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For individuals covered through Optima Health insurance plans, addiction treatment is broadly covered. Whether you are only just now recognizing the signs of an addiction or making an attempt to rebuild your life after years of addiction, Optima Health provides high quality addiction treatment coverage. The nature of such coverage, however, depends upon the specific Optima Health plan that a policyholder pays for.

Optima Health

Optima Health is a health insurance provider based in Virginia. They offer a wide variety of employer-sponsored health insurance plans as well as individual health insurance plans. Optima Health currently provides coverage to more than 585,000 thousand members in the United States. While mostly recognized for their comprehensive employee-owned and employer-sponsored plans, Optima Health lso offers individual and family plans, employee assistance plans, and plans for Medicaid and Medicare enrollees.

For individuals seeking addiction treatment, Optima Health’s extensive network of in-network providers offers countless options. Their provider network contains more than 35,000 facilities and specialists. This makes it easy for anyone suffering from addiction or mental health problems to find the services they need.

Moreover, Optima Health places a unique emphasis on helping policyholders who suffer from chronic illnesses — including substance use disorders. After an initial assessment, Optima Health designs customized wellness programs for each client, ensuring that anyone can get the behavioral health services they need.

What Addictions Does Optima Health Cover?

Optima Health covers treatment for substance use disorders regardless of what an individual’s substance of choice was. Optima Health recognizes that substance use disorders exist on a spectrum, with some suffering from more severe addictions than others. They also understand that substance use disorders, left untreated, tend to get progressively more severe over time. As such, they offer coverage to individuals even in the earliest stages of a substance use disorder. Providing treatment to these individuals is often more cost-effective in the long run.

Addictions covered by Optima Health include but are not limited to:

  • Benzodiazepine addiction (such as Xanax and Valium)
  • Cocaine and crack cocaine addiction
  • Heroin addiction
  • Adderall and other prescription stimulant addictions
  • Crystal meth addiction
  • Prescription opioid addiction (including Fentanyl, Oxycontin, and Vicodin)
  • Alcohol addiction
  • Marijuana addiction

Treatment Services Covered by Optima Health

There is no medically recognized “cure” for addiction. Treating an addiction often requires a broad array of services to help people learn to live with this chronic condition. Rehabs and other treatment programs help individuals deal with withdrawal symptoms, cope with triggers, and learn to live joyful and fulfilling lives without needing to rely on addictive drugs or alcohol. For any individual suffering from a substance addiction, Optima Health is generally willing to provide coverage for multiple treatment modalities to achieve the above-listed goals.

Treatment services that Optima Health often recommends and covers include:

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

Before an individual begins their addiction treatment journey, Optima Health generally requires an assessment from a primary care provider (PCP). This provider can determine which addiction treatment services, if any, are medically necessary.

What Will Optima Health Pay For?

All Optima Health plans offer coverage for addiction treatment. The extent of coverage, however, depends upon the specific plan that a person is covered by. Plans with more comprehensive coverage, which often require policyholders to pay higher premiums, are associated with lower out-of-pocket expenses. Cheaper and less comprehensive plans provide coverage for addiction treatment as well, but these are generally associated with additional out-of-pocket fees.

In some cases, especially when a client makes use of one of Optima Health’s in-network  rehabs, the cost is covered entirely by the insurance company. In most cases, however, policyholders are responsible for some of the cost. Most commonly, they are responsible for meeting a deductible. A deductible is a set amount of money that clients must pay before their insurance plan begins to cover the cost of a treatment service. Clients also are generally responsible for paying either a copay or coinsurance fee, and sometimes both. Coinsurance is apercentage of the cost of a treatment service, while copays are set fees that individuals must pay when they receive a treatment.

While clients are often responsible for a portion of the costs of addiction treatment, Optima Health will in most cases cover the majority of the expenses. This is especially true when a client makes use of an in-network rehab, such as NuView Treatment Center.

Types of Optima Health Plans

Optima Health offers a wide range of health insurance plans. Their employer sponsored plans are known as Optima Vantage (HMO), Optima POS, and Optima Plus (PPO). Meanwhile, Optima Health’s individual and family plans are known as OptimalFit plans. With so many plans to choose from, there are many small differences from plan to plan. However, all of them can be broadly classified into three distinct health insurance plan types:

Optima Health PPO
Optima Health’s PPO plans offer a great deal of flexibility to policyholders who might wish to see an out-of-network treatment provider. While out-of-network care is associated with an additional fee, PPO plans offer clients additional choices.

