GEHA Health Insurance Coverage

How to Check GEHA Rehab Coverage?

To check your  GEHA rehab coverage and explore treatment options, we invite you to fill out our convenient Insurance Verification Form. By providing some basic information, our team at NuView Treatment Center can assist you in understanding your specific coverage and guide you toward rehab options that align with your GEHA  insurance plan. If you prefer immediate assistance, please call us at (323) 307-7997, and our friendly staff will be ready to assist you. Don't miss out on the opportunity to take the first step toward recovery. Fill out the form now and let us help you on your journey to a healthier, happier life.

Types of GEHA Insurance Plans

GEHA Insurance offers a variety of plan options to meet the diverse healthcare needs of individuals and families. Each plan type has its characteristics, network options, and levels of flexibility. Here's an overview of each plan type:

• HMO (Health Maintenance Organization): With an HMO plan, you typically choose a primary care physician (PCP) from a network of providers. Your PCP will coordinate your healthcare and referrals to specialists within the network. HMO plans often require you to receive care within the network, except for emergencies or pre-approved out-of-network care.
• PPO (Preferred Provider Organization): PPO plans offer more flexibility in choosing healthcare providers. You have the freedom to see both in-network and out-of-network providers. In-network care is usually covered at a higher percentage, while out-of-network care may have higher out-of-pocket costs. PPO plans generally do not require a referral to see a specialist.
• EPO (Exclusive Provider Organization): EPO plans are similar to PPO plans in terms of provider flexibility. However, EPO plans do not typically cover out-of-network care except for emergencies or specific exceptions. You can usually seek care directly from any provider within the network without a referral.
• POS (Point of Service): POS plans to combine features of HMO and PPO plans. You choose a primary care physician within the network, and referrals to specialists are typically required for in-network coverage. However, POS plans also offer the option to seek care out-of-network, although it usually comes with higher out-of-pocket costs.

It's important to review the specific details of each GEHA Insurance plan to understand the benefits, coverage, and network limitations associated with your HMO, PPO, EPO, or POS option. Each plan type has its advantages and considerations, so choosing the plan that aligns with your healthcare needs and preferences is essential.

Does GEHA Insurance Cover Drug or Alcohol Rehab?

Yes, GEHA Insurance does cover drug and alcohol rehab services. GEHA Insurance recognizes the significance of addressing substance use disorders and provides coverage to support individuals in their recovery journey. The specific coverage details for drug and alcohol rehab will depend on the details of your GEHA Insurance plan. Typically, GEHA Insurance covers a range of rehab services, including:

• Inpatient Rehabilitation: GEHA Insurance provides coverage for residential treatment where individuals stay at a rehab facility for a specified period to receive intensive care and support.
• Outpatient Rehabilitation: Coverage extends to outpatient rehab, allowing individuals to attend therapy sessions and receive support while living at home.
• Detoxification Services: GEHA Insurance covers medical detoxification, which helps individuals safely manage withdrawal symptoms when stopping substance use.
• Counseling and Therapy: Coverage includes individual counseling, group therapy, family therapy, and other therapeutic services that are essential to the recovery process.
• Medication-Assisted Treatment (MAT): GEHA Insurance provides coverage for medications used in conjunction with therapy to treat substance use disorders, such as medications for opioid or alcohol dependence.

To get specific details about the coverage for drug and alcohol rehab services under your GEHA Insurance plan, it is recommended to review your plan documents or call NuView at (323) 307-7997. Our staff can provide accurate and up-to-date information regarding coverage, any limitations or requirements and assist you in finding appropriate treatment options within your coverage.

What Does GEHA Cover For Me?

GEHA coverage depends upon the specific plan an individual is paying for. Plans with higher monthly premiums are associated with lower out-of-pocket fees for treatment, and they often have more extensive out-of-network coverage. However, plans with lower monthly premiums are associated with higher deductibles, copays, and coinsurance payments. Understanding what your coverage levels are can be confusing. If you seek help and want a better understanding of your options, feel free to contact NuView Treatment Center. Contact us at (323) 307-7997. Our staff will gladly look into your specific GEHA insurance plan and investigate your options. Our outpatient rehab is covered by GEHA health insurance, but even if you are seeking another type of program or are not covered, we will work with you to connect you with the needed resources.

How Can I Pay The Costs Not Covered By My GEHA Plan?

