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HealthScope offers comprehensive health insurance plans to countless Americans. Their plans invariably cover drug and alcohol addiction treatment. However, the nature and extent of their coverage for substance addiction treatment varies from plan to plan. If you are considering treatment for substance abuse, HealhScope can likely support you on your recovery journey.

While the amount of coverage that HealthScope provides depends upon the specific plan that a policyholder has, attending an outpatient rehab that is within their provider network is likely to be covered almost entirely, if not completely. One such in-network outpatient rehab is NuView Treatment Center, located in West Los Angeles.

What is HealthScope Health Insurance?

HealthScope, is a third-party-administrator, or TPA. Technically, they are not a health insurance provider. As a third-party administrator, HealthScope works with insurance companies to coordinate clients’ varying needs. It plays an important role helping people manage their healthcare plans and services. Based in the United States, they are the third largest TPA in the country, with over 800 employees. It has been helping policyholders get addiction treatment services for over 30 years.

How Does a TPA Work?

HealthScope is a third-party administrator. This means that it works with clients and their insurance providers to ensure that policyholders get access to the specific treatments they need. As such, they works hard to provide excellent customer service and individualized attention to each client. They work with clients and coordinate with health insurance companies to make sure that clients get the most of their benefits. For individuals suffering from addiction, a TPA like HealthScope can help them get access to long term rehab programs and customized treatment programs.

What Addictions Does HealthScope Cover?

HealthScope plans cover all varieties of substance use disorders. They are not prejudiced against any specific substance addictions. It works hard to ensure that anyone suffering from any addiction, no matter what substance they abuse, is able to get the help they need. Addictions covered by HealthScope plans include:

  • Cocaine addiction
  • Benzodiazepine addiction (including Valium and Xanax addiction)
  • Heroin addiction
  • Prescription opioid addiction (including Oxycontin, Fentanyl, Percocet, and Vicodin addiction)
  • Adderall addiction
  • Crystal meth addiction
  • Marijuana addiction
  • Alcohol addiction

HealthScope and Addiction Treatment Services

HealthScope understands that no matter what substance a person was addicted to, it is essential for them to get help. Just as HealthScope does not distinguish between different types of addictions, it is also willing to cover treatment for individuals suffering from substance use disorders at all levels of severity. In fact, it is often cheaper for them to provide coverage to people who are in the early stages of addiction, since dealing with the disorder early is likely to prevent additional complications. Whether you have suffered from addiction for years or only just beginning to recognize the signs, HealthScope can help you devise a treatment plan that meets your needs.

Treatment services covered by HealthScope include:

  • Medical detox centers
  • Outpatient rehab
  • Group therapy, family therapy, and individual therapy
  • Inpatient rehab
  • Psychiatric services
  • Drug testing and drug screening
  • Medication-assisted treatment (MAT)

HealthScope will generally arrange an assessment to determine what addiction treatment services should be incorporated into your custom plan. As a third-party-administrator, HealthScope is an advocate for you. They will fight on your behalf to ensure that all of your needs are covered. Factors that determine which of the above services will be covered include:

  • Your desire to recover from addiction
  • The likelihood of a relapse
  • Your need for withdrawal management
  • Whether or not you suffer from comorbid physical or mental health conditions
  • How supported you are in your home environment

What Will HealthScope Pay for Specifically?

HealthScope works with insurance companies to help you get the services you need. As such, it does not directly pay for the cost of addiction treatment services. For policyholders, however, it is far easier to get comprehensive coverage. People who are insured through Anthem, for instance, often work with HealthScope to receive their benefits. For those seeking addiction treatment through Anthem HealthScope, the out-of-pocket treatment costs are often significantly reduced. Healthscope works hard to guarantee that policyholders only have to pay a fraction of the cost of treatment. In some cases, insurance will cover the entire cost of treatment.

Policyholders who work with them are guaranteed some degree of addiction coverage. However, in most cases they will have to pay some out-of-pocket expenses. These expenses vary from plan to plan. The most prevalent cost that clients face is a deductible. A deductible is a pre-arranged amount of money that policyholders are responsible for paying before their insurance will begin covering costs. Clients are also sometimes responsible for paying coinsurance and copays. Coinsurance is a percentage of the cost of a treatment service, and coinsurance is a set fee that clients pay when they receive a treatment service. These out-of-pocket fees are lower for individuals who have more comprehensive coverage with HealthScope.