Optima Health HMO
MO plans with Optima Health help clients obtain affordable and quality treatment services. These more affordable plans come with the caveat that policyholders must receive treatment only from providers within Optima Health’s network.

Optima Health POS
POS plans with Optima Health exist in the middle ground between PPOs and HMOs. They are affordable health insurance plans that allow clients to make use of out-of-network providers if they so choose.

Optima Health and Outpatient Rehab

Optima Health offers comprehensive coverage for a wide variety of addiction treatment services, but their coverage is especially excellent when it comes to outpatient treatment programs. Outpatient addiction treatment programs are ideal for individuals who are working to overcome alcohol or drug addictions of all severities. They are as effective as inpatient rehabs, but they are generally cheaper due to the lack of a residency requirement. This makes health insurance
companies like Optima Health more likely to cover longer term treatment plans for outpatient programs.

Outpatient rehabs are designed to help individuals begin to pick up the pieces of their lives. Unlike inpatient rehabs, clients do not live on the premises. Instead, they live alone or with a strong social support group, such as a family or a sober living home. This allows high functioning addicts the flexibility to pursue recovery while working a job or supporting a family. It also allows people with more severe addictions to begin slowly developing a life in the outside world as they develop a stronger foundation in sobriety.

Outpatient rehabs are recommended for individuals suffering from any kind of addiction at any severity. In fact, they are also the most commonly recommended type of treatment program for recent graduates of more acute treatment programs, such as medical detox centers and inpatient rehabs. As an aftercare program, an outpatient rehab can provide long term support and help clients continue to develop the coping tools they need to avoid relapse and meet the challenges of early sobriety.

Levels of care offered at most quality outpatient rehabs include:

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

How Much Will I Have to Pay with Optima Health?

Optima Health provides addiction treatment coverage with all of its plans, but the extent of such coverage varies from plan to plan. In many cases, policyholders are responsible for some share of the expenses. These out of pocket expenses most commonly include a deductible, which is a set dollar amount that clients are expected to pay before their insurance kicks in. Clients may also be responsible for copays and coinsurance. A copay is a pre-specified fee that clients must pay when they receive a service, and coinsurance is a small percentage of the cost of a service.

For individuals who are covered by one of Optima Health’s individual insurance plans, the deductibles can vary depending on the comprehensiveness of the plan. However, in most cases the copay for outpatient treatment runs between $10 and $40. Coinsurance fees range between 5% and 20% of the total cost of treatment. The exact amount of money that an individual will have to pay depends on their specific health plan as well as the treatment services they are

Medication-Assisted Treatment with Optima Health

Optima Health also provides excellent coverage for medication-assisted treatment, also known as MAT therapy. Medication-assisted treatment is an addiction treatment method that combines elements of behavioral therapy with pharmaceutical medication. It is important to note that medications cannot “cure” an addiction, but certain drugs have been shown to reduce cravings and mitigate withdrawal symptoms, especially in the cases of alcohol and opioid addiction.
Taking these drugs can help patients become clear-headed enough to reap the benefits of the behavior therapies that outpatient programs offer. MAT therapy also increases the likelihood that a client will commit to their rehab long enough to get sober.

Optima Health also provides coverage for other medication needs. This is essential, especially given the fact that individuals with substance use disorders commonly suffer from both physical and mental health disorders. Most high quality outpatient programs have the resources to deal with dual diagnosis patients who have comorbid addictions and mental health conditions. They employ medical professionals and psychiatrists who can diagnose disorders, prescribe medications — and they also coordinate treatment plans with clients’ insurance providers.

Out-of-Network Providers with Optima Health

Optima Health’s coverage for out of network providers varies from plan to plan. More comprehensive plans, which are generally associated with high premiums, sometimes offer some degree of coverage for out of network rehabs. In most cases, however, Optima Health recommends that clients see providers that are within their network. Going to an in-network rehab is not only more affordable, but it is often a way of guaranteeing a high calibre of care. Optima Health vets each of their in-network providers to ensure that rehabs are meeting contemporary standards of treatment practice.

Optima Health and the Affordable Care Act

The Affordable Care Act is perhaps most well known for dramatically increasing the number of US citizens who have insurance plans. However, it has also changed the way addiction treatment is handled by insurance companies. The ACA, as it is often known, prevents insurance companies from denying health plans to addicts. In the past, insurance companies sometimes argued that addiction was a “pre-existing condition,” which basically means a potentially expensive liability. Today, all insurance companies, including Optima Health, are
legally obligated to provide coverage even to people with severe addictions.

