Substance use disorders are serious medical conditions. Unfortunately, a high percentage of people with drug and alcohol addictions never seek treatment for their problem. There are many reasons behind this. In many cases, people simply don’t believe that addiction is a legitimate mental health disorder, in which case they may cling to the belief that they can control their problem if they only try harder. In other cases, people may recognize a need for help but have too much shame to reach out. All too often, individuals with substance use disorders mistakenly fear that drug and alcohol addiction treatment is simply too expensive to afford.
Fortunately, federal employees, retirees, and their family members who are covered by GEHA health insurance have excellent coverage for addiction treatment. A variety of addiction treatment programs are covered by GEHA insurance. This ensures that individuals suffering from addictions to any substance, any addictions of all severities, can get the help they deserve. Remember that addiction is a progressive illness that tends to accumulate more negative consequences with every passing month. However, quality rehabs and treatment plans can help people live prosperous, happy, and meaningful sober lives. If you are covered by a GEHA insurance plan, help is only a phone call away.
GEHA is one of the largest and most important medical insurance companies in the United States. It provides coverage to individuals associated with the federal government. This includes federal employees, retired federal employees, and their family members. GEHA insures over 1.8 million people in the United States. This not-for-profit company has relationships with a vast network of treatment facilities and treatment providers, ensuring that anyone can get quality addiction treatment.
GEHA Insurance and Addiction Treatment
People who are covered by GEHA are covered for addiction treatment. However, the nature of an individual’s specific health insurance plan is the primary factor that determines the benefits they’re entitled to. Specific plans vary in terms of their level of coverage. GEHA offers a wide variety of insurance plans, including standard plans, high deductible plans, and high plans. The high and standard GEHA plans are generally the best comprehensive in terms of addiction treatment coverage. These plans will often cover most if not all of the costs of addiction-related services. They also do not require high copays or coinsurance costs. Policyholders can take advantage of GEHA’s extensive selection of in-network rehabs and facilities.
GEHA does not distinguish between different severities or types of addictions. In fact, GEHA recognizes that substance addictions are generally progressive illnesses, which means it is often more cost-effective for them to cover treatment in the early stages. GEHA also provides coverage to individuals no matter what substance they are addicted to. Addictions covered by GEHA include:
- Methamphetamine addiction
- Prescription stimulant addiction
- Marijuana addiction
- Benzodiazepine addiction
- Prescription opioid addiction
- Heroin addiction
- Cocaine addiction
- Alcohol addiction
GEHA Coverage for Substance Abuse Treatment with
GEHA’s health insurance plans, while all distinct, commonly cover a significant portion of addiction treatment costs. This is especially true for outpatient rehabs that are in-network or have pre-existing relationships with GEHA, including NuView Treatment Center. GEHA recognizes that addiction treatment is often a long term multi-step process. Common elements of an addiction treatment plan that GEHA covers include:
- Outpatient rehab
- Drug tests
- Testing diagnostics
- Individual and group therapy
- Psychological evaluation and services
- Inpatient rehab
- Medical detox centers
- Medication-assisted treatment (MAT)
- Dual diagnosis treatment
The length of addiction treatment can vary. Depending on your specific GEHA health plan, your insurance may cover the entire length of your treatment. In other cases, only a portion of your treatment will be covered. Outpatient treatment centers that are in-network are more likely to be covered for the entire duration of a person’s addiction management program.
Types of GEHA Plans
For individuals struggling with alcohol or drug addiction, it is essential to get professional care from a facility with expertise in addiction treatment. Fortunately, GEHA offers an extensive network of rehabs and other treatment facilities. Individuals who make use of in-network facilities are often completely covered by their insurance plan, while in other cases they may have to pay a copay.
GEHA health plans are unique in that they actually have a limit for the deductibles and coinsurance that policyholders have to pay each year. This means that individuals who participate in rehab programs will never pay out-of-pocket expenses above the cap. These caps differ from plan to plan.
While GEHA offers countless health plans, they can generally be classified into three main types: the standard plan, the high plan, and the high deductible health plan (HDHP). The caps for these plans depend upon whether an individual is making use of an in-network or out-of-network rehab.
- Standard plan cap for in-network treatment: $5,000
- Standard plan cap for out-of-network treatment: $7,000
- High plan cap for in-network treatment: $4,000
- High plan cap for out-of-network treatment: $6,000
- High deductible health plan cap for individual plans: $5,000
- High deductible health plan cap for family plans: $10,000
Does GEHA Cover Outpatient Rehab?
GEHA has excellent addiction treatment coverage for people who make use of in-network facilities. In most cases, addiction 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 addiction. 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 both 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 addiction’s 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.
Does GEHA Cover Mental health Counseling?
Geha is a health insurance company. Geha does not cover mental health counseling. Geha does not cover mental health counseling, but it can provide coverage for other forms of therapy, such as physical therapy and speech therapy.
Geha is not available in all states or to all people; it does not cover pre-existing conditions or maternity care.
