Kaiser Permanente is headquartered in Oakland and is one of the nation's most extensive non-profit health plans and it serves over 12 million Americans. The largest membership base the insurance provider has is located in California. The organization is comprised of three parts, the Kaiser Foundation Health Plans, Kaiser Foundation Hospitals, and the Permanente Medical Groups. California Kaiser plans are provided in all of California's 19 pricing regions. Kaiser Permanente provides members with substance use treatment services in California. For example, in Sacramento, the program offers outpatient support and education-focused treatment approaches. Health plan members and their families can access weekly group and educational sessions.
Individual and family counseling are also available as well as self-help meetings. The services are available to Kaiser Permanente members, and no referral is necessary. Since 2014 in the state of California, there have been dramatic declines in the number of uninsured people. Approximately 90% of California residents have health insurance. Medi-Cal is the state Medicaid program and is responsible for most of the health insurance coverage in the state. The insurance marketplace in the state also continues to grow, with numerous California residents enrolling in different insurance plans. However, most of the uninsured Californians lived in low-income households. For example, in 2016, around 2.8 million California residents lacked health insurance.
Ask a Professional
Will my insurance pay for my rehab?
Maybe. Generally, the more severe the person’s addiction is, the more likely an insurance company will pay. The determining factor in getting coverage is if the insurance provider believes you need it. Insurance companies have a team of medical professionals that review all claims submitted. If they disagree that the person needs drug rehab, they don’t pay. All this being said, you must ensure the facility you want to attend accepts your insurance.
How do I know if a drug rehab accepts my insurance?
The easiest way to know if your policy is accepted is to call the treatment facility and give them your insurance information. They will be able to let you know if your insurance is accepted and verify your benefits to provide you with an idea of how much coverage you will get. Another way is to ask your insurance provider for a list of treatment facilities they work with. Doing so can save a lot of wasted phone calls to facilities that don’t accept your policy.
Do all health insurance policies cover drug rehab treatment?
Yes. Between the Mental Health Parity and Addiction Equity Act and the Affordable Care Act of 2010, all insurance providers must offer some form of substance abuse treatment coverage. The level of coverage varies between insurance providers and policies. Generally, more expensive private health insurance policies cover at a higher rate. It’s important to note that treatment facilities may limit the type of policies they accept. Even if your insurance plan has coverage, it may not be taken at the drug rehab you want to attend.
Can I purchase a policy specifically to cover treatment?
Technically, there’s no reason someone can’t purchase a policy specifically to cover their addiction treatment. What makes it challenging is private health insurance companies have developed tactics to prevent people from quickly purchasing a policy to avoid a significant expense like addiction treatment and then dropping the policy afterward. To prevent this financial loss, they only allow people to but policies during a certain period of the year, known as "open enrollment." Open enrollment can be a window as small as a few weeks out of the year, forcing people to wait until that time to get coverage. Other policies have "blackout periods" where major services like substance abuse treatment aren’t yet covered. Blackout periods usually last for one year, meaning the person must pay to keep the policy active for twelve continuous months before it will pay for any portion of an addiction treatment service.
How are Medicaid and private health insurance different?
Medicaid is free health insurance subsidized by each state and offered to qualified residents. To obtain Medicaid coverage, a person must demonstrate financial hardship that prevents them from getting private health insurance. Private health insurance is not free. It is purchased by individuals from insurance companies or may be provided through employment.
The questions from Addicted.org's "Ask a Professional" are answered by Michael Leach, CCMA. If you need further clarification on any of the questions above or have any other questions you can contact him directly at M.Leach@Addicted.org..
What's Next?
After completing a drug rehab in California covered by Kaiser, aftercare support is the next step. It is challenging to know what aftercare should be considered. However, the most common approaches include outpatient programs, sober living homes, sober coaching, or recovery meetings. Many of these aftercare options are available in California. The goal is to help you or your loved one continue the recovery journey.
