For policyholders who are covered by a Presbyterian Health plan, getting quality addiction treatment is not difficult. Presbyterian Health plans provide comprehensive coverage for a wide variety of substance abuse treatment programs, including outpatient programs. Whether you are just beginning to recognize the symptoms of a substance addiction or have long been suffering from drug or alcohol addiction, many treatment options are available. While the specific services that your Presbyterian Health insurance plan offers depend upon your location, needs, and the details of your unique health plan, all plans cover addiction treatment.
Presbyterian HealthCare Services, based in New Mexico, is a private not-for-profit health care provider and health care system. Not only does it operate and manage 8 distinct hospitals throughout New Mexico, it also offers health insurance plans. The Presbyterian Health Plan was first established as an outgrowth of this network of hospitals. Today, it offers coverage that includes these in-network providers as well as many other quality healthcare and addiction treatment service providers.
Naturally, the Presbyterian Health Plan is firmly rooted in the beliefs of the Presbyterian Church. The Presbyterian Church, which includes over 1.7 million members, believe that salvation is a direct gift from God — and that their own deeds and actions have no bearing on whether or not they go to Heaven. Members of the Presbyterian Church work hard to follow their ethical principles. Nonetheless, they recognize that addictions can make it difficult for individuals to be the best versions of themselves. For this reason, they bend over backwards to make sure that members of the Presbyterian Church who suffer from addiction have access to the highest quality levels of care.
What Addictions Does the Presbyterian Health Plan Cover?
The Presbyterian Health Plan does not distinguish one type of substance addiction from another. No matter what drug an individual primarily uses, substance use disorders are all characterized by similar characteristics. With any substance use disorder, an individual will experience a wide range of harms that make it difficult for them to function in everyday life. Moreover, substance use disorders are characterized by a lack of individual control over substance use. No matter how strongly an individual might want to stop abusing drugs or alcohol, they will find it difficult if not impossible to do so. Without outside help, addictions tend to get worse over time.
Substance addictions that the Presbyterian Health Plan offers coverage for include:
- Heroin addiction
- Cocaine and crack cocaine addiction
- Benzodiazepine addiction
- Crystal meth addiction
- Prescription stimulant addiction
- Prescription opioid addiction
- Marijuana addiction
- Alcohol addiction
Treatment Services Covered by the Presbyterian Health Plan
In most cases, addiction recovery requires a range of distinct treatment approaches. As an individual recovers from the most dangerous side effects of their addiction, their treatment needs generally change. For this reason, the Presbyterian Health Plan provides coverage for a diverse range of different treatment services. Many of these treatment services are available at the hospitals and clinics that Presbyterian HealthCare Services runs — but they also provide coverage for many treatment providers that are run by other organizations. Treatment modalities that Presbyterian Health Plan offers coverage for include:
- Medical detox centers
- Outpatient rehabs
- Individual, group, and family therapy
- Inpatient rehab
- Psychiatric services
- Drug testing
- Medication-assisted treatment (MAT therapy)
Presbyterian Health Plan generally arranges an evaluation before agreeing to pay for the above treatment services, except in the case of an emergency when immediate treatment is required. They also offer a wide variety of faith-based addiction treatment programs for members of the Presbyterian Church.
Outpatient Rehab and the Presbyterian Health Plan
Outpatient rehab programs are appropriate for individuals suffering from addiction at all levels of severity. The Presbyterian Health Plan offers comprehensive coverage for outpatient programs. These programs, unlike inpatient rehabs, do not require clients to live or sleep on-site. Instead, clients live at home with their social support systems. As such, outpatient rehabs provide clients with the opportunity to recover and develop sober tools while expanding their lives in the outside world and developing their autonomy. Due to the lack of a residency requirement, outpatient rehab is generally more affordable for insurance companies, as well as offering increased flexibility to clients who have jobs or families.
In a quality outpatient program, clients engage in treatment services once or several times a week. During this time, they take part in a range of evidence-based therapies, including cognitive-behavioral therapy and group therapy. Throughout this process, clients are able to reach a better understanding of their substance use disorders, develop new coping techniques, and learn new life skills to help them better face the challenges of early sobriety.
Outpatient rehabs offer multiple levels of care to meet the needs of individuals suffering from addiction at all levels of severity. Making use of multiple levels of care as one progresses through one’s recovery journey is associated with lower rates of relapse.
