Kaiser Permanente provides coverage for drug and alcohol addiction treatment. Learning about the different coverage options your plan provides is the first step to getting help for you or a loved one.

Getting help for a substance use disorder often begins with deciding which treatment center to attend and learning how much your insurance policy will cover. There are many different drug and alcohol treatment options to consider, all of which will come with different costs and for which your insurance plan will provide different levels of coverage.

Kaiser Permanente is a major private insurance carrier available in many states that offers coverage for common treatment programs for substance use disorders.

Using Kaiser Permanente Insurance For Alcohol And Drug Rehab

Kaiser Permanente is one of the nation’s largest multispecialty insurance groups and prides itself on its expert care teams that span across many different medical specialties. This provider offers high-quality, comprehensive care at affordable rates to provide health insurance to as many people as possible.

Kaiser offers coverage in eight states—Colorado, California, Hawaii, Washington, Oregon, Georgia, Maryland, and Virginia—as well as the District of Columbia. Healthcare is offered to both employers and individuals as well as Medicare coverage for individuals over the age of 65.

Thanks to the 2008 Mental Health Parity and Addiction Equity Act, substance abuse and mental health services are now covered just as extensively as other medical services under insurance plans. This means that if, for example, your insurance plan will pay for part of a hospital stay, then it will also cover part of an inpatient drug and alcohol rehab program.

What’s more, the Affordable Care Act protects those people with pre-existing conditions, such as a substance use disorder, from being denied coverage. This means that even if you are already suffering from a substance use disorder, you can still get Kaiser Permanente insurance and seek treatment.

If you have Kaiser Permanente insurance either through your employer or privately, you can rest easy knowing that this provider offers coverage options for substance use disorders and mental health under all of its plans. What is covered specifically will depend on the type of plan you have with Kaiser.

How Much Will Kaiser Permanente Insurance Cover For Addiction Treatment?

In order to understand how much Kaiser will cover for drug and alcohol programs, you’ll need to understand three basic insurance terms:

 

  • Deductible—the amount of money you will need to pay each year before Kaiser will pay anything. Because your deductible must be met each year, it’s important to schedule your treatment in such a way that you don’t have to meet your deductible twice (i.e. treatment that starts and ends in two different years will require you to meet two different yearly deductibles).

 

  • Copay/coinsurance—a percentage or flat fee that you will pay for each visit, treatment, or day of a stay at a drug rehab facility. For example, if you’re in an inpatient rehab program, you may need to pay $185/day with Kaiser picking up the rest. Or, Kaiser may pay 80 percent of a certain type of treatment and you pay the remaining 20 percent.

 

  • Maximum Out-of-Pocket—Most Kaiser plans will have a maximum out-of-pocket expense to you. Once you’ve reached this amount, they pay covered services at 100 percent.

The percentage of coverage that you receive will depend on the particular plan you have with Kaiser, but the overall cost of treatment will depend on the rehab facility you choose to attend. If a rehab program costs $10,000 for a 30-day stay, and Kaiser covers 80 percent of treatment, you will be responsible for paying $2,000. However, if a 30-day rehab program costs $40,000, and Kaiser covers 80 percent, you will be responsible for $8,000.

This is something to keep in mind when deciding on which rehab facility to attend. Certain rehab facilities may provide payment options for your out-of-pocket expense, including sliding-scale payment plans, individual grants, access to scholarships, or personal financing.

Prior Authorization Requirements For Kaiser Permanente Insurance Plans

All non-emergency outpatient and inpatient services require an authorization from Kaiser prior to the start of treatment. This is to ensure that only covered and medically necessary treatments are performed to avoid unexpected bills after the fact.

Do Rehab Centers Need To Be In-Network For Kaiser Coverage?

Kaiser Permanente offers coverage in certain regions in each state that are considered in-network, and this is where you will find the most sufficient coverage options for drug and alcohol addiction treatment.

Additionally, employers offering Kaiser Permanente may provide group plans that include discounts for out-of-network services. Out-of-network care will require a higher out-of-pocket fee for the individual.

Kaiser Permanente group plan options offered by some employers may include:

 

  • Preferred Provider Organization (PPO): This is often considered the best plan and provides out-of-network coverage that allows individuals under the plan to receive treatment outside of a Kaiser region at a reduced cost. Out-of-network coverage under the PPO plan with Kaiser is provided through Private Healthcare Systems (PHCS).

 

  • Out-of-Area: This is a plan option that also lets individuals receive out-of-network coverage through PCHS.