Out-of-Network Rehabs with HealthScope

Another important factor that determines your level of coverage with HealthScope is the specific treatment facility you use. HealthScope coordinates with health insurance companies like Anthem so that policyholders have access to a wide variety of treatment providers. Making use of an addiction treatment facility within their official network is likely to be associated with significantly lower out-of-pocket costs.

Policyholders have the freedom to see any treatment provider they wish. However, they should be aware that HealthScope will generally provide less coverage for out-of-network providers. In some cases, HealthScope will provide no coverage whatsoever for out-of-network rehabs. Ultimately, the extent of HealthScope out-of-network coverage depends upon the specific plan that a policyholder has.

NuView Treatment Center, an outpatient rehab in Los Angeles, is considered in-network with most HealthScope plans. For individuals who are interested in recovering from addiction in an outpatient treatment center, NuView Treatment Center’s programs are likely to be almost entirely if not fully covered by most HealthScope health insurance plans.

Outpatient Treatment with HealthScope

HealthScope offers comprehensive coverage for outpatient programs, especially in-network outpatient programs like NuView Treatment Center. Outpatient rehabs offer evidence-based treatment modalities to help people recover from addictions of all severity levels. Outpatient rehabs are often cheaper than inpatient rehabs, due to the fact that clients do not have to pay for lodging there. As such, they are often more appealing to healthcare companies, who are often willing to cover the costs of treatment on a long term basis for clients making use of outpatient services.

Outpatient rehabs require clients to attend their treatment programs once a week, or several times a week for more acute levels of care. In general, these sessions last from one to several hours. As such, outpatient rehabs offer a great deal of flexibility to clients. They are often appealing to individuals who have commitments at work or who have demanding family lives. Even for individuals who don’t have full lives, outpatient programs are ideally suited for clients who are interested in developing their lives — since the flexibility and support they offer makes it easy to build a new life in sobriety.

For this reason, outpatient rehabs are often recommended for individuals who have recently graduated from more acute treatment programs, such as inpatient treatment programs. HealthScope is often willing to cover outpatient treatment as part of an aftercare plan for residential rehab graduates. Ultimately, doing so is likely to be cheaper for one’s insurance company in the long run, since outpatient care significantly lowers the risk of relapse. Research shows that transitioning from a more acute level of care to a less acute level makes relapsing less likely, especially when compared to individuals who simply graduate and return to their old lives.

Outpatient programs, such as those offered at NuView Treatment Center, are designed to cover all levels of addiction severity. Levels of care that outpatient rehabs provide include:

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

Does HealthScope Pay for Medication

Medication can sometimes be helpful for individuals suffering from addiction. Not only do people with addictions often have physical health problems, but approximately 50% have comorbid mental health disorders. Dual diagnosis patients often require medications to address their underlying mental health conditions. HealthScope ensures that these individuals can get pharmaceutical treatments without breaking the bank.

HealthScope also provides extensive coverage for medication-assisted treatment (MAT). Medication-assisted treatment is a treatment modality that combines behavioral therapy with medication to help people recover from addictions. MAT is available at most outpatient rehabs, including NuView Treatment Center. Taking medications in the context of a medication-assisted treatment plan can lower the risk of relapse, help people stay committed to their rehab program, reduce their cravings, and mitigate the symptoms of withdrawal.

Medications that HealthScope covers include drugs to help with opioid withdrawal, including: 

  • Buprenorphine
  • Suboxone
  • Methadone

HealthScope also provides coverage for medications that help people manage alcohol withdrawal, such as:

  • Disulfiram (Antabuse)
  • Naltrexone (Vivitrol, Revia)
  • Acamprosate (Campral)

HealthScope and the Affordable Care Act

As a TPA, HealthScope works hard to ensure that the healthcare companies it works with follow the rules laid out by the Affordable Care Act. The Affordable Care Act has radically changed how health insurance companies handle addiction treatment. First and foremost, it stipulates that substance use disorders are not pre-existing conditions. This means that health insurance companies cannot legally deny people coverage simply because they suffer from a substance use disorder.

Perhaps more importantly, the ACA, as it is often known, officially makes addiction treatment into an “essential health benefit.” Not only can insurance companies no longer deny people with addictions coverage, they also have to offer some degree of addiction treatment coverage. Mental health disorders, which often occur alongside addictions, must also be covered. This means that no matter what insurance company a person uses, they will have guaranteed access to addiction treatment services. Naturally, the nature and extent of such coverage varies from plan to plan, however.