The Affordable Care Act also makes addiction treatment coverage an “essential health benefit.” Not only must insurance companies offer medical insurance to individuals with substance use disorders, they are also legally obligated to offer some degree of addiction treatment coverage. This policy applies to mental health disorders as well. While the exact extent of a specific plan’s coverage depends on a range of factors, anyone covered through Optima Health can expect to receive addiction treatment if they suffer from a substance addiction.

What Does Optima Health Cover For Me?

With so many distinct plan types offered, it can be difficult sometimes to determine exactly which treatments you are covered for. Even once you find out this information, you may still have questions about which rehabs are considered in-network and which ones are out of network. For simple and specific questions, calling your insurance representative is generally the best course of action. Their phone number is listed on the back of your Optima Health insurance card.

However, it is often helpful to have an advocate working on your behalf to help you get the best treatment. NuView Treatment Center staff are available at all times for free and confidential consultations. Our outpatient program is in-network with Optima Health, and we are happy to serve as an intermediary between clients and their insurance providers to help them get maximal coverage. Even in the event that a different kind of treatment program is required, we will help you to answer any question you may have about your health insurance coverage and treatment options. Contact us at (323) 307-7997, and let us help assess your treatment options and connect you to the services you need.

Outpatient Treatment at NuView Treatment Center

NuView Treatment Center is an outpatient rehab located in Los Angeles westside. Our rehab is widely recognized for offering a wide variety of evidence-based treatment modalities. We work diligently to ensure that our clients recover from the devastating consequence of both substance use disorders and the mental health disorders that often accompany them. Combining evidence-based therapies with compassion is, we believe, a recipe for recovery.

At NuView Treatment Center, it is our philosophy that recovery is never a one-size-fits-all process. Instead, we work to construct individualized treatment plans for each client. Our staff understand that all clients have different backgrounds and unique needs. These can range from mental health disorders to problematic and triggering family conflicts. We help clients address every underlying issue, develop new coping skills, and plan out strategies for dealing with potential triggers. At the same time, we help clients develop the life skills they need to live
successful and fulfilling lives in sobriety long into the future.

Outpatient treatment programs at NuView Treatment Center include every level of care, including partial hospitalization programs, intensive outpatient programs, and standard outpatient programs. We also work with clients who are graduating from rehab to set up aftercare treatment plans to ensure long term recovery. NuView Treatment Center’s staff are also experienced when it comes to integrated treatment for dual diagnosis clients, as well as medication-assisted treatment.

If you are covered by Optima Health, NuView Treatment Center is in-network for you. For individuals who are ready to begin their recovery journey, recovery is only a phone call away. Contact NuView Treatment Center today

Frequently Asked Questions

Optima Health requires preauthorization for certain types of addiction treatment services. Preauthorization is the process by which Optima Health reviews the proposed course of treatment to ensure that it meets our medical necessity, quality, and safety standards. To receive approval for treatment, your provider must submit a request to Optima Health outlining the type of care you need. Optima Health will review the request and contact your provider with an approval or denial decision within five business days.

Yes, you can get addiction treatment through your Optima Health Insurance policy without a doctor's referral.  This is because some Optima Health Insurance plans offer out-of-network benefits for addiction treatment. Out-of-network benefits give you the freedom to work with any qualified provider without needing a referral from your doctor. However, if your plan only offers in-network benefits for addiction treatment, then a doctor's referral may be required. To determine the type of coverage you have and if a referral is necessary, it's important to contact Optima Health Insurance directly.  They can answer any questions you may have about your Optima Health Insurance policy and what type of coverage you have for addiction treatment. 

Yes, Optima Health provides coverage for medications related to addiction treatment. The medication covered depends on the plan chosen by the customer. Generally speaking, Optima Health covers most prescription medications and features a Generics First program to encourage its members to use generic medicines first when available. In addition, members can receive help finding lower-cost options for medications not covered in their plan. For specific information about medication coverage, customers should review their plans or contact Optima Health for assistance.

Yes, a case manager is available to help you understand your Optima Health Insurance and its benefits at an addiction treatment center. Case managers provide individualized care, assisting clients in identifying the most appropriate services and resources to meet their goals. They also assist in navigating insurance plans, coordinating with providers and other community organizations, providing information on insurance policies, and helping to ensure that the client’s rights are adhered to. Case managers can provide comprehensive assistance in understanding Optima Health Insurance's benefits, including coverage for mental health services, substance abuse treatments, and outpatient programs. They also help clients understand the pre-authorization process for medical care and other billing services.

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

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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.