 

  • Point-of-Service (POS): This is a group plan option that combines a PPO plan with a health maintenance organization (HMO) plan and offers a great amount of flexibility. Individuals can select from three different tiers of coverage that include in-network, out-of-network, or care through a PHCS provider.

 

  • Customer-Directed Health Plan: Under this plan, individuals may pay more for treatment but are offered a tax-free health savings account (HSA) or a flexible savings account (FSA) to help pay for healthcare fees. Employers may also provide a reimbursement for employee healthcare costs through a Health Reimbursement Arrangement (HRA).

Most individual plans offered through Kaiser are HMOs and require individuals to go through in-network providers to receive coverage. Some plans may cover part of out-of-network care.

Addiction Treatment Services Covered By Kaiser Permanente

Kaiser Permanente puts great importance on quality care for those suffering from addiction. They see it as a contribution to their member’s overall health as well as a contribution to society as a whole to provide the resources needed to recover from a substance use disorder.

Outpatient Rehab Treatment Covered By Kaiser

Kaiser covers many aspects of drug and alcohol addiction treatment, starting with the initial diagnosis. The following are outpatient treatment services typically covered under an insurance plan with Kaiser.

 

  • Diagnosis—Some people choose to see their primary care physician before deciding which form of treatment to pursue. During this phase, you’ll see your PCP and possibly other doctors who will ask questions, observe and run tests to determine the severity of your addiction, and recommend the best course of treatment. They will then write a doctor’s order (prescription) for the treatment. Kaiser will cover diagnosis.

 

  • Drug Replacement—In this therapy, your drug of choice is replaced with a more manageable, “less harmful” drug. Over time the doctors then lower the dosage to slowly reduce the dependency. This is covered by Kaiser. They don’t, however, cover methadone maintenance in which the drug of choice is replaced with little or no intention of lowering the dosage over time. Because Kaiser considers this method to be harm-reduction without healing, they choose not to cover it.

 

  • Outpatient Rehab Programs—Outpatient drug and alcohol treatment can be in the form of intensive outpatient or regular outpatient programs. Both programs include similar treatments like counseling, educational classes, and group therapy. Intensive outpatient treatment requires individuals to go to the facility many days of the week, while regular outpatient programs may require only one or two days a week. Kaiser covers outpatient rehab programs and often requires this to be the first course of action for a substance use disorder before covering additional forms of treatment, such as inpatient rehab programs.

Inpatient Treatment Services Covered By Kaiser Permanente

The following inpatient drug and alcohol addiction services are typically covered under a Kaiser insurance plan. What is covered will depend on your individual plan.

 

  • Medical Detox—This is a hospital stay during which you are under the care of medical professionals while you eliminate substances from your system. Kaiser typically provides coverage for medical detox services, which provides a safe and effective way to withdraw from drugs or alcohol comfortably.

 

  • Inpatient Rehab Programs—Inpatient rehab programs can be in the form of a traditional hospital stay or in a setting that is more home-like, while removing your access to substances. During your stay, you work with psychiatrists, counselors, teachers, therapists, and nurses to learn how to manage your addiction. Kaiser covers inpatient rehab programs only after you have tried outpatient services.

If you need additional assistance understanding what your individual Kaiser plan covers, working through financial barriers, or finding effective and respected facilities in your area, call our free, confidential helpline to talk with a compassionate and knowledgeable professional.

Identifying Your Kaiser Permanente Insurance Coverage

To get the most out of your Kaiser coverage, you’ll first need to understand your network.

If you have a Kaiser HMO plan, you will have a select group of medical providers and facilities to choose from. You will have a primary care physician (PCP) you must see first. This PCP will then refer you to in-network specialists and treatment centers as needed. If you choose not to see your PCP or you decide to go out of your Kaiser Network, Kaiser may not pay anything for your visits and addiction treatment.

If you have a Kaiser PPO or POS plan, you will still have a preferred network, but you can go out of network if you choose, however, Kaiser will require you to pay a larger portion of the bill.

The most cost-effective way to use Kaiser Permanente Insurance is to always to stay within the network of providers. If you feel you will get greater benefit from an out-of-network treatment program, you will need to weigh the cost versus the benefit.

Contact us to learn more about using Kaiser Permanente for drug and alcohol rehab treatment.

 


Sources

Kaiser Permanente2015 Individual Plan Membership Agreement and Evidence of Coverage for Kaiser Permanente for Individuals and Families, Health Insurance Exchanges: What You Need To Know