If you have costs that are not covered by your GEHA Insurance plan, there are several options to consider for paying those expenses:

• Out-of-Pocket Payment: You can pay the costs not covered by your GEHA plan using your own funds. This involves directly paying the healthcare provider or facility for the services received. Remember that the amount you must pay out of pocket will depend on the specific services and your plan's coverage details.
• Health Savings Account (HSA) or Flexible Spending Account (FSA): If you have an HSA or FSA, you can use the funds in these accounts to pay for eligible healthcare expenses, including the costs not covered by your GEHA plan. Contributions to these accounts are made pre-tax, saving you money for healthcare expenses.
• Payment Plans or Financing Options: Some healthcare providers and facilities offer payment plans or financing options to help you manage the costs of services not covered by insurance. These arrangements allow you to spread out the payments over some time, making it more manageable to cover the expenses.
• Personal Loans or Credit Cards: Consider using personal loans or credit cards to pay for the costs not covered by your GEHA plan. However, it's important to carefully evaluate the terms, interest rates, and repayment terms associated with these options to ensure it aligns with your financial situation.
• Seek Financial Assistance or Grants: In certain circumstances, financial assistance programs or grants may be available to help individuals cover healthcare costs. Non-profit organizations, government agencies, or specific disease-specific foundations often offer these programs. Research and reach out to these organizations to explore any available assistance.

The best payment option for you may depend on your financial situation and the specific costs involved. It's recommended to discuss your situation with the healthcare provider or facility billing department to explore payment options and potential discounts. Additionally, it's always beneficial to review your GEHA Insurance plan documents or contact NuView Treatment Center for any potential avenues of coverage that you may need to look into.

GEHA Substance Abuse Coverage

• Benzodiazepine use
• Prescription stimulant use
• Heroin use
• Alcohol use
• Prescription opioid use
• Crystal meth use
• Marijuana use

What Is GEHA Insurance & How Does It Work?

GEHA Insurance, also known as Government Employees Health Association, is a non-profit health insurance company that provides healthcare coverage to federal employees, retirees, and their families. It offers a range of health insurance plans designed to meet the diverse needs of its members. GEHA Insurance operates as a fee-for-service plan, which means that members have the freedom to choose their healthcare providers. Here's an overview of how GEHA Insurance works:

• Enrollment: Eligible individuals can enroll in GEHA Insurance plans during the open enrollment period or when experiencing a qualifying life event, such as marriage, the birth of a child, or loss of other health coverage.
• Plan Options: GEHA Insurance offers different options, including HMO, PPO, EPO, and POS plans. Each plan type has its characteristics, network options, and levels of flexibility. Members select the plan that best suits their healthcare needs and preferences.
• Premiums and Contributions: Members pay monthly premiums for their GEHA Insurance coverage. Additionally, there may be cost-sharing in the form of deductibles, copayments, and coinsurance for various healthcare services.
• Network of Providers: GEHA Insurance has a network of healthcare providers, including doctors, specialists, hospitals, and pharmacies. Members can choose providers within this network, and some plans may offer coverage for out-of-network care, although at higher costs.
• Covered Services: GEHA Insurance covers a wide range of healthcare services, including preventive care, doctor visits, hospital stays, prescription medications, mental health services, substance abuse treatment, and more. The specific coverage details and limitations depend on the chosen plan.
• Claims Process: Members or healthcare providers submit claims to GEHA Insurance for reimbursement when receiving healthcare services. The insurance company reviews the claims and pays the covered portion according to the plan's benefits and guidelines.
• Customer Support: GEHA Insurance provides customer support to assist members with questions, claims inquiries, finding in-network providers, understanding coverage details, and other related services.

How To Find Rehabs That Take GEHA Insurance Near Me?

Contact NuView Treatment Center

Our team at NuView Treatment Center is here to assist you in finding a rehab facility near you that accepts GEHA Insurance. Give us a call at (323) 307-7997, and our knowledgeable staff will be happy to answer your questions and guide you through the process. Alternatively, you can fill out our insurance verification form to provide us with the necessary details, and we will promptly review your information to determine your coverage options. We are committed to helping you access the appropriate treatment resources for your recovery journey.

GEHA Insurance Statistics

Here are some statistics related to GEHA Insurance:

• Over 2 million federal employees and retirees, military retirees, and their families choose GEHA.
• In 2022, GEHA Health had 1,500 employees, and the revenue per employee ratio was 1.9B.
• GEHA is the nation's second-largest federal employee health care and dental insurer, serving more than two million members in all 50 states.
• GEHA offers five medical plans: Elevate, HDHP, Standard, High, and Elevate Plus. 

 

Out-of-Network Rehabs Through GEHA

GEHA Insurance may provide coverage for out-of-network rehabs. Still, it's important to note that out-of-network services' coverage and reimbursement rates are typically different from those for in-network services. Here's some information about out-of-network rehabs through GEHA Insurance:

• Coverage Variations: GEHA Insurance plans may offer partial coverage for out-of-network rehabs, but the extent of coverage can vary depending on your specific plan. It's crucial to review your plan documents or contact NuView Treatment Center to understand the details of your out-of-network coverage, including any deductibles, copayments, or coinsurance you may be responsible for.
• Higher Out-of-Pocket Costs: Generally, seeking treatment at an out-of-network rehab facility may result in higher out-of-pocket expenses than in-network facilities. This can include higher deductibles, a larger percentage of the treatment cost being your responsibility, or the need to meet out-of-network deductibles before coverage kicks in.
• Prior Authorization: GEHA Insurance may require prior authorization for out-of-network rehab services. This means you must obtain approval from the insurance company before starting treatment at an out-of-network facility. Please obtain prior approval to ensure coverage for the services received.
• Balance Billing: You may be subjected to balance billing when utilizing an out-of-network rehab. Balance billing occurs when the provider charges you the difference between their billed amount and what GEHA Insurance considers reasonable and customary. It's essential to understand the potential for balance billing and clarify with the rehab facility if they accept GEHA Insurance's reimbursement rates as payment in full.
• Reimbursement Process: With out-of-network rehabs, you typically pay the full cost of treatment upfront and then submit a claim to GEHA Insurance for reimbursement. The reimbursement is based on your plan's out-of-network benefits and fee schedule. It's important to keep documentation of all expenses and submit the necessary paperwork to facilitate the reimbursement process.

