What Type of Drug Treatment Program Accepts Humana Health Insurance?

Content Overview

I have Humana health insurance. What kind of drug treatment program can I use?

Humana is one of the largest health insurance providers in the country. As a result, its network of approved providers is vast. Coverage is dependent on the type of plan you have purchased and the area in which you live. It is best to call Humana directly before you enroll in any treatment program, but your substance abuse provider may be willing to handle that call for you.

One of the larger medical insurance providers in the United States, Humana recently announced a merge with Aetna that, according to Business Wire, will bring the number of covered individuals to 33 million.

With a wide range of services ranging from Medicare to individual medical, dental, pharmacy, and vision plans to group healthcare coverage provided through employers, Humana is a large and technologically advanced company with many health insurance options to choose from.

Humana has a comprehensive prescription drug program that includes the Humana Pharmacy (previous called RightSource) that can mail prescriptions directly to patients, and a partnership with Walmart for pharmacy services as well. With a website full of resources and even an app to provide access to healthcare information on a mobile device, Humana is a client-centered provider.

The National Survey on Drug Use and Health (NSDUH) reported that in 2013, only about 10 percent of the almost 23 million Americans over the age of 12 who needed treatment for an alcohol or drug abuse problem or dependency received the care they required. Many who desired treatment cited lack of healthcare coverage or finances as a barrier to their potential treatment. The Affordable Care Act (ACA) sought to change that by improving coverage for more Americans and enhancing the Mental Health Parity and Addiction Equality Act (MHPAEA) of 2008 by making substance abuse and mental health treatment akin to other medical services, like surgical procedures, and opening up this coverage to more people.

An innovative and diverse company providing health insurance to families, self-employed individuals, military members, and senior citizens, Humana offers several insurance plans that at least partially cover mental health or substance abuse treatment services.

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Types of Coverage

insurance coverage There are several types of individual medical insurance plans on the market; the most common are likely preferred provider organizations (PPOs) and health maintenance organizations (HMOs). A Humana PPO may be more flexible than an HMO, allowing individuals to seek care without a referral both in-network and out-of-network. An HMO requires that you designate a specific primary care physician (PCP) and see only in-network providers. HMOs typically have lower monthly premiums than PPOs, and using an out-of-network provider with a PPO is likely to incur higher out-of-pocket expenses. Coverage and plans may differ depending on where a person lives and can be different in different states.

Currently, Humana provides plans and coverage for individuals in the following states:

  • Florida
  • Wisconsin
  • Illinois
  • Indiana
  • Louisiana
  • Kentucky
  • Ohio
  • Tennessee
  • North Carolina
  • Virginia
  • Nevada
  • Arizona
  • Missouri
  • Colorado
  • Mississippi
  • Georgia
  • Michigan
  • Kansas
  • Texas
  • Utah

Group and Individual Medical Plans

Group insurance is generally purchased through an employer and offered to employees during specific enrollment periods. Some employers may pay part of the monthly premiums while others may deduct them directly from an employee’s paycheck.

Group medical plans offered from Humana through employers include:

  • PPOs: These have higher monthly costs with lower deductibles, meaning fewer out-of-pocket fees and more flexibility to see in-network and out-of-network providers, although using out-of-network providers usually means higher fees across the board.
  • HMOs: There are two main types: Open Access and Traditional, with the Open Access allowing individuals to seek treatment from any HMO network provider for slightly higher monthly premiums. Traditional HMOs are typically cheaper, and individuals have all care coordinated through one PCP.
  • Humana Classic: Individuals may pay more for coverage but are entitled to see any provider without extra costs. Copays and monthly deductibles are a factor, and individuals may pay coinsurance fees as well. Coinsurance is a percentage of allowable costs, and individuals pay the uncovered percentage. Once out-of-pocket-maximums are reached any additional expenses, beyond copays, will be covered 100 percent.
  • Point of Service (POS): These plans allow flexibility for individuals to make the decision to use in-network providers for lower costs, or pay more for out-of-network providers while still being covered. Out-of-network services do not require a referral. Most services will likely charge a copay.
  • High Deductible Health Plan: Generally speaking, higher deductibles mean lower monthly premiums, and this type of plan includes pharmacy cost in the deductible amounts, meaning that they may be reached sooner. Once annual maximum out-of-pocket caps are reached, coinsurance kicks in, and individuals pay a percentage of any additional expenses. Preventative services may be covered 100 percent without first reaching the deductible and individuals may set up a health savings account (HCA) that they or their employers, or both, may contribute tax-free money to that can be used to pay copays and medical costs toward the deductible or coinsurance fees.
  • Coverage First: Most medical services and preventative care is 100 percent covered under this plan up to a $500 allowance, meaning that, with the exception of copays, an individual can receive in-network medical care for no additional costs up to $500. Once the allowance is met, individuals will pay out-of-pocket costs up to a set deductible and then coinsurance coverage starts.
  • Personal Care Account (PCA) Plan: Individuals may have a PPO, HMO, or POS plan, and it is combined with a PCA spending account set up by the employer who deems what services are covered. There are no copays, and services are covered from funds out of the spending account until the deductible is reached. Then, out-of-pocket fees may be incurred, and coinsurance rates may start. Individuals are billed for services, and payments come out of the spending account.
  • Humana Simplicity: This plan has no deductible, and individuals pay only copays up to a set out-of-pocket maximum for in-network services.

