Meritain Health Insurance Coverage for Drug and Alcohol Rehab

Table of Contents

Does Meritain Insurance Cover Drug or Alcohol Rehab?

Meritain Insurance, like many other health insurance providers, typically offers coverage for drug or alcohol rehab as part of their behavioral health benefits. The coverage for addiction treatment can vary based on an individual or employer’s specific plan and policy.

Usually, Meritain Insurance provides coverage for inpatient and outpatient drug or alcohol rehabilitation programs. Inpatient rehab involves staying at a treatment facility while receiving intensive treatment and support. In contrast, outpatient rehab allows individuals to receive treatment while living at home and attending therapy sessions.

The coverage for alcohol or drug abuse rehab may include various services, such as medical detoxification, individual and group therapy, counseling, medication-assisted treatment (MAT), and aftercare planning. These services are designed to help individuals overcome addiction, address underlying issues, and develop coping skills for lasting recovery.

However, it’s essential to review the specific details of your Meritain Insurance policy to understand the extent of coverage for addiction treatment. Insurance plans may have different levels of coverage, co-payments, deductibles, and limitations, so it’s crucial to know what services are covered and any potential out-of-pocket costs.

If you or a loved one are seeking addiction treatment, reviewing your plan documents to understand the available benefits is recommended. Additionally, for guidance and support in navigating your insurance coverage and finding the right addiction treatment program, you can also contact NuView Treatment Center for assistance.

Does Meritain Cover Mental Health and Substance Abuse Treatment?

Meritain Insurance generally covers mental health and substance abuse treatment as part of its behavioral health benefits. This coverage encompasses a range of services, including therapy, counseling, medication management, and addiction treatment programs. By offering comprehensive coverage for mental health and substance abuse treatment, Meritain aims to support individuals in achieving better overall well-being. However, the specific coverage details may vary depending on your Meritain Insurance plan. To determine the extent of coverage and any applicable requirements, it is recommended to review your plan documents or contact NuView Treatment Center for support in accessing mental health and substance abuse treatment services.

Will Meritain Cover Dual Diagnosis Treatment?

Yes, Meritain Insurance will likely cover Dual Diagnosis Treatment, which involves treating mental health and substance abuse disorders concurrently. Dual Diagnosis Treatment is a specialized approach that addresses co-occurring conditions to ensure comprehensive and effective care for individuals with complex needs.

Meritain aims to promote integrated care and support those facing co-occurring mental health and substance abuse challenges by covering Dual Diagnosis Treatment. To understand the specifics of your coverage for Dual Diagnosis Treatment, it’s essential to review your Meritain Insurance plan documents or consult with NuView Treatment Center for assistance.

Does Meritain Cover Therapy for Addiction Treatment?

Yes, Meritain Insurance generally provides coverage for therapy as part of addiction treatment. This can include individual therapy, group therapy, family therapy, and other evidence-based therapeutic approaches. Therapy is crucial in addressing the underlying factors contributing to substance abuse and supporting individuals in their recovery journey.

By covering therapy for addiction treatment, Meritain aims to facilitate access to quality care and promote successful outcomes for those seeking recovery from addiction. For information about the specifics of your therapy coverage, it is advisable to review your Meritain Insurance plan details or seek guidance from NuView Treatment Center.

Meritain Outpatient Rehab Coverage

Meritain Insurance typically offers coverage for outpatient rehab as part of its behavioral health benefits. Outpatient rehab programs allow individuals to receive addiction treatment without the need for residential stays, providing flexibility for those with work or family commitments.

Meritain’s coverage for outpatient rehab includes a variety of treatment options, such as:

  1. Intensive Outpatient Programs (IOP): These programs provide a higher level of care than traditional outpatient services and may involve several hours of weekly therapy and counseling sessions.

  2. Outpatient Programs (OP): Standard outpatient programs offer more flexibility, with fewer weekly treatment hours, suitable for individuals with less severe addiction issues or those transitioning from higher levels of care.

  3. Individual Therapy: Meritain Insurance often covers individual therapy sessions with licensed therapists specializing in addiction treatment.

  4. Group Therapy: Coverage may include participating in group therapy sessions, providing peer support, and a sense of community during recovery.

  5. Family Therapy: Meritain may also cover family therapy sessions involving loved ones in the recovery journey and help address family dynamics related to addiction.

It’s essential to review the specifics of your Meritain Insurance plan to understand the extent of coverage for outpatient rehab services. NuView Treatment Center can assist you in navigating your insurance benefits and finding the appropriate outpatient treatment program for your unique needs.

How to Check Meritain Rehab Coverage?