It's recommended to contact NuView Treatment Center to discuss your specific out-of-network rehab coverage, reimbursement rates, and any other requirements or limitations associated with your plan.

GEHA and the Affordable Care Act

The Affordable Care Act, which is sometimes known merely by its acronym ACA, has made substance use treatment an "essential health benefit." This recognition means that health insurance companies, including but not limited to GEHA, are legally required to offer substance use treatment coverage. While the extent and nature of this coverage depend upon a person's specific health plan, everyone can be guaranteed some degree of coverage. Just as importantly, the Affordable Care Act has determined that health insurance companies cannot deny people coverage just because they suffer from a substance use disorder. Under the Affordable Care Act (ACA), addictions are not considered pre-existing conditions. In the past, insurance companies could deny coverage to individuals with severe substance use issues, viewing them as a financial liability due to the potential cost of treatment. However, the ACA prohibits this practice. Regardless of the severity of a person's substance use or the type of treatment program needed, GEHA Insurance will provide coverage, ensuring access to essential care without denial based on pre-existing conditions.

Does GEHA Cover Mental Health and Substance Abuse Treatment?

Yes, GEHA Insurance covers mental health and substance abuse treatment. GEHA Insurance recognizes the importance of providing comprehensive coverage for mental and behavioral health services, including treatment for substance use disorders. This coverage typically includes various forms of treatment, such as therapy and counseling, medication management, outpatient programs, and inpatient rehabilitation when necessary. Mental health and substance abuse treatment are considered essential healthcare services, and GEHA Insurance aims to support individuals in accessing the care they need.

Will GEHA Cover Dual Diagnosis Treatment?

Yes, GEHA Insurance may cover dual diagnosis treatment. Dual diagnosis refers to individuals who simultaneously experience both a mental health disorder and a substance use disorder. GEHA Insurance understands the complexity of dual-diagnosis cases and often provides coverage for integrated treatment approaches that address mental health disorders and substance abuse. This may include therapy, medication management, and specialized programs to treat dual-diagnosis conditions. Reviewing your specific GEHA Insurance plan or contacting NuView Treatment Center to understand the extent of coverage for dual diagnosis treatment is essential.

Does GEHA Cover Therapy for Substance Use Disorder Treatment?

Yes, GEHA Insurance generally covers therapy for substance use treatment. Therapy is a key component of treatment, addressing the underlying causes, triggers, and behaviors associated with substance use. GEHA typically provides coverage for individual therapy, group therapy, family therapy, cognitive-behavioral therapy (CBT), and other evidence-based approaches. However, coverage specifics can vary based on your plan, so it's important to review your GEHA plan documents or contact NuView Treatment Center for personalized information on therapy coverage. Make sure to confirm the details for mental health, substance use, dual diagnosis, and therapy services under your specific plan.

GEHA Outpatient Rehab Coverage

GEHA has excellent substance use treatment coverage for people using in-network facilities. In most cases, substance use treatment entails that an individual will attend an outpatient rehab program. Outpatient rehab programs can be used as transitional programs after an individual has graduated from a residential treatment center. However, they can also effectively be used as a first-line treatment for substance use. Outpatient rehabs, which offer evidence-based treatment for substance use disorder, are clinically effective. Moreover, these programs allow clients to live at home and pursue their outside lives, making them flexible for patients and cost-effective for insurance companies like GEHA. Outpatient programs support people as they engage in the recovery process. They do this by offering a wide assortment of evidence-based treatment modalities, including talk therapy and medication-assisted treatment. Clients work to address the underlying issues that may be motivating their substance abuse, learn new coping skills to mitigate the likelihood of relapse, and take steps toward building new lives in sobriety. Outpatient rehabs covered by GEHA include a wide variety of programs that address substance use disorders broad spectrum of severity levels. These programs, ordered from most acute to most flexible, include:

• Partial hospitalization programs (PHPs)
• Intensive outpatient programs (IOPs)
• Outpatient programs (OPs)
• Aftercare planning

GEHA recognizes that long-term sobriety is often predicated on making use of multiple rehab programs for an extended period of time. In fact, many studies confirm that individuals who remain involved in treatment programs for longer periods of time are less likely to relapse in the years ahead. GEHA is committed to supporting policyholders as they progress in their recovery journeys.