GEHA and the Affordable Care Act
The Affordable Care Act, which is sometimes known merely by its acronym ACA, has made addiction treatment an “essential health benefit.” This recognition means that health insurance companies, including but not limited to GEHA, are legally required to offer addiction treatment coverage. While the extent and nature of this coverage depends 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. Addictions, according to ACA, are not pre-existing conditions. In the past, insurance companies would deem people with severe addictions a liability, and they would deny coverage on the basis that they suffered from a potentially expensive pre-existing condition. No matter how severe a person’s addiction is or what kind of treatment they require, GEHA will provide coverage.
GEHA and Comorbid Conditions
Approximately 50% of people who suffer from substance use disorders also have diagnosed mental health conditions. The reverse is also true, with approximately half of all people with mental illness reportedly having problems with substance addiction. In many cases, these conditions are very intertwined. Individuals experiencing emotional distress may turn to addictive substances as a way of obtaining temporary relief from their feelings. Ultimately, however, drug addiction tends to exacerbate these emotional disturbances, leading to the development of conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD).
The Affordable Care Act classifies mental health treatment as an essential health benefit. It also ensures something known as “parity.” Parity means that seeing a doctor for a mental health problem or addiction problem cannot cost more than seeing a doctor about a physical health ailment. If the copay for seeing a doctor about a cold is $60, then parity guarantees that seeing a doctor about an anxiety disorder cannot cost more than $60. This ensures that people with addiction and comorbid mental health disorders, often known as dual diagnosis patients, can get the care they need.
GEHA health plans cover a wide variety of in-network outpatient rehabs. Quality outpatient rehabs offer a treatment modality known as integrated treatment. Integrated treatment combines multiple therapies to comprehensively address mental health disorders and addictions simultaneously. By addressing both conditions at once, outpatient rehabs help people achieve long term sobriety.
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. Plans with lower monthly premiums, however, are associated with higher deductibles, copays, and coinsurance payments. Understanding what your coverage levels are can be confusing.
If you are seeking help and want a better understanding of your options, feel free to reach out to NuView Treatment Center. Contact us at (323) 307-7997. Our staff will be more than happy to 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 you are not covered, we will work with you to connect you with the resources you do need.
Addiction Treatment at NuView Treatment Center
NuView Treatment Center is an outpatient program located in West Los Angeles, in the midst of Southern California’s thriving recovery community. Our outpatient programs are run by highly trained staff and medical professionals with extensive experience in addiction treatment. We believe that addiction treatment is not one-size-fits all; instead, we work with each client to develop an individualized treatment plan that suits their unique needs.
While we utilize the latest evidence-based treatment modalities, at NuView Treatment Center we believe that recovery requires compassion above all else. No matter where you’ve been or how hopeless you feel at the start of your recovery journey, we will treat you like a human being — and help you achieve your goals. Our outpatient programs treat all addiction severities; they include partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning. We aim to provide a path forward toward joyous, fulfilling, and prosperous lives in sobriety.
NuView Treatment Center has a relationship with GEHA health insurance, ensuring that policyholders can begin a treatment program without worrying about their finances. If you are ready to begin a new way of life, reach out to us today.
Frequently Asked Questions
GEHA Insurance covers a variety of addiction treatment options, including detoxification and residential programs. To ensure that members receive only medically necessary care, GEHA requires pre-authorization. Preauthorization is the process of obtaining approval from GEHA before providing treatment.
Providers must complete the Preauthorization Request Form and submit it to GEHA to obtain preauthorization for addiction treatment. The request form is available on the GEHA website or by calling their customer service.
When submitting the preauthorization request, providers must include all necessary documentation, such as lab results, medical records, and diagnostic codes. GEHA reviews these documents and then decides on coverage. It typically takes 5-7 days for an authorization request to be processed.
Yes, there may be co-payments and additional costs associated with addiction treatment through GEHA Insurance. Your plan's Summary of Benefits will outline applicable deductibles, coinsurance, or copayments for services provided by an in-network provider. Additionally, non-covered services or out-of-network providers may incur additional fees that are not covered by your insurance policy and are the patient's responsibility. Reading and understanding your plan's Summary of Benefits is essential to ensure you are aware of all costs associated with treatment. If you have any questions, please contact GEHA directly for more information.
Yes, GEHA Insurance does provide coverage for medications related to addiction treatment. These medications may be covered under your medical or pharmacy benefits, depending on the type of medication and the plan you have selected. Please contact your provider's office or Customer Service department to find out if a specific medicine is covered. Additional information regarding covered medications can be found in a plan's Summary of Benefits. Please note that before any treatments or medications are approved for coverage under your plan, you may need to get pre-approval from your provider.
Yes, GEHA provides case managers to help members understand their insurance plan and its benefits when seeking addiction treatment. Case managers can answer questions about coverage, provide direction on where to find the proper care for you or your loved one, and coordinate with doctors and other providers related to your treatment. They can also answer any questions you have about a potential treatment center and the services they offer. GEHA case managers can help you 24 hours a day, seven days a week.
At NuView Treatment Center, we accept most major health insurance plans. To find out if your GEHA insurance plan is accepted, please call our office at 323-307-7997. Additionally, you can fill out this verification of insurance benefits form. Our staff will be more than happy to answer any questions you may have and help determine the best plan for your treatment.