If you or a loved one suffers from a drug or alcohol addiction, it is crucial to enroll in a quality addiction treatment program. Left untreated, substance use disorders generally become progressively worse. However, clinical addiction treatment programs can help a person free themselves from the obsessive desire to abuse substances. Moreover, clinical treatment programs provide copious support for individuals working on rebuilding their lives in sobriety. For individuals who are insured through Simplan, quality addiction treatment is affordable and very accessible.
Simplan provides a diverse range of plans through national and regional PPO networks. It is Simplan’s goal to make quality insurance plans accessible and as simple as possible. Simplan has partnerships with a wide variety of networks, ensuring that individuals with mental health conditions and substance use disorders can get the treatment they need.
Addictions Covered by Simplan
Simplan’s health insurance plans all provide coverage for drug and alcohol addiction treatment. No matter what drug a person is addicted to, treatment is available. Simplan does not differentiate between different types of drug addictions. Receiving a diagnosis of a substance use disorder is sufficient to become eligible for treatment. Drug addictions covered through Simplan include:
- Benzodiazepine addiction
- Prescription stimulant addiction
- Heroin addiction
- Alcohol addiction
- Prescription opioid addiction
- Crystal meth addiction
- Marijuana addiction
Treatment Services Available
While all plans with Simplan health insurance provide benefits for addiction treatment, the services offered can vary. Most plans, however, cover a variety of distinct addiction treatment services. Simplan recognizes that addiction recovery is a multi-step process, and individuals in recovery generally have changing needs as they progress in their sobriety journeys. While it is not possible to state with any certainty what all plans cover, the vast majority of Simplan plans are likely to provide benefits for the following common addiction treatment services:
- Outpatient rehab
- Inpatient rehab
- Individual therapy, group therapy, and family therapy
- Medication management
- Psychiatric services
- Medication-assisted treatment (MAT), including methadone and Suboxone
- Opioid overdose reversal medications (naloxone)
How Much Will I Have to Pay with Simplan Coverage?
The amount of money that a policyholder is expected to pay depends upon their specific health plan with Simplan. Other important factors that can determine their coverage include their location, the severity of their substance use disorder, and the specific treatment center they utilize. Plans vary considerably in terms of their level of coverage. More comprehensive plans tend to have higher monthly premiums, but policyholders benefit from paying fewer out-of-pocket fees. Less comprehensive plans may be cheaper, but treatment may require some out-of-pocket expenses.
In many cases, clients may not have to pay any fees whatsoever. However, when policyholders do pay fees, they are generally limited to three types: deductibles, copays, and coinsurance. Most plans with Simplan have a deductible. Deductibles vary from plan to plan; they represent a quantity of money that the policyholder must pay on their own before their insurance plan will begin covering expenses. After the deductible is met, Simplan will begin footing the bill. Copays and coinsurance fees, however, are often expected when a person receives a specific treatment. Copays are flat fees, while coinsurance fees represent a small percentage of the cost of treatment.
Arguably the best way of reducing out-of-pocket expenses is attending a treatment center that is within Simplan’s approved network. While some Simplan plans provide out-of-network coverage, this coverage is rarely as comprehensive as in-network coverage. In-network rehabs have been pre-approved by Simplan and are guaranteed to meet contemporary standards of quality. Simplan maintains a working relationship with in-network providers, which allows them to provide the fullest possible coverage. By attending an in-network rehab, such as NuView Treatment Center, policyholders can keep their expenses low and ensure that Simplan will cover the majority of the costs associated with addiction treatment.
Outpatient Rehab with Simplan
Outpatient rehab is generously covered by the vast majority of Simplan insurance plans. Outpatient rehab is a type of treatment center that clients attend without having to live on site. Unlike residential treatment programs, clients are under no obligation to uproot themselves. This makes outpatient treatment centers very flexible. These programs are often recommended to individuals who are working on rebuilding their lives in the outside world. They can be useful transition programs for recent graduates of more acute inpatient treatment programs. Moreover, they are essential resources for people with busy work or family lives who require flexible treatment.
Outpatient rehabs make use of a diverse range of therapeutic methods and treatment modalities to help clients recover from drug or alcohol use disorder. It is common for outpatient treatment programs to offer group therapy, skills training, and individual therapy like cognitive behavioral therapy. Outpatient rehabs are clinical treatment centers that employ physicians, so they are also capable of prescribing medications and making use of medication-assisted treatment. These programs provide copious support as clients rebuild their lives and develop the skillset they need to maintain long-term sobriety.
A variety of outpatient treatment programs are available to meet the needs of different clients. Outpatient rehabs recognize that addiction is a spectrum condition, and individuals who suffer from substance use disorders at different levels of severity have different needs. More acute treatment programs meet more frequently and provide more hands-on support, while less acute programs work to build clients’ autonomy. Levels of care offered by outpatient rehabs include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
It is worth noting that many clients progress from one level of care to another as they progress in their recoveries. In fact, doing so is likely to significantly reduce the likelihood of relapse. Studies show that the longer a person stays involved in a clinical addiction treatment program, the lower their chances of relapse become. Fortunately, because outpatient programs have no residency requirement, they are often very affordable. As such, health insurance plans with Simplan often provide generous long-term coverage.
