Using GEHA Coverage for Addiction Treatment
Government Employees Health Association, Inc., or GEHA, is a medical benefits provider that exclusively serves current and former federal employees, military retirees, and families. Currently, GEHA provides access to millions of healthcare providers across the country. If you or a loved one has a GEHA Health plan, you may be wondering if they are covered for drug and alcohol addiction treatment or rehabilitation.
For persons suffering from a substance abuse problem, treatment and rehabilitation are incredibly important to help you begin your path toward recovery. Whether you are dealing with a drug or alcohol addiction, detoxification treatment and rehab are critical. The Affordable Care Act (ACA) has mandated that almost all health plans in the United States, including GEHA plans, cover at the very least some of the cost of addiction treatment. Rehabilitation is considered a substance use disorder (SUD) treatment. As such, it falls under the classification of mental and behavioral health services, which are considered essential health benefits under the ACA. As a result, most insurers are required to provide coverage for this type of treatment.
What is a “GEHA Approved Rehab”?
The term “GEHA Approved Rehab” essentially refers to any facility that accepts GEHA Health Insurance policies with SUD coverage. Facilities that accept GEHA policies allow persons seeking treatment for addiction to access care without paying altogether (or at all) out-of-pocket.
What are In-Network vs. Out-of-Network GEHA Facilities?
The discussion of in-network and out-of-network facilities and how that affects coverage can be a complex concept to wrap your head around, but, in reality, it’s pretty simple. Some facilities have contracts with insurance providers that make them part of their “network” of healthcare providers. Because of the contractual agreement, you would typically get lower costs at these facilities, and, therefore, your out-of-pocket costs end up being significantly reduced. Facilities that don’t have that contractual agreement in place invariably cost more. This does not mean that an out-of-network facility won’t accept your insurance policy. It is best to search for and choose a facility that is “in-network” with your insurance company if at all possible.
The Tiers of GEHA Health Plans
GEHA health plans have a maximum limit on the amount of overall of deductible and coinsurance their clients have to pay per year. What does this mean? Depending on the type and amount of treatment you require, the out-of-pocket costs you are responsible for would not exceed the following amounts depending on your particular plan:
- Standard plan in-network: $5,000
- Standard plan out-of-network: $7,000
- High option in-network: $4,000
- High option out-of-network: $6,000
- HDHP option for individual plans: $5,000
- HDHP option for family plans: $10,000
The level of coverage you will experience is affected by many factors and varies widely across people. Factors like your state, length of stay, whether or not the facility is in or out of the network, and the specifics of your insurance plan contribute to the level of coverage. The cost of treatment itself will vary from facility to facility and is affected by the type of treatment being sought.
What are my GEHA Substance Abuse Treatment Options?
You might have many questions about what treatments are covered under GEHA policies. “Is medication-assisted treatment possible with GEHA?” “Will my GEHA policy cover medical detox?” “Can I get dual diagnosis treatment with GEHA?” “Can GEHA insurance cover residential treatment?” “Does GEHA cover aftercare services or sober living?” There are MANY questions about this topic. Let’s break it down. Below are some of the general treatment types that GEHA policies offer coverage for in terms of Substance Use Disorder Treatment:
Medical Detox
Clinicians monitor the patient around the clock and ensure safety during the period of acute withdrawal symptoms.
Medication-Assisted Treatment (MAT)
For those seeking to battle their addiction with a combination of therapy and medication, MAT is used with opioid-specific and alcohol-specific medicines that are FDA-approved and proven to help people overcome addiction.
Inpatient Treatment
This generally includes physician oversight and 24/7 monitoring for the entire duration of the patient’s treatment and program.
Partial Hospitalization Programs (PHPs)
Partial Hospitalization Programs type of treatment is generally considered a step-down from inpatient treatment. The patient spends most of their days at the facility but returns home at night.
Outpatient Treatment
The patient comes to the facility regularly for treatment and therapy. A typical schedule is once or twice per week.
Intensive Outpatient Programs (IOP)
Intensive Outpatient Programs generally refers to treatment plans requiring that you attend treatment programs for longer and more frequent than a standard outpatient treatment program.
Aftercare
Programs that fall into this category are focused on the support of sustained sobriety after the process of intensive treatment and therapy. This may include support groups, therapy, and community programs.
What are the Regions Serviced By GEHA Policies?
There are healthcare providers who are part of the GEHA network in all 50 states in the United States.
Premiums And Deductibles
Premiums and Deductibles are symbiotic systems inherent to how insurance policies work. High premium and low deductible versus a low premium and high deductible. How does this work in practice? Your premium is the monthly payment you pay into your policy. Your deductible would be the amount you pay out-of-pocket before your insurance policy kicks in and starts covering the cost of your treatment. Typically, if your premium is higher, you’ll have to pay a smaller amount of money with your deductible. Whereas if you’re paying a lower premium, your deductible will be higher. If you’re willing to pay more upfront when you NEED the care, you can pay less in your monthly payments into the policy.
What are the Features of GEHA Rehab Programs?