Levels of care include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
Presbyterian Addiction Treatment Approaches
The Presbyterian Church provides coverage for scientific and evidence-based approaches to addiction treatment. Nonetheless, they also recognize that policyholders insured through the Presbyterian Health Plan often have an interest in more faith-based approaches. Many rehabs emphasize the principles of 12-step programs, such as Alcoholics Anonymous and Narcotics Anonymous. These programs encourage individuals to rely on a “higher power” of their own understanding, which can mean relying on the support of other people in recovery or on the support of God.
There are also many specific rehab programs that are faith-based by design. These include Celebrate Recovery, which is an approach to the 12-steps that is specifically Christ-centered. A church in Pennsylvania, known as The Presbytery of Redstone, also runs a network for healthcare professionals, pastors, and individuals who have family members with addiction. In this network, they can engage in faith-based approaches to recovery and share their experiences. The Presbyterian Health Plan also has a relationship with The Addictions Ministry Network, which works to raise awareness of the opioid epidemic and helps spread the word about naloxone, a drug that can reverse opioid overdoses and save lives.
It is important to note that even rehabs that are not specifically faith-based are often appropriate and suitable for individuals who have devout faith. The vast majority of rehab programs are non-denominational and open to individuals of all faiths.
Types of Plans with the Presbyterian Health Plan
Individuals who are insured through the Presbyterian Health Plan have a wide variety of specific plans to choose from. All of the plans offered provide coverage for addiction treatment services. However, the extent of such coverage varies from plan to plan. Certain plans also offer broader coverage for out-of-network treatment providers, or reduced out-of-pocket expenses. While the Presbyterian Health Plan offers innumerable different health plans, they can broadly be grouped into four distinct types: HMO, PPO, POS, and Fee-for-Service.
Health Management Organization (HMO)
The Presbyterian Health Plan’s HMO plan requires policyholders to pay a monthly premium to receive health coverage. Their HMO plans require clients to select a primary care physician who is responsible for overseeing their treatment needs. Clients work with a finite network of healthcare providers, and their primary care physician helps coordinate their treatment needs.
Preferred Provider Organization (PPO)
PPO plans with the Presbyterian Health Plan are similar to HMOs in that clients work with a finite network of treatment providers. Attending an in-network costs considerably less than working with an out of network treatment provider. Clients are responsible, however, for paying copays in most cases. Unlike an HMO, however, clients have the flexibility to choose out of network providers, though their out-of-pocket expenses will be higher.
Point-of-Service Plans (POS)
Point-of-service plans are offered by some of Presbyterian Health Plan’s HMO-based plans. With a POS plan, a client’s costs will be covered when their provider refers them outside of the HMO network. Clients, however, must have a referral in order to be covered; in the event of a self-referral, they will likely be responsible for coinsurance fees or be denied coverage entirely.
Presbyterian Health Plan’s Fee-for-Service plans are often considered more traditional plans. They allow policyholders to purchase the plan and then see a doctor at any facility whatsoever. These plans do not make a distinction between in-network and out of network providers. While they offer a great deal of flexibility, these plans can be somewhat pricier than alternatives.
The Presbyterian Health Plan and the Affordable Care Act
The Affordable Care Act regulates health insurance practices throughout the United States. Not only has its insurance requirement raised the number of Americans who have access to health insurance, but the legislation has also altered the way addiction treatment is handled by insurance companies. Along with other healthcare providers, the Prebsyterian Health Plan is legally obligated to provide addiction treatment coverage as an “essential health benefit.” Addictions and mental health disorders can also not be categorized as pre-existing conditions, or pretexts for denying individuals health insurance. This ensures that anyone who has health insurance in the United States, including people insured through the Presbyterian Health Plan, can get access to addiction treatment services if they need them.
What Does the Presbyterian Health Plan Cover For Me?
The Presbyterian Health Plan offers a wide variety of health plans with excellent addiction treatment coverage. However, the details of each plan are distinct. For people who are covered by the Presbyterian Health Plan, as with any insurance company, it can be difficult to determine exactly what types of treatment services are in the network and what expenses one will be responsible for paying. If you already have a good idea of what your treatment goals are, you can generally get answers to specific questions by calling the phone number listed on the back of your insurance card.
