Does Gilsbar Insurance Cover Addiction Treatment?
Substance use disorders are serious mental health conditions that cause a person to suffer increasingly severe consequences. Over time, people with addictions suffer from wrecked relationships, shattered families, ruined employment prospects, and dangerous physical and mental health problems. Many people die from overdoses without ever getting help. Why do so few people seek help for their addictions?
There are many reasons individuals with drug or alcohol addictions are reluctant to get help. They may believe that it is shameful to admit to having a problem. Or they may not believe addiction is a legitimate problem. One of the most common reasons people avoid getting treatment is the misconception that addiction treatment is prohibitively expensive. In reality, a quality health insurance plan will generally cover the majority of expenses associated with addiction treatment. Individuals who receive health insurance through Gilsbar have countless options.
Gilsbar is one of the leading privately-held health and benefit management organizations in the United States. Technically, Gislbar is not a health insurance company. It does not offer health insurance plans. Rather, Gilsbar is what is known as a third-party administrator, sometimes abbreviated to TPA. Third-party administrators like Gilsbar work with insurance companies. Their primary role is managing the benefits that insurance plans offer. This means that policyholders whose insurance plans are administered by Gilsbar are in luck. Gilsbar will work as an advocate on behalf of policyholders to ensure they receive all of the addiction treatment benefits they are entitled to.
What Addictions Are Covered Through Gilsbar?
If you have been diagnosed with a substance use disorder, you are eligible for coverage through Gilsbar. Gilsbar, as well as the health insurance companies they work with, do not offer different coverage levels for different types of addiction. The only requirement is that a person is diagnosed with a substance use disorder. Types of addictions eligible for coverage through Gilsbar include:
- Benzodiazepine addiction
- Prescription stimulant addiction
- Heroin addiction
- Alcohol addiction
- Prescription opioid addiction
- Crystal meth addiction
- Marijuana addiction
In most cases, your health insurance plan will arrange for an evaluation to be conducted before presenting you with treatment options. This ensures that your treatment options will be an appropriate match for your addiction’s severity.
What Benefits Does Gilsbar Provide?
If your health plan is administered by Gilsbar, you’re in luck. Gilsbar understands that addiction is a chronic condition that cannot simply be “cured.” Addiction recovery is a long-term process that often requires a range of different resources. Gilsbar works tirelessly on behalf of policyholders to ensure they can access the addiction treatment services they may need. Services offered through most plans are likely to include:
- Outpatient rehab
- Inpatient rehab
- Individual therapy, group therapy, and family therapy
- Medication management
- Psychiatric services
- Medication-assisted treatment (MAT), including methadone and Suboxone
- Opioid overdose reversal medications (naloxone)
How Much Will Gilsbar Cover?
Since Gilsbar is a TPA, not a health insurance provider, Gilsbar does not actually pay the bills for addiction treatment. Instead, Gilsbar serves as an intermediary between policyholders and their insurance companies. As such, they ensure that clients’ needs are covered by their health insurance plan. While all health insurance plans that Gilsbar administrates offer addiction treatment benefits, the specific benefits can vary from plan to plan.
In general, your health insurance plan will cover the majority of addiction treatment expenses if you have been approved for the treatment and attend a recommended treatment center. In some cases, you may not pay anything whatsoever for addiction treatment. However, it is normal to expect a certain degree of out-of-pocket expenses. These out-of-pocket expenses generally come in the form of deductibles, copays, and coinsurance.
Deductibles: Deductibles are determined by your specific health plan. A deductible is an amount of money that a client must cover with their own money. After this amount of money has been paid, the insurance plan will take over and begin paying the bills. Deductibles are generally higher with cheaper plans.
Copays: Copays are flat fees that are set by your specific health plan. A policyholder is responsible for paying a copay when they see a medical service provider or enroll in rehab.
