Does the Prominence Health Plan Offer Addiction Treatment Coverage?
Substance use disorders are legitimate and quite serious mental health conditions. By definition, an individual suffering from drug or alcohol addiction is unable to control or manage their substance abuse without outside help. With a quality addiction treatment program, however, making a full recovery is possible. For individuals who are insured through the Prominence Health Plan, addiction treatment is broadly covered. However, the types of services available and the expenses that policyholders are responsible for paying depend upon their location and the specific plan they have.
Prominence Health Plan
The Prominence Health Plan offers insurance primarily to individuals, families, businesses, and communities in Nevada and Texas. Not only do they offer many individual plans, but they are widely recognized for their comprehensive employer-based plans. Prominence Health Plan is a subsidiary of Universal Health Services, Inc. UHS, as it is sometimes known, is one of the United States’ largest providers of healthcare and hospital services. As such, Prominence Health Plan is able to provide an extensive network of treatment providers to their members.
Addiction Treatment with Prominence Health Plan
Prominence Health Plan offers coverage for a wide variety of alcohol, drug, and mental health problems. Their vast network of treatment providers include specialists and specialty rehabs designed to treat specific substance abuse problems and varying levels of care.
Prominence Health Plan does not make distinctions between different types of addictions in terms of their coverage, however. No matter what substance an individual is addicted to, they can expect to receive coverage from Prominence. Addictions covered 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
Services Offered by Prominence Health Plan
Prominence Health Plan recognizes that addiction treatment is generally a long term process that requires the utilization of multiple treatment modalities. With that in mind, they offer broad coverage for a diverse range of addiction treatment programs. In most cases, policyholders must be assessed to determine which type of program is right for them. Doing so helps ensure maximum coverage from Prominence Health Plan.
Treatment programs covered by Prominence Health Plan include:
- Medical detox centers
- Residential or inpatient rehab
- Outpatient rehab
- Individual therapy, group therapy, and family therapy
- Drug testing and drug screening
- Psychiatric services
- Psychological testing
- Medication-assisted treatment (MAT)
Types of Plans Offered by Prominence Health
Prominence Health Plan has many plans available for individuals of different financial means. While all of their plans provide coverage for addiction treatment, the out-of-pocket expenses and out of network coverage vary from plan to plan. Most Prominence Health plans can be broadly grouped into the following four categories: HMO, PPO, POS, and HMO Freedom plans.
Prominence’s HMO plan helps people obtain easy and comprehensive care from in-network facilities and specialists. Policyholders do not need a referral to see a specialist or enroll in a rehab.
Prominence Health Plan’s PPO plans are notable for having lower out-of-pocket costs when members make use of in-network providers. These plans also offer policyholders the flexibility to use out-of-network providers if they so choose.
POS plans with Prominence Health Plan offer a middle ground between PPOs and HMOs. They feature the low out-of-pocket expenses associated with HMOs, the choice of a PPO provider, and the flexibility to make use of both in-network and out-of-network healthcare providers.
The HMO Freedom plan is unique to Prominence. These flexible programs offer out-of-network coverage as well as out-of-area coverage.
Outpatient Care Through Prominence Health Plan
Prominence Health Plan offers especially comprehensive coverage for outpatient programs. Outpatient rehabs are a type of addiction treatment program where individuals receive treatment services once or several times a week. Unlike inpatient rehabs, clients do not live on-site. Clients have the flexibility to live alone, with their families, or in a sober living home. This allows clients with busy work or family lives to easily access treatment services. For individuals with severe addictions, it allows them to develop their lives in the outside world and practice coping skills while receiving weekly or daily support.
Outpatient rehabs are recommended both to individuals who are just getting sober for the first time as well as recent graduates of more acute addiction treatment programs, such as inpatient rehabs. Because outpatient programs are flexible and less intensive than residential programs, they serve as excellent bridges between more acute programs and the outside world, allowing clients to make a gradual and comfortable transition as they develop increased autonomy.
Outpatient treatment is suitable for a wide variety of addiction severity levels. Levels of care covered by Prominence Health Plan include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
How Much Will Treatment Cost with Prominence Health Plan
The expenses associated with addiction treatment are lower for individuals covered by a comprehensive health plan such as Prominence. However, the exact expenses an individual is responsible for paying depend upon the nature of their specific health plan. The most common out-of-pocket expenses that people are required to pay are deductibles, copays, and coinsurance.
A deductible is a set amount of money that an individual is required to handle on their own before their health insurance begins covering treatment costs. Deductibles vary from plan to plan, with cheaper plans often having higher deductibles.