While the specific treatments on offer vary widely amongst facilities, some general characteristics indicate a high-quality program and facility. Doing your research before enrolling yourself or a loved one in any facility or program is very important. Nevertheless, keep these things in mind, and you’ll be better prepared to discern the facility and program that’s the best fit for what you or your loved one needs:
PROPER STAFF CREDENTIALS
Appropriately trained individuals should administer therapy and treatment services ls. Clinicians with higher education and national certifications are more likely to adopt evidence-based practices in treatment. Rehabilitation facilities typically display the credentials of staff. It shouldn’t be challenging to check if the staff has the relevant certifications. Failing this, you should always feel free to ask about this!
PROGRAM ACCREDITATION
Accreditation is an essential marker of a high-quality rehab facility and program. This accreditation comes from third-party organizations that have inspected and verified the rehab’s facilities. Official approval from the Joint Commission Accreditation for Addiction Treatment (JCAHO), or the Commission on Accreditation of Rehab Facilities (CARF), can generally be a good sign that the treatment facility operates according to high healthcare standards. The only way for treatment programs to become accredited and stay that way is by offering a high quality of care. An accredited facility employ staff that have gone through appropriate training regimens. They also have high standards for safety, and are HIPAA-compliant.
FINANCING OPTIONS
Trustworthy rehabilitation centers generally have a sense of transparency and work to help you access treatment despite your financial limitations. If you are rendered assistance in understanding your financial obligations for treatment, there’s a good chance that the facility in question is honorable in other aspects of its operations. They may not be able to give every detail about the cost up-front. Still, they should make efforts to help you understand your coverage options and any other financing options available, including sliding scale payments. Addiction affects individuals of every socioeconomic status; therefore, a facility that recognizes which financial restrictions a patient may face and works with them to find ways to afford care is likely to be a sincere advocate for their recovery progress.
TAILORED TREATMENT PLANS
Effective addiction treatment is not a one-size-fits-all thing. Custom and individualized plans must cater to the unique needs of the patient. A facility that does not operate this way should be avoided as that inflexibility may signify a lower-quality program. High-quality treatment addresses multiple aspects of one’s addiction, including any associated psychological, medical, or social issues. A customized treatment program will offer a bespoke service suite that matches the patient’s unique needs and case. Dual-diagnosis patients, for instance, require particular therapeutic approaches. Another example might be individuals with specific substance use disorders who may be good candidates for medication-assisted treatment (MAT). A quality facility would thoroughly evaluate your condition and create a plan that considers your stressors, supports, and circumstances and what did or did not work for you in previous recovery attempts, if there were any.
ACCESS TO PROFESSIONAL MEDICAL CARE ONSITE
Addiction affects the body and mind in many ways, some of which typically aren’t obvious until the individual tries to stop. Because of this, professional medical attention should be present and available to address any physical and mental health concerns that arise due to the physiological dependence on the substance and associated withdrawal syndromes. The care received from qualified nurses and physicians during detoxing is essential for managing withdrawal from opioids and alcohol due to the possibility of severe discomfort and potential medical complications.
LIFE-SKILL TRAINING
Ultimately, the goal of addiction treatment is for the recovering individual to live a fulfilling and satisfying life after the conclusion of the treatment. To successfully reintegrate with the outside world, life skills must be developed that allow the former addict to cope with the stressors associated with daily life that frequently do come up. It is common for high-quality treatment centers to offer life skill coaching that can range from finance management to navigating peer pressure so that the patient may be equipped with the knowledge and tools needed to live independently.
LOCATION
Certain social and environmental triggers can increase the chances of suffering a relapse. In the early recovery phase, it is beneficial to eliminate as many triggers as possible so that the patient can focus on recovery without stressors and distractions. There is a significant caveat to this one. While location CAN be important, many rehab programs without the benefit of a lengthy list of plush amenities or vacation like-environments still do provide quality services. A program’s treatment approach should be the main focus.
AFTERCARE PLANNING
Aftercare is a critical and necessary element of the treatment process for addiction. Adequate rehabilitation facilities focus quite a bit of their resources and attention on each patient’s aftercare plan. Typically, a staff member is involved in the treatment process whose responsibility and purview is to develop a plan with the recovering individual for care and support after treatment. This plan may include things like :
- Individual and/or group therapy sessions that go beyond the acute treatment period.
- Enrollment in a step-down program from inpatient care to a formal sober living environment externally.
- Continued and ongoing outpatient treatment.
- 12-step or other recovery support group.
Without a proper aftercare program and support, the risk of relapse can be high. A facility that does not account for this may not be offering treatment of suitably high quality.
Find Lasting Recovery with GEHA Coverage at Pathfinders Recovery
Pathfinders Recovery has over two decades of experience treating and rehabilitating persons struggling with substance abuse and addiction. Our expert medical team and holistic care professionals work with you to help you navigate the entire detoxing process, healing from the psychological trauma that led to the addiction in the first place, and the Aftercare process that helps our clients be ready for life post-treatment. Achieving a happy and fulfilling life is the goal for every client that seeks treatment with us, and our results speak volumes. If you or someone you love is struggling with substance abuse issues, please know that hope exists. Contact us today for more information or a consultation!
