Health New England Insurance Coverage For Alcohol And Drug Rehab
- Insurance Coverage For Drug Rehab
- Do I Have To Stay In-Network?
- Out-Of-Pocket Costs
- Covered Treatment Programs
- Verifying Your Health New England Coverage
Health New England Insurance offers a group of HMO and PPO plans with individual, small and large group coverage. Addiction treatment services may be covered through your policy with Health New England insurance policy.
Health New England is a non-profit insurance provider that serves residents in Massachusetts. It consists of a network of 23 different hospitals and medical centers along with another 11,000 healthcare providers. The insurance company offers a comprehensive group of plans that do provide coverage for drug and alcohol rehabilitation.
The total amount of coverage you’ll have with your plan depends on the specific policy.
Some current plans offered include:
Massachusetts rehab centers, like Spring Hill Recovery Center, are in-network with a number of health insurance policies.
If you’re looking to cover your behavioral health services in Massachusetts with insurance, you will need to understand:
- The treatments and services covered by your insurance policy
- The total amount you will be expected to pay out of pocket
- What you need to do to verify your plan and coverage before seeking treatment
Health New England Insurance Coverage For Alcohol And Drug Rehab
The amount of health care coverage you have through your plan will vary based on the plan you’ve purchased. All private health care plans do offer coverage as required by the Affordable Care Act.
Health New England insurance coverage may vary, but some policies include coverage as noted below:
- HMO Wise 3000/10% LG policies require a 10% coinsurance fee after meeting the deductible
- PPO Essential 2000 LG plan covers 100% of the expenses for in-network treatment providers after you meet the deductible
- HMO Silver A Connector plans require a $1,000 copay for admission
- HMO Wise 3000/10% HDHP LG has a $25 copay per office visit after the deductible
- PPO Essential 2000 LG requires a $20 copay per visit for in-network providers and a 20 percent coinsurance fee after the deductible is met for out-of-network care
- HMO Silver A Connector plan specifies a $30 copay per visit
Expect to stay in-network if and when you can, so that you can get the most out of your insurance coverage. With PPO plans, you can obtain some out-of-network benefits, but these may not be covered as fully as in-network drug rehab programs.
It’s important to note that none of these policies require preauthorization for care, so you can seek treatment as soon as possible.
Do I Have To Stay In-Network To Use My Health New England Insurance Coverage?
Health New England insurance plans may be categorized as (PPO) or health maintenance organization (HMO) plans. Both HMO and PPO plans have networks of treatment providers that are “in-network.”
If you would like to go to an in-network treatment facility, it’s normally best to use your HMO coverage, which is more extensive. However, out-of-network providers may be covered, at least in some part, by PPO plans when needed.
What Will Be My Out-Of-Pocket Costs For Rehab?
The out-of-pocket costs you’ll have to pay for rehab will vary based on your insurance plan and current deductible, your expected copays, and any coinsurance you’re expected to pay.
You may have to cover your deductible as well as coinsurance and a specific out-of-pocket amount before the provider will cover the remainder of your drug and alcohol treatment in full.
In the case that your copays are too high or your deductible still has not been met, you may be able to speak with the rehab facility about additional options, such as receiving a private scholarship for treatment or applying for grants. Many treatment centers also offer sliding-scale fees for those paying out of pocket.
How Do I Find A Massachusetts Rehab Center That Accepts Health New England Insurance?
Health New England Insurance is accepted at many treatment providers’ offices, hospitals, and other treatment facilities. Speak with your insurance adjuster if you need help finding a treatment facility, or reach out to our agent at Spring Hill Recovery Center.
Does Health New England Insurance Cover Massachusetts Inpatient/Residential Rehab?
Health New England covers inpatient rehab programs but may require a coinsurance payment or copay from the insured party. The total cost to you will depend on the specific plan that you purchase.
For example, the HMO Wise 3000/10% plan requires a 10% coinsurance fee after your deductible. Health New England will pay nothing toward your treatment until you meet the deductible.