To check your Meritain 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 Meritain 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 Meritain Insurance Plans

Meritain Insurance offers a variety of health insurance plans to cater to the diverse needs of individuals and employers. Some of the common types of Meritain Insurance plans include:

  1. Health Maintenance Organization (HMO) Plans: HMO plans require policyholders to choose a primary care physician (PCP) from within the HMO network. PCPs coordinate all healthcare services and provide referrals to specialists. Out-of-network services may only be covered for emergencies.

  2. Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility in choosing healthcare providers. Policyholders can visit both in-network and out-of-network providers, but they typically receive more extensive coverage and lower out-of-pocket costs when using in-network providers.

  3. Exclusive Provider Organization (EPO) Plans: EPO plans combine features of HMO and PPO plans. Policyholders must use in-network providers for coverage, except for emergency care or urgent situations.

  4. Point of Service (POS) Plans: POS plans allow policyholders to choose a primary care physician and get specialist referrals. While POS plans focus on in-network coverage, they may provide limited out-of-network coverage in certain circumstances.

  5. High Deductible Health Plans (HDHPs): HDHPs typically have higher deductibles than other plans but are paired with Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs) to help offset costs.

  6. Consumer-Driven Health Plans (CDHPs): CDHPs combine high-deductible health plans with tax-advantaged health savings accounts, empowering individuals to make informed healthcare decisions and manage their healthcare costs.

  7. Medicare Advantage Plans: Meritain offers Medicare Advantage plans to individuals who qualify for Medicare. These plans may include additional benefits beyond original Medicare.

  8. Medicaid Plans: Meritain may offer Medicaid plans in collaboration with state-run Medicaid programs, providing essential healthcare coverage to low-income individuals and families.

It’s essential for individuals and employers to review the details of each Meritain Insurance plan to choose the one that best suits their healthcare needs and budget.

Meritain Substance Abuse Coverage

Meritain Insurance generally provides coverage for a variety of substance abuse addictions. Some of the addictions commonly covered by Meritain plans include:

  • Crystal Meth Addiction

  • Prescription Opioid Addiction (including Fentanyl, Oxycontin, and Vicodin)

  • Alcohol Addiction

  • Marijuana Addiction

  • Benzodiazepine Addiction (such as Xanax and Valium)

  • Cocaine and Crack Cocaine Addiction

  • Heroin Addiction

  • Adderall and Other Prescription Stimulant Addictions

To fully understand the extent of coverage for these specific addictions and associated treatment services, reviewing your specific Meritain plan documents or contacting NuView Treatment Center is essential. This will help you effectively determine the available options for addressing your substance abuse needs. Meritain’s commitment to supporting individuals in their journey to recovery ensures access to quality addiction treatment services.

What Is Meritain Insurance & How Does It Work?

Meritain Insurance is a third-party administrator (TPA) that provides health benefits management services to employers and their employees. As a TPA, Meritain works on behalf of employers to administer their self-funded health insurance plans. Unlike traditional insurance companies that assume the financial risk for the claims they cover, the employer funds self-funded plans, and the TPA handles the day-to-day administration of the plan.

Here’s how Meritain Insurance works:

  1. Self-Funded Plans: Employers who choose self-funded plans assume the financial risk of providing healthcare benefits to their employees. They set aside funds to cover medical claims and other healthcare expenses.

  2. Health Benefits Administration: Meritain is the employer and healthcare provider intermediaries. They process and pay claims, handle customer service inquiries, and manage other administrative tasks related to the health plan.

  3. Provider Network: Meritain maintains a network of healthcare providers, including doctors, hospitals, and other medical facilities. Employees covered under the plan are encouraged to use in-network providers to maximize their benefits.

  4. Plan Options: Employers can customize their self-funded plans with different benefit options, such as deductibles, co-payments, and coverage for specific services like mental health and substance abuse treatment.

  5. Employee Coverage: Employees covered under the self-funded plan receive a health insurance card and access to the Meritain network of providers. They can use their coverage to seek medical services, including drug or alcohol rehab, within the plan’s guidelines.

  6. Claims Processing: When an employee seeks medical treatment, the healthcare provider submits the claim to Meritain for processing. Meritain reviews the claim, verifies coverage, and pays the provider according to the plan’s terms.

  7. Customer Support: Meritain provides customer support to employers and employees, helping them understand their benefits, answer questions, and address any issues related to the health plan.

It’s important to note that the specific details of Meritain Insurance’s work may vary depending on the employer’s chosen plan and the benefits offered. Employees should refer to their plan documents or contact NuView Treatment Center for comprehensive information about their coverage and how to access healthcare services under the Meritain plan.

How To Find Rehabs That Take Meritain 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 on your behalf that accepts Meritain Insurance. Call us at (323) 307-7997, and our knowledgeable staff will happily 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.