Coinsurance and copays are fees that individuals pay when they receive services. Coinsurance is a percentage of the cost of treatment, whereas a copay is a pre-set fee that an individual pays when they receive a service. Again, cheaper plans often have higher copays and coinsurance costs, while more costly and comprehensive plans often require fewer out-of-pocket payments.
The cost of addiction treatment with Prominence Health Plan also depends upon the specific rehab or health service provider that a policyholder uses. In general, Prominence Health Plan offers less coverage for those seeing out of network providers, and in some cases no coverage whatsoever. Again, this depends upon the specific plan that an individual has. For individuals who make use of in-network rehabs, such as NuView Treatment Center, however, the cost to the policyholder is minimal or nonexistent.
Medication-Assisted Treatment with Prominence
Prominence provides coverage for medications prescribed by a physician. Clinical addiction treatment centers, including outpatient rehabs, employ physicians who often prescribe medications. In some cases, these medications are prescribed to treat a co-occurring physical or mental health disorder. Addressing comorbid mental health disorders is critical in addiction treatment, since roughly 50% of people with addiction suffer from mental health disorders as well. More often than not, both conditions are mutually reinforcing. Prominence Health Plan recognizes this and provides coverage for mental health treatment to the same extent as addiction treatment.
Medications are also sometimes prescribed in the context of a medication-assisted treatment (MAT) plan. MAT therapy is an addiction treatment modality that combines elements of behavioral therapy with pharmaceutical interventions. This is especially common for people who suffer from alcohol or opioid addiction. Medications, such as Suboxone and methadone, can reduce the severity of withdrawal symptoms as well as cravings. By engaging in MAT therapy, clients can improve their chances of staying involved in their outpatient program long enough to develop the coping tools they need to stay sober over the long term.
Prominence Health Plan and the ACA
Prominence Health Plan adheres to health insurance laws in the United States as outlined by the Affordable Care Act. The Affordable Care Act ensures that no one who suffers from addiction can be denied coverage on the basis that they have a pre-existing condition. Before the passing of the ACA, healthcare companies commonly denied individuals coverage on the basis that their addiction was a potentially expensive liability.
The Affordable Care Act also requires health insurance companies like Prominence Health Plan to offer addiction treatment coverage. Addiction treatment coverage, as well as mental health services, are both now considered “essential health benefits.” As such, even though the details of specific health plans vary from one to another, all health insurance plans with Prominence offer some degree of addiction treatment — as well as integrated care for dual diagnosis individuals with comorbid mental health disorders.
What Does Prominence Cover For Me?
Navigating the ins and outs of a health insurance plan can be difficult for anyone. It is all the more difficult for people living in the fog and uncertainty of active substance addiction. The process of getting approved for treatment, or finding an in-network rehab, or even determining what the out-of-pocket expenses will be, can seem intimidating. With so many plans available, reading a single article online is unlikely to answer all of a person’s questions. It is often best to call the number on the back of your health insurance card if you have specific questions about your coverage; your health insurance representative can likely answer them.
For most people however, it is best to have an advocate working tirelessly on your behalf. The staff at NuView Treatment Center have years of experience working with insurance companies, including Prominence. If you are interested in addiction recovery but unsure what your options are, give us a call today at (310) 984-1730. During your free and confidential consultation, a NuView Treatment Center staff member will help assess your needs and determine your treatment options. Our outpatient program is in-network with Prominence Health Plan, but even if our program isn’t suitable for you, we will strive to connect you to whatever services best fit your needs.
Recover Today at NuView Treatment Center
NuView Treatment Center is an outpatient rehab in West Los Angeles. Our modern facility is designed to help individuals suffering from addiction at all levels of severity. Our staff members are trained and up to date with the latest evidence-based therapies and treatment modalities. We are a compassionate, open-minded, and diverse facility — and we recognize that addiction treatment is not one-size-fits-all.
Emphasizing compassion above all, our staff develop individualized treatment plans for each client. It is our goal to help clients not only get sober, but work with them to build up stable and fulfilling lives in sobriety. By making use of multiple evidence based therapies, such as group therapy and CBT, we help clients address underlying issues, develop plans for dealing with common triggers, and face the challenges of early recovery. At NuView Treatment Center, we offer long term support, including aftercare planning for graduates.
Our comprehensive outpatient facility allows clients to progress from more acute levels of care to less acute ones as they become more confident and independent in their newfound sobriety. Our programs include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs
- Aftercare planning
If you are ready to let go of old habits and start your recovery journey, contact NuView Treatment Center today. Our facility is in-network with most Prominence health plans.