The Affordable Care Act also enforces a policy known as “parity.” Parity means that the out-of-pocket expenses associated with addiction or mental health treatment services cannot be higher than comparable services for physical health problems. If an individual is responsible for a $25 copay when they see a doctor about their flu symptoms, this copay cannot be higher if they are seeing a physician about a mental health or addiction problem.

What Does My HealthScope Plan Cover For Me?

If you receive your insurance benefits through HealthScope, you are likely covered for a wide variety of addiction treatment services, including outpatient treatment. However, your levels of coverage depend in large part on your specific healthcare plan as well as your state of residence. Navigating the finer details of your health insurance plan can be tricky — even intimidating. You may not be sure which services you are covered for, which facilities are considered in-network, or what your out-of-pocket expenses are. If you are unsure about the answers to any of these questions, calling your insurance representative can often help you get some more specifics.

If you are eager to begin your recovery journey sooner rather than later, however, it can be helpful to have an advocate working on your behalf. Staff members at NuView Treatment Center have years of experience working with insurance companies and have broad familiarity with all manner of recovery resources. Contact NuView Treatment Center today for a confidential and free consultation. We will help assess your treatment needs, determine what your insurance plan will pay for, and help connect you with the best treatment services possible for your unique situation.

Outpatient Treatment at NuView Treatment Center

NuView Treatment Center, located in West Los Angeles, offers outpatient programs that are covered by the majority of HealthScope plans. Our evidence-based programs are designed to meet the needs of individuals experiencing addiction at all severities, whether they are just beginning their recovery journey or pursuing outpatient recovery after graduating from a more acute treatment program. Our programs include partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning services.

At NuView Treatment Center, we firmly believe that recovery is best achieved through individualized attention. Addiction treatment should never be one-size-fits-all. Instead, we work with each client to assess their unique needs and develop personalized treatment plans designed to address them. Above all, our highly trained staff emphasize compassion.

NuView Treatment Center works with people of all backgrounds to help them develop new coping strategies, life skills, and relationships. While developing sobriety, our clients also take steps toward living more joyful and fulfilling lives in recovery. To that end, our outpatient addiction treatment programs incorporate a wide variety of evidence-based treatment modalities, including group therapy, cognitive behavioral therapy, and medication assisted treatment.

Recovery is possible for those who seek help. If you are covered through HealthScope, our in-network outpatient programs can help you begin living a new life that you never thought possible. Reach out to NuView Treatment Center today.

Frequently Asked Questions

HealthScope requires preauthorization for all addiction treatment services. Preauthorization is an administrative process that assesses the medical necessity of a proposed service or course of treatment before its provision. To ensure timely and appropriate care, preauthorization must be obtained before the start of any treatment. 

To obtain reauthorization, providers must present a complete and accurate clinical review with supporting documentation of the patient’s diagnosis, treatment plan, and other relevant information. HealthScope also requires that all providers have proper credentials and adhere to applicable regulatory requirements. Once preauthorization is granted, providers can begin providing treatment services to their patients.

Yes, co-payments or other additional costs may be associated with addiction treatment depending on the plan and the provider. For those seeking addiction treatment through Anthem HealthScope, the out-of-pocket treatment costs are often significantly reduced. Healthscope works hard to guarantee that policyholders only have to pay a fraction of the cost of treatment. In some cases, insurance will cover the entire cost of treatment. Please refer to your specific plan details for more information regarding any applicable co-payments and fees.

Yes, HealthScope provides coverage for medications related to addiction treatment. Generally speaking, most medically necessary medications are covered under your plan. Please refer to your specific plan details and contact your provider or pharmacist if you have any questions or concerns about the medications associated with your treatment. Some treatments covered by HealthScope include:

  • Medical detox centers
  • Outpatient rehab
  • Group therapy, family therapy, and individual therapy
  • Inpatient rehab
  • Psychiatric services
  • Drug testing and drug screening
  • Medication-assisted treatment

Yes. Every HealthScope Plan has a dedicated case manager who can help you understand your plan and its benefits. Your case manager will be knowledgeable about the available services and treatments at an addiction treatment center and any restrictions or exclusions that may apply to certain services. They can also provide resources such as additional insurance coverage or payment plans. With the help of your case manager, you can feel confident that you are receiving all of the benefits and services to which you are entitled.

At NuView Treatment Center, we accept most major health insurance plans. To find out if your specific HealthScope 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.

We are here for you.

You are not alone.

Realizing you need help with your addiction can feel overwhelming, but that’s why you have us here to support you every step of the way. We are here every day and committed to your recovery. We’re in this together.

Call us now, no obligation.