Out-of-Network Rehabs Through Meritain

Regarding out-of-network rehabs, the coverage provided by Meritain Insurance will depend on the specific self-funded health plan chosen by the employer. As a third-party administrator (TPA), Meritain processes and administers claims for employers’ self-funded health plans, and each plan may have different rules and guidelines regarding out-of-network coverage.

Generally, when a policyholder seeks treatment at an out-of-network rehab facility, the coverage may differ from using an in-network provider. Here are some key points to consider regarding out-of-network rehabs through Meritain:

  1. Higher Out-of-Pocket Costs: Out-of-network providers may charge higher fees than in-network facilities. As a result, policyholders may be responsible for paying a higher percentage of the treatment costs in the form of co-insurance or a higher deductible.

  2. Different Coverage Levels: The plan’s benefits for out-of-network rehabs may differ from those for in-network facilities. For example, while in-network treatment centers may have pre-negotiated rates and better coverage, out-of-network facilities might have less favorable terms.

  3. Preauthorization Requirements: Some self-funded health plans, including those administered by Meritain, may require preauthorization for certain services, including out-of-network rehab treatment. It’s essential for policyholders to check their plan documents or contact the NuView Treatment Center to understand the preauthorization process and any requirements for coverage.

  4. Balance Billing: Out-of-network providers may engage in balance billing, which means they bill the policyholder for any amount not covered by the insurance plan. Policyholders should be aware of this possibility and discuss costs with the rehab facility before seeking treatment.

  5. Accessing Out-of-Network Care: Policyholders considering treatment at an out-of-network rehab should contact the NuView Treatment Center to inquire about coverage details, potential costs, and any preauthorization requirements. Understanding the financial implications of using an out-of-network facility and exploring in-network options when available to maximize coverage and minimize out-of-pocket expenses is essential.

Policyholders should review their specific self-funded health plan documents to make informed decisions about accessing out-of-network rehab facilities or contact the NuView Treatment Center to understand their coverage options and associated costs.

Meritain and the Affordable Care Act

As a third-party administrator (TPA), Meritain Insurance manages self-funded health plans for employers. Self-funded plans are exempt from specific Affordable Care Act (ACA) requirements, also known as Obamacare, including some of the essential health benefits and consumer protection provisions mandated for fully insured plans. Therefore, the impact of the ACA on Meritain-administered plans may vary depending on the employer’s specific plan design.

However, it’s important to note that even though self-funded plans are exempt from specific ACA requirements, many employers voluntarily choose to include ACA-compliant provisions to provide comprehensive coverage to their employees. This means some Meritain-administered self-funded plans may still offer benefits that align with ACA standards.

Key aspects of the ACA that may still apply or be voluntarily adopted in Meritain-administered self-funded plans include:

  1. Preventive Services: The ACA requires health plans to cover certain preventive services, such as vaccinations, screenings, and wellness visits, without cost-sharing. Many self-funded plans, including those managed by Meritain, offer preventive services as part of their benefits.

  2. Dependent Coverage: The ACA allows dependent children to stay on their parent’s health insurance plan until age 26. Many self-funded plans offer this extended dependent coverage.

  3. Pre-Existing Conditions: The ACA prohibits health insurance plans from denying coverage or charging higher premiums based on pre-existing conditions. Many self-funded plans comply with this provision to ensure equal access to coverage.

  4. Annual and Lifetime Limits: The ACA eliminated annual and lifetime limits on essential health benefits—self-funded plans, if ACA-compliant, will not impose such limits on covered services.

While Meritain-administered self-funded plans may not be subject to all ACA regulations, many employers offer comprehensive coverage that includes essential health benefits and consumer protections to provide valuable healthcare options for their employees.

What Does Meritain Cover For Me?

Meritain Insurance offers a range of coverage options depending on your employer’s specific self-funded health plan. As a third-party administrator (TPA), Meritain manages self-funded plans on behalf of employers, and the benefits offered can vary based on the employer’s plan design. However, in general, Meritain-covered plans may include the following:

  1. Preventive Care: Meritain typically covers preventive services, such as vaccinations, screenings, and wellness check-ups, without requiring you to pay out-of-pocket expenses like co-payments or deductibles.

  2. Hospital and Medical Services: Your Meritain plan will likely cover hospital stays, surgeries, doctor visits, and other medical services, either through in-network providers or with partial coverage for out-of-network providers, depending on your plan type.

  3. Prescription Drugs: Meritain often includes coverage for prescription medications, with varying co-payments or co-insurance, depending on your plan.

  4. Mental Health and Substance Abuse Treatment: Meritain provides coverage for substance abuse and mental health treatment, which may include counseling, therapy, and addiction treatment programs.