Individual medical plans differ from state to state. More can be learned about the details of these plans by going to the Humana website and entering a specific zip code.

Humana covers a large amount of individuals on Medicare, which is federal health insurance coverage for individuals aged 65 and older. Many of these plans have no costs for general services and low out-of-pocket fees. Humana offers several Medicare coverage options that include:

  • Humana Gold Choice (HMO) Plans: This is a general Medicare plan similar to Original Medicare, with zero cost for annual screenings using in-network providers. It includes prescription drug coverage.
  • Humana Gold Choice Private Fee-for-Service (PFFS) Plans: These plans have affordable monthly premiums, and annual screenings are usually free. They include prescription drug coverage. They are similar to Original Medicare and allow individuals to see any providers who accept the plan without penalty.
  • HumanaChoice (PPO) Plans: No referral is necessary, and annual screenings are typically free. Individuals have the freedom to choose any provider, with affordable monthly premiums, fixed deductibles, and affordable copays and coinsurance rates.
  • Medicare Supplemental Insurance Plans: These plans allow individuals to supplement costs not covered by Medicare Parts A and B with moderate monthly premiums and a variety of plans to choose from.
Mental health services often include substance abuse treatment and may fall under the behavioral health services umbrella. Under a typical Humana HMO plan, mental health services that are charged by an in-network hospital, healthcare practitioner, or healthcare treatment facility that is not considered a halfway house or residential treatment center may be covered. Inpatient services that are covered include visits to the healthcare practitioner, and covered outpatient treatment includes therapy and office exams.Medically necessary mental health services are generally covered when they are provided by a network provider and considered medically necessary. Emergency and urgent care is also covered when sought at an in-network hospital or provider, and it may incur a copay. Individuals who cannot get to an in-network hospital, in the case of an emergency, may still be covered at an out-of-network hospital provided they contact Humana within 48 hours to report the situation. Use of a non-network urgent care provider may require authorization prior to treatment in order to be covered.Preventative services may also include counseling and screening to help prevent or reduce alcohol abuse in covered individuals over the age of 18 and preventative tobacco counseling or education services to dependents between the ages of 10 and 17. A general Humana PPO plan may also cover stays in a residential treatment center and psychological testing.The National Alliance on Mental Illness (NAMI) estimates that around half of the individuals who abuse drugs and a third of alcohol abusers also battle mental illness. When substance abuse co-occurs with mental illness, there may be more coverage options available. Behavioral health services include treatment for anxiety, depression, bipolar disorder, substance abuse disorders, and more.

Types of covered behavioral health services by Humana, which is managed by LifeSynch, may include inpatient acute detox services, inpatient acute psychiatric care, partial hospitalization, intensive outpatient care, concurrent routine outpatient services, and neuropsychological and psychological testing. Services must be deemed medically necessary in order for treatment to be covered by Humana.


Using Humana Coverage for Substance Abuse Treatment

When seeking substance abuse treatment, first ensure that the specific policy provides coverage for these services.

Most substance abuse treatment centers will have professional staff on hand to help individuals understand their policy and if coverage exists for the particular service in question.

Humana insurance does have the option to purchase specific substance abuse and behavioral health treatment coverage as an add-on if it isn’t specifically covered in the plan already. Treatment generally starts with a visit to the primary care physician (PCP) who can then seek authorization to refer an individual to a substance abuse treatment provider. This treatment provider may contract with Humana to provide covered treatment services. More than 5 million members are covered under Humana Behavioral Health programs. Members may use the online “Provider Look-Up” tool or call the number on the back of their insurance card to find a network healthcare provider 24 hours a day, seven days a week.
Many services may require a copay, which is a set amount that individuals are required to pay upon seeking treatment. The rest of the expenses may be billed to Humana, which will then determine what services are covered up to the maximum allowable fees for that plan. There may be a deductible amount that must be reached before services are covered, and there is also usually a maximum amount of out-of-pocket fees per year. Any fees that are considered out-of-pocket are fees that must be paid outside of and beyond monthly insurance premiums. Some expenses may not be covered and will need to be paid for by the individual directly to the provider.

Most substance abuse providers have dedicated staff members who strive to ensure that individuals can receive required treatment.

These staff members will work to help families understand how to make insurance coverage work or help find alternative funding options when possible.

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