How to Pay for Drug and Alcohol Rehab With Sierra Health and Life Insurance
American Addiction Centers works with SHL to provide coverage for people with addictions. Learn more about your payment options and check your benefits for free.
Types of Addictions Sierra Health and Life Typically Covers
Sierra Health and Life typically covers treatment for most major addictions, including:
- Prescription drugs such as benzodiazepines and opioids.
Most rehab programs are able to treat these addictions. While SHL generally covers treatment for addiction, coverage for certain drug addictions may depend on the specific plan, so it is best to verify your insurance benefits beforehand.
What Kind of Coverage Does Sierra Offer for Addiction Treatment?
Sierra Health and Life offers coverage for substance abuse and mental health services through
Behavioral HealthCare Options (BHO). BHO covers various types of addiction and mental health services, including: 1
- Mental health and substance use treatment.
- Inpatient and outpatient treatment.
- Online education and resources.
- 24/7 crisis intervention and stabilization.
- Employee assistance programs (employer-sponsored programs to help employees with mental health and addiction problems).
When seeking drug and alcohol addiction treatment, your records are kept confidential from your employer. Treatment centers are not allowed to disclose that you are a patient without your written consent.
The only cases in which your information may be disclosed without your consent is if there is a court order or the disclosure is to a medical professional during a medical emergency or for purposes of research, an audit, or a program evaluation.
How Does Coverage Work?
Every insurance plan offers different benefits, and benefits may vary from year to year. It is best to contact us for the most up-to-date information on your coverage.
If you have health insurance, you may choose to see an in-network or out-of-network provider. An in-network healthcare provider has a contract with your insurance company to provide services for members at pre-negotiated rates. Providers that are out-of-network with your insurance company are not contracted. You may have to pay more out-of-pocket to see these providers.
Your plan may require you to pay copay or co-insurance, or meet a deductible, when you receive care.
- You may be required to pay a copay for an in-network or out-of-network provider for any level of care. A copay is a cost that you pay each time you see a provider.
- A deductible is a fixed amount of money that you must pay before your insurance will cover services.
- Coinsurance is a share of the cost you are required to pay before or after you’ve met your deductible.
When receiving services, you may need a prior authorization after admission and within the first 48 hours of treatment. Some plans may require authorization before admission. During a prior authorization, an insurance company determines whether they will cover a specific service, such as inpatient treatment. If you do not complete a prior authorization, your insurance company may not cover your treatment.
Sierra Health and Life’s PPO plan covers in-network outpatient substance abuse and behavioral health services with a $20 copay. If you see an out-of-network provider, you will have to pay 40% coinsurance once you meet your deductible.2
If you are in need of inpatient treatment, you will have to pay 20% coinsurance for an in-network facility, or 40% co-insurance for an out-of-network facility.2
Types of Addiction Treatment That May Be Covered
Sierra Health and Life covers various addiction treatment options:
- Detox is the start of treatment for people withdrawing from drugs or alcohol. Medical detox programs help people safely and comfortably complete withdrawal with medications and medical supervision.
- Inpatient or residential treatment provides daily therapy sessions, medical treatment, medications, and peer support and requires the person to live at the facility.
- Standard outpatient treatment commonly involves group and/or individual therapy sessions that meet 1 to 3 times per week. The patient lives at home while they are in treatment.
- Intensive outpatient treatment programs meet more frequently than standard outpatient programs—typically 3 to 5 times per week.
- Partial hospitalization is a form of outpatient treatment that offers comprehensive treatment that is similar to an inpatient program, but the person goes home at the end of each day. However, AAC provides room and board for clients in its partial hospitalization and intensive outpatient programs who are not from the local area.
Types of Plans
Sierra Health and Life offers the following types of healthcare plans:3,4
- SHL’s PPO plan covers most of your medical expenses when you visit an in-network provider, urgent care center, or hospital. This gives you access to a large network of providers with low out-of-pocket costs. You can also visit an out-of-network provider or facility at a reduced rate.
- HSA PPO. SHL’s HSA PPO allows you to pay a lower premium for coverage, but it requires you to meet a deductible before your medical services are covered by the plan. You can also contribute the money you save from a lower premium into a tax-free health savings account, which can be used toward your medical expenses.
Sierra Health and Life Facts
Sierra Health and Life has over 35,500 members across 43 states and the District of Columbia.4 The company was founded in 1906 and was later purchased by UnitedHealth Group in 2007.4,5 Its main headquarters is located in Nevada.4
How Do I Get Started?
In addition to checking your coverage, we can help you explore your treatment options.
The first step is to verify your insurance benefits with us. In addition to checking your coverage, we can help you explore your treatment options so that you can choose the best treatment facility based upon your insurance coverage and personal circumstances.
There are a few different options for verifying your coverage. You can start by:
- Calling an admissions navigator.
- Using the chat feature on our site.
There is no pressure when working with us to verify your insurance coverage. Our goal is to help you find the best program for you that meets your needs. Everything that you share with us is confidential. Give us a call at (888) 966-8152.
- Sierra Health and Life. (2019). Mental health and substance use benefits.
- Sierra Health and Life. (2015). Summary of benefits and coverage: What this plan covers and what you pay for covered services.
- Sierra Health and Life. (2019). How to use your health plan.
- (2019). Sierra Health and Life in Nevada.
- Moore, M. (2007, March 12). United Health to acquire Sierra Health for $2.6 bln. Marketwatch.
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