  5. Maternity and Newborn Care: Many Meritain plans cover maternity care and newborn services, including prenatal visits, delivery, and postnatal care.

  6. Emergency Services: Meritain covers emergency medical services, ensuring you can receive essential care in critical situations.

  7. Laboratory Tests and Diagnostic Services: Your Meritain plan should cover laboratory tests, X-rays, and other diagnostic services needed for your healthcare.

It’s essential to review the specific details of your Meritain-administered self-funded plan, such as the deductible, co-payments, co-insurance, and any limitations on coverage, to understand precisely what services are covered for you. The coverage details may vary based on the plan your employer has chosen.

If you have questions about your plan or the available benefits, NuView Treatment Center can assist you in navigating your insurance coverage and accessing the services you need for your healthcare journey.

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

If your Meritain Health family plan does not cover certain medical expenses or if you have out-of-pocket costs not covered by the insurance, there are several options available to help you manage those expenses:

  1. Out-of-Pocket Payments: You can pay for the uncovered costs directly using your personal funds or credit cards.

  2. Health Savings Account (HSA): If you have a Health Savings Account, you can use the funds in your HSA to pay for qualified medical expenses not covered by your insurance.

  3. Flexible Spending Account (FSA): If you have a Flexible Spending Account, you can use the funds set aside in your FSA to cover out-of-pocket medical costs.

  4. Payment Plans: Some healthcare providers offer payment plans that allow you to spread out the cost of treatment over time, making it more manageable.

  5. Medicaid or State Programs: Depending on your income and circumstances, you may qualify for Medicaid or other state-run programs that can provide additional financial assistance for healthcare costs.

  6. Scholarships or Grants: Some organizations and foundations offer scholarships or grants to help individuals with the costs of specific medical treatments.

  7. Appeal or Negotiation: In some cases, you can appeal a claim denial or negotiate with your healthcare provider to reduce the cost of treatment.

It’s essential to discuss your situation with the NuView Treatment Center to find if insurance plans by Meritain Health cover treatment costs. We can help you explore your payment options and find financial assistance.

Questions about treatment options for substance addiction?

Our admissions navigators are available 24/7 to listen to your story and get you started with next steps.

Frequently Asked Questions

  • What is the preauthorization process for addiction treatment under Meritain insurance?

    The preauthorization process for addiction treatment under Meritain insurance typically involves obtaining approval from the insurance company before receiving specific treatments or services. Preauthorization may be required for addiction treatment for inpatient rehab, outpatient rehab, or specialized therapies. To initiate the process, the healthcare provider will submit a request to Meritain, providing details about the proposed treatment plan. Meritain will review the request to ensure that the treatment is medically necessary and meets the criteria outlined in the insurance policy. Once preauthorization is granted, the treatment can proceed with coverage from the insurance plan.


  • Are there any co-payments or additional costs associated with addiction treatment through Meritain insurance?

    Co-payments, co-insurance, and deductibles are common components of health insurance plans, including those offered by Meritain. Depending on the specific plan and coverage details, these out-of-pocket costs may apply to addiction treatment services. Co-payments are fixed amounts you pay for each visit or service, while co-insurance is a percentage of the total cost that you are responsible for. Additionally, some plans may have deductibles that must be met before insurance coverage kicks in. It’s essential to review your Meritain plan documents or contact the NuView Treatment Center to understand your specific cost-sharing responsibilities for addiction treatment.


  • Does Meritain insurance provide coverage for medications related to addiction treatment?

    Meritain insurance typically covers a range of prescription medications, including those related to addiction treatment. Medications that help manage substance abuse, such as medications for opioid use disorder or alcohol dependence, may be covered under the Meritain health pharmacy solutions. However, coverage specifics, such as copay amounts and restrictions, may vary depending on your plan and the medications prescribed. It’s best to consult your Meritain plan documents or speak with a representative at the NuView Treatment Center to understand the details of medication coverage for addiction treatment.


  • Is there a case manager available to help me understand my Meritain insurance and its benefits at an addiction treatment center?

    Meritain Insurance may provide case management services to assist policyholders in understanding their insurance benefits and navigating the healthcare system, including addiction treatment services. A case manager can help answer questions related to coverage, preauthorization, network providers, and available treatment options. If you’re seeking addiction treatment, reaching out to a case manager provided by Meritain or contacting the NuView Treatment Center can be beneficial in gaining clarity about your insurance benefits and making informed decisions about your treatment journey.


  • How can I determine if NuView Treatment Center accepts my Meritain insurance?

    At NuView Treatment Center, we accept most major health insurance plans. To find out if your specific Meritain insurance is accepted, please call our office at (323) 307-7997. Additionally, you can fill out this insurance verification form. Our staff will be more than happy to answer any questions you may have and help determine the best plan for your treatment.

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