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How to Pay for Drug Rehab With ConnectiCare Insurance

Last Updated: September 6, 2019

ConnectiCare is a health insurance company that offers numerous plans including health maintenance organization (HMO), point of service (POS), preferred provider organization (PPO), health savings accounts, health reimbursement accounts, individual health plans, and Medicare plans. It serves members in Connecticut, Massachusetts, and New York.1

ConnectiCare covers mental health and substance abuse treatment. If you are looking for a drug rehab program, confirm your benefits with us and get more information about payment and costs.

Types of Addiction Treatment Options ConnectiCare Health Insurance Typically Covers

Therapist comforting a patient at officeYour ConnectiCare plan may provide coverage for the following types of rehab:

  • Inpatient/residential. This level of treatment generally requires you to temporarily reside in a hospital or freestanding facility. Programs consist of individual and group therapy and medical supervision, and may include detox and/or 12-step meetings. Inpatient treatment periods can range from a few days to a few months.
  • Partial hospitalization (PHP). In a PHP, you have access to medical care and other hospital services during treatment but are able to return home outside of program hours. During treatment, you will attend several group sessions, but you may also meet individually with a therapist, social worker, psychologist, or psychiatrist. These programs typically meet 4 to 6 hours per day, from 5 to 7 days per week. It may be the first type of treatment that you receive, or you may transition to this type of program after being an inpatient.
  • Intensive outpatient (IOP). This is a form of drug rehab that can be a step-down from partial hospitalization or inpatient treatment. However, many people do go straight to IOP when seeking rehab services. IOPs will usually meet about 3 hours per day for 3 to 4 days or more per week. Some programs offer daytime sessions, while others are held in the evenings. Many people in this type of program are able to continue work or school while obtaining treatment. American Addiction Centers offers room and board for clients in its IOP and PHP programs who do not live locally.
  • Outpatient treatment. Standard outpatient treatment efforts may consist of 1 to 2 individual or group sessions with a counselor per week. Sessions will typically last about an hour. Continued outpatient treatment frequently serves as a step-down from an IOP program, partial hospitalization, or inpatient treatment. However, some people may only seek outpatient treatment for addiction rehab.

A professional assessment can help you decide which form of treatment is best for you. Factors that may affect which treatment is the right fit include:2

  • Likelihood of need for withdrawal management.
  • Physical and mental health status.
  • Desire to change.
  • Possibility of relapse.
  • Home environment.

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*Insurance Disclaimer: American Addiction Centers will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” American Addiction Centers will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.

Types of Addictions ConnectiCare Health Insurance Typically Covers

ConnectiCare will cover treatment most drug addictions. The typical addictions covered by ConnectiCare include:

  • Heroin.
  • Prescription drugs, such as opioids, benzodiazepines, and stimulants.
  • Methamphetamine.
  • Cocaine.
  • Alcohol.
  • Marijuana.
  • Hallucinogens.
  • Inhalants.

While most rehab programs can treat these types of addictions, some may specialize in certain types of drug addiction treatment.

What if My Provider Is Out of Network?

When a provider is in-network, ConnectiCare will usually have a contract with the provider to offer services at certain prices, and your out-of-pocket costs are usually lower than if you go to an out-of-network provider. If you choose to go to an out-of-network provider, you will usually end up paying a higher percentage of the cost of your treatment or even the full cost.

However, if you prefer an out-of-network provider for rehab, you can often work out a payment plan with the provider to pay back the cost of treatment over time.

What Does ConnectiCare Health Insurance Specifically Pay For?

For most plans, ConnectiCare will pay for standard services that are part of substance abuse treatment. These services include:

  • Assessments.
  • Physical exams.
  • Detox.
  • Medications.
  • Group and/or individual therapy.
  • Costs for staying at an inpatient or residential program, such as room and board and meals.

How Much Will I Pay Out of Pocket?

 In many cases, ConnectiCare must pre-authorize your drug rehab treatment.

Your coverage for drug rehab will vary by plan. Most insurance plans have a deductible, which is the amount of money you must pay before the insurance starts to cover the cost. You may also need to pay coinsurance before or after your deductible is met. Coinsurance is a percentage of the cost of a covered service that you are responsible for paying. Additionally, you may have a copay, which is a fixed amount you pay for a covered service.

In many cases, ConnectiCare must pre-authorize your drug rehab treatment before you begin treatment or shortly after you’re admitted to a program. During this process, they will determine whether you meet their criteria for needing drug rehab (medical necessity). Usually, the provider will call ConnectiCare after assessing you and present the information to them for approval.

How Do I Get Started?

To find out how to get started using ConnectiCare, contact American Addiction Centers and have us verify your insurance benefits. Then we can help you pick the most appropriate treatment for your coverage and specific needs.

You can call us and speak with an admissions navigator at (888) 966-8152, use the chat feature on our site, or use the benefits verification form on this page.

Sources

  1. Bloomberg. Company Overview of ConnectiCare, Inc.
  2. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine (Sixth ed.). Philadelphia: Wolters Kluwer

 

 

Last Updated on September 6, 2019
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About the author
Leah K. Walker
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Leah K. Walker is a licensed marriage and family therapist with a Ph.D. in family relations.

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