Coinsurance: Like copays, coinsurance fees are paid when a policyholder sees a service provider or enrolls in rehab. Unlike copays, however, coinsurance fees are not flat fees. Rather, they constitute a percentage of the cost of a treatment service. These percentages vary from plan to plan.
The most important factor that determines a policyholder’s out-of-pocket expenses is their choice of rehab. Your health insurance plan through Gilsbar will generally include a network of approved providers. While some plans offer coverage for out-of-network providers, it is likely to be significantly less comprehensive. Choosing an in-network rehab, such as NuView Treatment Center, is by far the best way to get the most out of the benefits your health insurance plan provides.
Outpatient Rehab Through Gilsbar
All plans administered by Gilsbar offer coverage for outpatient rehab. Outpatient rehabs are treatment programs for addiction that allow clients to continue living at home. Clients attend their outpatient treatment program once or several times a week. There, they can expect to engage in a variety of treatment modalities and therapies that can help them address underlying issues, develop new coping skills, and rebuild their lives in sobriety.
Outpatient rehabs are suitable for many different types of clients. They are often recommended to recent graduates of inpatient rehab programs since outpatient programs are flexible programs that provide extensive support as graduates transition from an acute treatment center to everyday life. Their flexibility also makes them appealing options for people with busy work or family lives who cannot afford to enroll in residential treatment programs.
Addiction is a spectrum condition. As such, outpatient rehabs offer multiple levels of care to meet the needs of clients suffering from different levels of addiction. In many cases, clients progress from acute levels of treatment to less acute programs as they rebuild their lives and develop increased independence. Staying involved in a clinical addiction treatment program for longer periods of time is associated with lower rates of relapse. Levels of care offered by outpatient rehabs include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
Gilsbar will often work with your insurance provider to ensure that you are covered for outpatient treatment for as long as clinically necessary.
What Will Gilsbar Cover For Me?
No matter what health insurance plan you have, you are guaranteed to have addiction treatment benefits. This is due to a piece of legislation known as the Affordable Care Act. The Affordable Care Act officially makes addiction treatment an “essential health benefit,” which means that all health insurance plans in the United States are required to cover addiction treatment. The ACA also prevents insurance companies from denying coverage to individuals with substance use disorders, since addiction can no longer be legally classified as a pre-existing condition.
While it is a certainty that you have access to addiction treatment, you may still be confused as to what services you are entitled to. For individuals in active addiction, the process of determining your benefits may be confusing — or even intimidating. It can be helpful to call your health insurance representative. This phone number is often listed on the back of your insurance card.
If you recognize that you need addiction treatment, however, the fastest and most effective way is to simply reach out to an in-network rehab. NuView Treatment Center, an outpatient program covered by most Gilsbar-administered health plans, is available to work on your behalf. Contact us today at (310) 984-1730 for a free and confidential evaluation. We will get you enrolled in a treatment program as soon as possible and negotiate with Gilsbar to ensure that you get all of the benefits to which you are entitled.
Outpatient Treatment at NuView Treatment Center
NuView Treatment Center is an outpatient rehab located in the heart of West Los Angeles. We offer modern facilities, highly trained staff, and evidence-based treatment methods. At NuView Treatment Center, we work hard to ensure that clients recover fully from their substance use disorders. In doing so, they not only free themselves from the obsessions and cravings associated with addiction, but they begin to lead joyful and fulfilling lives in sobriety.
NuView Treatment Center offers every level of care, including partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning services. Clients frequently make their way from more acute programs to less acute ones as they become confident in their sobriety and develop full lives.
We believe that compassion and individualized care are key ingredients for addiction treatment. We offer individualized treatment plans for every client. Our goal is to help each client develop their weaknesses as well as their strengths as they address their own unique set of underlying issues. Clients develop new coping tools, a strong peer support system, and new life skills through a combination of multiple therapeutic methods.
No matter where you are in the recovery journey, our in-network outpatient rehab can get you the help you need. Contact NuView Treatment Center today.