The PPO Essential 2000 LG plan pays the full amount of your treatment after you meet your deductible. If you go to an out-of-network provider, the PPO plan includes a 20% coinsurance fee after the deductible and up to $500 in reduced benefits.
If you have an HMO Silver A Connector plan, you’ll need to pay $1,000 as a copay for admission. This is all you pay if you have already met your deductible.
Is Medical Detox Covered By Health New England?
Health New England policies may cover at least some of the costs associated with medical detox. Coverage for drug and alcohol detox programs depends on the specific plan that you purchase.
Does Health New England Cover Outpatient Treatment?
Health New England does cover outpatient rehab programs. Again, coverage depends on the policy and coverage level.
These are just a few sample plans:
- HMO Wise 3000/10% HDHP LG has a $25 copay per office visit after the deductible.
- PPO Essential 2000 LG requires a $20 copay per visit for in-network providers and a 20 percent coinsurance fee after the deductible is met for out-of-network care.
- HMO Silver A Connector plan specifies a $30 copay per visit.
Is Partial Hospitalization Covered Through Health New England?
Partial hospitalization programs (PHP) can be covered by Health New England insurance at one of the in-network drug and alcohol treatment centers. Coverage depends on the plan you purchased. PPO plans may cover out-of-network options.
Is Massachusetts Intensive Outpatient Treatment Covered Through Health New England?
Intensive Outpatient Treatment (IOT) is not mentioned in the literature, but outpatient treatment is covered. Depending on the policy, you may need to stay in-network or to pay copays, coinsurance, or a deductible before coverage kicks in.
Does Health New England Cover Sober Living?
Your aftercare options may be covered by your insurance provider, but Health New England does not specifically mention it in the benefit document. If you would like to find out more about if sober living coverage is available, speak with your insurance agent or one of our helpful treatment counselors.
Does Health New England Medication-Assisted Treatment?
Medication-assisted treatment (MAT) programs may be covered, at least in part, by Health New England policies. MAT may help reduce the risk of relapse by using drugs such as methadone, naltrexone, naloxone, or buprenorphine in combination with behavioral therapy.
Are Methadone Costs Covered By Health New England?
Methadone may be covered by Health New England insurance as part of a medication-assisted treatment program. Coverage is determined by the policy level.
Will Health New England Cover Suboxone Therapy?
Health New England also covers treatment with buprenorphine or naloxone, which may be better known as Suboxone, Zubsolv, or Bunavail. Your Health New England pharmacy benefits packet should include more information about each specific prescription’s cost and coverage.
Verifying Your Health New England Coverage
If you’re ready to go to an addiction treatment center or are supporting a loved one who is, it’s time to verify your insurance coverage and learn about drug rehab costs.
Call us at Spring Hill Recovery Center, and we can help verify the coverage that you’ll receive. You can also review your Health New England coverage handbook or speak with your insurance carrier to find out more about the coverage you are being provided.
To make going to drug rehab easier, our team at Spring Hill Recovery Center is here to help. We will look at your insurance policy and tell you what kinds of treatment are offered and what your total out-of-pocket costs may be based on the program you choose.
If you live in the New England region, we can help you get involved in the right rehab program.
We currently offer alcohol and drug rehabilitation programs across several states including:
Learn more about Spring Hill Recovery and how we can help you along the path to health and sobriety. We are here to help you now, and we are looking forward to finding you the right treatment program. Call us today to speak with us about getting started.
Written by Spring Hill Editorial Team
©2023 Spring Hill Recovery Center | All Rights Reserved
This page does not provide medical advice.
- Health New England—Health New England | Where you matter https://healthnewengland.org/
- National Institute on Drug Abuse (NIDA)—Types of Treatment Programs https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
- Substance Abuse and Mental Health Services Administration (SAMHSA)—Medication-Assisted Treatment https://www.samhsa.gov/medication-assisted-treatment