Simplan Insurance and the Affordable Care Act
Simplan operates in the United States and, like other American insurance companies, it follows the guidelines set forth by the Affordable Care Act. The Affordable Care Act, or ACA, stipulates that addiction treatment is an essential health benefit. In practice, this means that all health insurance plans are legally obligated to offer benefits for addiction treatment. While the nature of the specific benefits a particular plan offers varies considerably, no one with addiction can be left behind.
The Affordable Care Act not only makes addiction treatment an essential health benefit. It also provides the same guarantee for mental health treatment. This is of paramount importance for people with addiction, given that roughly 50% of addicts suffer from one or more comorbid mental health disorders. These conditions, which range from depression and anxiety to ADHD and OCD, can drive a person to abuse drugs and alcohol if left untreated. For dual diagnosis clients, getting simultaneous care for all comorbid conditions is essential for preventing relapse. Fortunately, Simplan offers coverage for outpatient treatment centers that provide integrated treatment, including NuView Treatment Center.
What Does Simplan Cover For Me?
Determining what benefits you are entitled to can be confusing. You may recognize a need for addiction treatment, and you may be well aware that Simplan offers coverage for addiction treatment — but you might still be shaking your head in confusion. What will your out-of-pocket expenses be? Which treatment services are you eligible for? How long will you be covered for addiction treatment? Which rehabs are considered in-network? Calling your health insurance representative can be a good resource for answers to general questions, but it is even more helpful to get an advocate who will fight to get you the treatment you need.
NuView Treatment Center, an in-network outpatient rehab, can work on your behalf to set up your treatment plan with Simplan. Our staff will conduct a preliminary evaluation to determine your treatment needs, after which we will work with your insurance company to ensure your treatment is covered as comprehensively as possible. We have a long-standing working relationship with Simplan and understand the ins and outs of health insurance plans. Even if our outpatient program is not suitable for you at the present moment, we will ensure you are connected to an appropriate treatment program that meets your individual needs. Contact us today at (323) 307-7997 to set up a free and confidential consultation.
Outpatient Rehab at NuView Treatment Center
NuView Treatment Center, located in West Los Angeles, is an outpatient rehab that specializes in evidence-based addiction treatment. Our modern facilities employ highly trained staff who are committed to helping people in need. We work with clients from all backgrounds to ensure that they develop the coping skills and tools that they need to get sober, stay sober, and lead fulfilling lives in sobriety.
We believe that compassion and individualized attention are essential ingredients for successful addiction treatment. At NuView Treatment Center, we never use a one-size-fits-all approach to addiction treatment. Instead, our staff creates individualized treatment plans for clients that are designed to address their unique underlying issues. We recognize that each person has a distinct background and a unique story to tell, and we take into account clients’ goals, strengths, and weaknesses while formulating a treatment plan.
NuView Treatment Center offers every level of care. Our outpatient rehab is suitable for all severities of addiction. Programs offered include partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning services. Whether you are struggling to function as a result of your addiction, or simply feeling unfulfilled in early sobriety, we are here to help.
NuView Treatment Center is in-network with the vast majority of Simplan health plans. If you are ready to make a change, contact us today.
Frequently Asked Questions
Simplan preauthorization is a process where addiction treatment providers submit requests to Simplan for approval of services. The request includes details on the patient, diagnosis, and proposed care plan. Simplan then reviews the request against its criteria and either approves or denies coverage. If approved, Simplan provides a unique preauthorization number that must be used when billing for services.
The process, in its entirety, will take 7-10 business days. During that time, Simplan will evaluate the request, provide feedback to providers and patients, and issue a preauthorization number. The preauthorization process ensures that appropriate treatments are provided while protecting patients’ financial responsibility concerning their coverage plan.
Yes, there may be co-payments or additional costs associated with the treatment that are not covered by your insurance plan. It is important to understand what is and isn't covered in order to make an informed decision about your care.
Yes, Simplan provides coverage for medications related to addiction treatment. Depending on the plan, individuals may be covered for any medications approved by the U.S. Food and Drug Administration (FDA) prescribed or recommended by a plan-approved provider to treat substance use disorders, including opioid and alcohol dependence. In addition, Simplan covers FDA-approved medications to prevent and treat side effects of addiction, such as nausea and vomiting. Furthermore, Simplan covers certain over-the-counter medications deemed medically necessary by the prescribing doctor or another qualified provider to treat a substance use disorder.
To ensure individuals get the best possible care, Simplan works with healthcare providers to provide access to the most appropriate medications for addiction treatment. Simplan also provides coverage for long-term, ongoing maintenance therapies such as Vivitrol or Suboxone for individuals who have been prescribed this type of therapy by a qualified provider.
Yes, most addiction treatment centers have case managers who can help you understand your Simplan Insurance policy and the associated benefits. Case managers will work with you to review your insurance coverage and benefits so that you know what services are covered by your plan and which ones are not. They will also assist in identifying any additional coverage that may be available and resources you may be eligible for. Case managers ensure that the treatment plans are tailored to each individual's unique circumstances so that you can get the most out of your Simplan Insurance policy. Your case manager will also help to coordinate care with other providers and facilities if needed.
At NuView Treatment Center, we accept most major health insurance plans. To find out if your specific Simplan Insurance 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.