In many cases, however, people who suffer from addiction often feel lost and confused while navigating the ins and outs of their healthcare coverage. It can help to have an advocate tirelessly working on your behalf. The staff at NuView Treatment Center, an in-network outpatient rehab in Los Angeles, have a strong relationship with the Presbyterian Health Plan. We utilize our experience in addiction treatment and our working knowledge of the health insurance industry to help you get the services you need at the lowest possible expense to you. Whether you want to attend or in-network outpatient rehab or require another kind of treatment program, we can help evaluate your coverage and connect you to the services you need. Contact us at (323) 307-7997 for a free and confidential consultation.
Outpatient Addiction Treatment at NuView Treatment Center
NuView Treatment Center, located in West Los Angeles, is a modern outpatient rehab that specializes in the latest evidence-based treatment modalities. It is our goal to help clients of all backgrounds develop the skills and coping tools they need to get sober, stay sober, and live fulfilling and joyful lives in sobriety. We work with individuals of all faiths and circumstances. It is our belief that evidence-based treatment tools and compassion can help anyone make a full recovery, regardless of the severity of their addiction.
We firmly believe at NuView Treatment Center that recovery is not a one-size-fits-all process. Our highly trained staff devise individualized treatment plans for every client to help them address their underlying issues, which range from mental health disorders to interpersonal communication problems. Clients utilize behavioral therapy to better understand themselves, learn to cope with their unique set of triggers, and connect to a strong social support system. They also work to develop new life skills so that they can meet the challenges of early recovery and begin living full lives without needing to resort to drugs or alcohol.
Outpatient programs at NuView Treatment Center cover all levels of care, from partial hospitalization programs and intensive outpatient programs to standard outpatient programs. We work with individuals who are graduating from acute residential rehabs to ensure that they get long term support as they rebuild their lives in recovery. NuView Treatment Center also offers aftercare planning services so that residents feel supported long after they have left our center.
If you are ready to let go of drug or alcohol addiction and begin a new way of life, contact NuView Treatment Center today. Our rehab is in-network with the Presbyterian Health Plan, and we can help coordinate your treatment plan with your healthcare provider.
Frequently Asked Questions
Presbyterian insurance covers addiction treatment that is medically necessary and is provided by a licensed healthcare provider in their network. Treatment must be prescribed for a specific diagnosis according to the insurer's medical policies, which can vary depending on the plan. To qualify for coverage under Presbyterian Insurance, treatment programs must meet certain criteria, including:
- The program must be licensed by the state in which it is located
- The program must have an agreement with Presbyterian Insurance and accept their terms of payment
- A physician’s prescription or referral is required to receive treatment
- Treatment must follow evidence-based practices that the insurer approves
- Services provided must meet the insurer's criteria for medical necessity
- Treatment must be provided in an appropriate setting that meets regulatory standards
- The treatment provider must document the individual’s progress with periodic reports
Yes, there may be additional costs associated with addiction treatment through Presbyterian Health. These could include co-payments for counseling sessions, medication management services, or other specialized care. Depending on your insurance plan and the type of services you need, these costs may vary. You should contact your insurance provider to determine what specific coverage is available for addiction treatment.
Yes, Presbyterian Health provides coverage for medications related to addiction treatment. Members of the health plan can access a variety of prescription drugs to help treat substance use disorder and other addictive behaviors. In addition, certain types of counseling and therapy may also be covered under Presbyterian Health's health plans depending on the specifics of each member's situation. The team at Presbyterian Health is committed to helping members find the resources they need to manage their treatment, including medications. Please contact a Presbyterian Health customer service representative to learn more about the types of coverage available for addiction treatment and related medications. They can provide further information about specific types of coverage and help you determine if your health plan includes medication or other treatments that may benefit you.
Yes, Presbyterian Health Insurance offers case management services at addiction treatment centers. Case managers are dedicated professionals who can provide you with personalized assistance in navigating the complexities of healthcare coverage and understanding your plan benefits. They help to ensure that you have access to the best possible resources for recovery, including identifying appropriate care settings, insurance coverage eligibility, and benefit utilization.
At NuView Treatment Center, we accept most major health insurance plans. To find out if your specific Presbyterian 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.