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How to Pay for Drug Rehab With Geisinger Insurance

Last Updated: September 4, 2019

If you have Geisinger insurance, both substance abuse treatment and mental health services may be covered if Geisinger determines that these services are medically necessary. But you may still have some out-of-pocket expenses.

If you are unsure about your benefits and need clarification about what services are covered with Geisinger, you can confirm your benefits online. 

What Is Geisinger Insurance?

Geisinger is a healthcare services company located in Danville, Pennsylvania. It owns and operates outpatient facilities, medical centers, hospitals, children’s hospitals, rehabilitation hospitals, and research centers. Its primary areas of focus are cancer treatment, heart services, neuroscience, orthopedics, pediatrics, transplants, and women’s health.1

Geisinger also offers health plans to seniors, individuals, families, and employers.

How Does Geisinger insurance Coverage Work for Substance Abuse Treatment?

Man paying bill for treatment to female staffLike other types of insurance, health coverage is based on your insurance plan. Although substance abuse treatment is not a guaranteed service, it is generally covered by insurance.

Substance abuse treatment will most likely require a preauthorization, a process by which your insurance provider deems a service, drug, or medical equipment medically necessary. However, a preauthorization is not a guarantee of coverage.

Even if substance abuse treatment is covered by your insurance, you can still expect to pay some out-of-pocket fees. A deductible is a very common component of health insurance. A deductible is the amount of money you must pay before the insurance company will start to cover the cost of your services. If your deductible is $500, for example, you will have to pay $500 before the insurance company will pay for services.

A co-pay is another common component of health insurance. A co-pay is a fixed amount of money your insurance provider requires you to pay at the time you receive covered services. The amount of a co-pay can vary depending on the type of service you are receiving. For example, a co-pay at the emergency room can be different than the co-pay at your doctor’s office.

Co-insurance is a percentage of what you are responsible for paying after your deductible is met. This percentage is set by your insurance provider and can vary based on your insurance plan. If your deductible is $500 and your co-insurance is 20%, you would be responsible for the remaining 20% of the medical bill after you pay the deductible.

If you receive substance abuse treatment, you are more than likely going to pay a co-pay, deductible, co-insurance, or a combination of the 3 for the services you receive. You can contact your insurance provider to obtain specifics on what your deductible, co-pay, and co-insurance amounts are.

Another common practice of insurance providers is to set parameters or limits for services. For instance, your insurance provider may limit the number of outpatient substance abuse treatment visits they will cover per year. They may also only authorize a certain number of inpatient treatment or detoxification days per year.

Should you require more treatment than your insurance company initially authorizes, the treatment facility or medical professional can request to extend the number of visits or length of stay. Your insurance provider can inform you of the number of visits or days you are approved for under your plan.

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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 Geisinger Insurance Typically Covers

Geisinger covers substance abuse treatment and most major addictions. Types of addictions covered include:

  • Heroin and other opioids, such as prescription painkillers.
  • Stimulant medications, such as Adderall or Ritalin.
  • Inhalants, such as paint thinner, gasoline, nitrous oxide, or amyl nitrite.
  • Alcohol.
  • Cocaine.
  • Benzodiazepines, such as Xanax or Ativan.
  • Hallucinogens, such as LSD or psilocybin mushrooms.
  • Marijuana.

The substance addictions mentioned above are fairly common and are treated at most substance abuse rehabilitation facilities. As long as the treatment provider you choose is in-network, you should be able to obtain treatment under Geisinger.

Types of Treatment Options Typically Covered

 For certain substances, medical detoxification may be required to help you safely and more comfortably manage withdrawal.

There are many different types of treatment for addiction. During an assessment, an addiction treatment professional can explain the types of services offered and which form is treatment is best suitable for you. It is important to disclose facts about your substance abuse problem, including how long you’ve been using, the type of drug(s) you use, the amount you use, and your frequency of use.

For certain substances, medical detoxification may be required to help you safely and more comfortably manage withdrawal. Detox is often the first step in substance abuse treatment, as many people continue with some form of rehabilitation or care after successful management of the withdrawal period. Other types of care that may be suitable for you include inpatient or residential treatment, standard outpatient therapy, intensive outpatient therapy, and partial hospitalization programs.

Inpatient or residential treatment is a type of service in which you stay for days or even weeks at a treatment facility. As part of many inpatient programs, you have access to medical and psychiatric care and participate in activities such as support groups, individual therapy, group therapy, and relapse prevention groups with the goal of learning skills to cope with life without the use of drugs or alcohol.

Partial hospitalization programs (PHPs) are similar to inpatient programs, except you return home at night. They can meet up to 7 days a week, and they run for several hours at a time.

Intensive outpatient therapy (IOP) usually occurs 3 to 5 days a week for a few hours at a time. PHPs and IOPs are sometimes used as additional avenues of ongoing treatment after completion of a residential program. Depending on the length and severity of your addiction, you may be referred directly to an IOP program.

Outpatient therapy is the least intensive treatment option. Regular outpatient counseling may serve as an outlet for stress management and the reinforcement of other sobriety-promoting behavioral changes to assist you in dealing with the challenges of life effectively without using drugs or alcohol. Outpatient can be a follow up to a higher level of care or serve as someone’s primary mode of treatment.

What if My Provider Is Out of Network?

Your insurance plan will most likely recommend that you to obtain substance abuse treatment with an in-network provider. If a provider is in-network, it simply means that they have an agreement to provide services for members of your insurance company at set prices. If a provider is out-of-network, it means that they do not have such a contract with your insurance company.

If you choose to receive services with an out-of-network provider, your insurance company will most likely not cover the full cost of your services. Unfortunately, that means that you may be charged the entire amount of the services rendered or a large portion of the cost. You can talk to the provider to see if they offer discounts, scholarships, or incentives to help offset the cost or discuss the possibility of arranging a payment plan.

How Do I Get Started?

The best place to start is to verify your insurance benefits. Once you have verified your benefits, we can help you choose a treatment program based on your insurance plan and individual needs. Remember, substance abuse treatment comes in many forms, and it is important to identify a provider that suits your needs.

There are several ways to verify your benefits, and they are all confidential. You can call one of our admissions navigators at (888) 966-8152, use our benefits verification form, or take advantage the chat feature on our website.

You do not have to handle this alone; our admissions navigators are here to help.

Sources

[1]. Bloomberg. Company Overview of Geisinger Health System.

Last Updated on September 4, 2019
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About the author
Jacquelyn Buffo
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Jacquelyn Buffo, M.S., L.P.C., C.A.A.D.C., is a licensed professional counselor with experience and expertise in substance abuse and mental health issues.

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