
• Health Maintenance Organization (HMO) — Patients with an HMO plan are usually only covered for treatment by in-network providers. In most cases, you will need a referral or prior authorization for a specialist.

WellCare Insurance also offers two other special plans in some areas:

• WellCare D-SNP — This is a special kind of Medicare Advantage plan that provides additional support and benefits at no extra cost for those who qualify for Medicare and Medicaid. However, you cannot choose a separate Part D plan.
• WellCare C-SNP — This type of plan is proactive for those who suffer from chronic conditions, including congestive heart failure, cardiovascular disease, and diabetes. It helps provide affordable, preventive medication to manage these conditions.

If you or someone you love are looking for substance abuse treatment options for a drug or alcohol addiction, you may be curious about what kinds of addiction your health insurance will cover.

Due to the fact that substance use disorders fall under the umbrella of mental health conditions, many different kinds of addictions are covered by insurance providers.

The following are some of the addictions that WellCare Insurance covers treatment for:

• Alcohol
• Benzodiazepines
• Opioids
• Methamphetamine
• Prescription drugs
• Marijuana
• Cocaine
• Heroin

If you have any questions regarding your insurance provider’s coverage for addiction treatment, contact us today. Our addiction treatment specialists are ready to assist you.

For most people seeking drug and alcohol treatment, finding a treatment center that accepts your insurance is a key factor in making a decision. Thankfully, determining which addiction treatment programs actively accept your insurance can be easy to do.

Here are some ways to look for a WellCare-covered rehab program:

1. Use your insurance card. On the back of your card, you’ll find a phone number for an insurance representative who can help you narrow down the substance abuse treatment centers in your area.
2. Access your member account. When you log in to your WellCare account, there is an option to find providers, hospitals, and treatment centers in your network.
3. Check out our list of treatment providers. We list top rehab facilities in your home state with insurance and cost information.

Due to the fact that some WellCare Insurance plans require prior authorization to gain access to substance abuse treatment centers, you may want to check with your insurance representative before making a final decision.

If you or a loved one are seeking treatment to end an addiction to drugs or alcohol, you can find rehab centers that are covered by your WellCare health plan.

WellCare provides coverage in Florida, Kentucky, Texas, and numerous other states. If you are ready to begin your road to sobriety and wellness, there is help ready and waiting for you.

Call our RehabNet.com helpline to be connected to an addiction treatment expert who can guide you through understanding your insurance policy and coverage and help you find the right treatment program for you.