Using Kaiser Permanente Insurance to Pay for Drug Rehab
What Is Kaiser Permanente?
With 11.8 million members in 2017, approximately 22,000 doctors, 57,000 nurses, 39 hospitals, and 682 medical offices and other facilities, Kaiser Permanente is a top-tier, not-for-profit health plan service and healthcare provider.1
Kaiser Permanente has close ties to local communities, investing large amounts of money and expertise into community outreach. Kaiser also creates new technology, conducts extensive medical research, and focuses on ensuring the overall well-being of members to create a healthier society.
As a company, Kaiser Permanente boasts high-quality ratings by providing comprehensive, competent, and affordable healthcare to as many people as possible. Kaiser offers health insurance plans to employers as group coverage, as well as to families and individuals as private insurance. The company also provides Medicare coverage for seniors age 65 or older or people with a disability that qualifies them for Medicare.
Offering coverage in 8 states (Washington, Oregon, Colorado, California, Hawaii, Georgia, Virginia, and Maryland), as well as the District of Columbia, Kaiser Permanente is one of the primary healthcare providers in the United States.2
How to Use Kaiser Permanente Coverage for Rehab?
Individuals who live within a Kaiser Permanente coverage area, and have a Kaiser Permanente healthcare plan, may choose a Kaiser Permanente healthcare provider at kp.org and may change doctors at any time. Appointments can be made online or over the phone. Nonurgent health concerns may be addressed via email communication with a doctor’s office; lab results may be viewed online; prescriptions can also be refilled online; and nurses are available for medical advice 24 hours a day, 7 days a week.3,4
The first step to seeking treatment for a substance abuse or dependency concern is often an initial meeting and conversation with your primary Kaiser Permanente doctor. Individuals can set up this meeting or appointment over the phone or online, or email the doctor’s office.
Depending on medical necessity, a primary care physician may refer or authorize individuals for further treatment.
Depending on medical necessity, a primary care physician (PCP) may refer or authorize individuals for further treatment, after an initial assessment, in a specialized substance abuse treatment facility. Drug and alcohol treatment centers often have professionals who understand the complexities of insurance and how to help individuals use their coverage to pay for services. When treatment is not entirely covered, these same professionals are likely to have suggestions on alternate funding.
Individuals can find covered treatment providers for counseling or therapy services using the locator tool. An advice nurse is also available by phone around the clock, as is a wellness coach between the hours of 7 a.m. and 7 p.m., Monday through Friday, for discussion about individual mental health goals and options; the numbers for both can be found on the website. Kaiser Permanente medical centers also provide classes and programs as well as support groups on a variety of mental health topics, including chemical dependency.
Scope of Coverage
What is specifically covered depends on the individual plan. Some of the typical treatment services for substance abuse may include:
- Outpatient treatment.
- Intensive outpatient treatment.
- Inpatient or residential treatment.
- Transitional recovery services.
One example of standard coverage is the Kaiser Permanente Platinum HMO plan for California. This plan covers inpatient detox to manage medical withdrawal from drugs or alcohol in a plan hospital and with plan physician services. Room and board, medical services, medications, education, recovery services, and counseling may all be included. Individuals will pay a copay of $250 per day, up to a maximum of $1,250 per stay under this plan.5
Covered outpatient services, where the individual attends treatment during the day and goes home at night, may include intensive outpatient programs, day treatment programs, medical withdrawal treatment, and chemical dependency counseling in a group and/or individual setting for a copay of $15 per visit for individual treatment and $5 per group session.5
Coverage may also include residential treatment at a $100 copay per admission. The services must be provided in a licensed facility that provides 24-hour care, and can include individual and group counseling, medical services and monitoring, room and board, social services, medications, and aftercare planning.5
Substance abuse treatment is a wise investment. When you add up alcohol, drug, and tobacco dependence costs to society as a whole, it comes to more than $740 billion per year in healthcare costs, lost workplace production, and law enforcement and legal costs, according to the National Institute on Drug Abuse.6
Specific Plan Details
There are 3 main types of health plans offered by Kaiser Permanente: group or employer-based plans, family and individual plans, and Medicare plans. Plans may vary from region to region and state to state.
Employer-based or group plans are offered to businesses that provide health insurance to their employees, often with premiums directly deducted from paychecks. Group plans through Kaiser Permanente may include:
- Traditional or deductible plans: Fees may be paid by the plan participant until deductibles are met, and generally, there is an out-of-pocket annual maximum amount. Copays may be necessary.
- Preferred Provider Organization (PPO) plans: These plans may be optimal for individuals who don’t reside in a Kaiser Permanente service region or who wish to use out-of-network providers. Coverage can be maintained at a higher rate when non-preferred physicians are used, and in-network coverage costs less.
- Point-of-Service Plans: This type of comprehensive coverage plan allows individuals to use in-network Kaiser Permanente providers and network-contracted providers, or pay more for out-of-network providers. It is a combination of an HMO and PPO plan.
- Out-of-Area Plans: Individuals living outside of a Kaiser Permanente coverage area can receive healthcare services without a referral. Preventative services are typically covered, and other services may be subject to cost-sharing or a deductible amount.
- Consumer-Directed Health Plans: Several options are available, including a health reimbursement account (HRA) plan where employers contribute for qualified medical expenses, a health savings account (HSA) plan that is a tax-free account set up by individuals to pay for medical expenses, and a flexible savings account (FSA) where individuals make contributions that are considered pre-tax, toward many different medical expenses.
Individual plans range between Gold, Silver, Bronze, and Platinum, depending on the maximum out-of-pocket fees, deductible, and copay amounts as well as monthly premiums. The plans may differ depending on the coverage area. In general, the following types of plans are available:
- Deductible plans: With maximum caps, services are provided for a fee until the deductible is met, and many services have a copay as well. Preventative services may be completely covered.
- Copay plans: Preventative services are covered, and there is no deductible amount for these services, though they are subject to a copay for office visits and services rendered. This is a comprehensive coverage plan that may incur higher monthly premiums.
- Health Savings Account (HSA) plans: These plans have a combined pharmacy and medical cost deductible, and all costs are out of pocket until the deductible is reached. Costs are then covered at a percentage until the maximum out-of-pocket cap is reached. A health savings account can be set up for a tax break on medical costs.
- Deductible catastrophic: Individuals with financial hardship or younger than 30 may qualify for this plan in most coverage regions. It covers up to 3 doctor’s visits a year. All additional fees are out-of-pocket expenses until the annual maximum deductible amount is reached. Many preventative services are covered at no charge as well.
Medicare is federal insurance coverage for adults over the age of 65, and Kaiser Permanente Medicare plans may provide more options than standard Medicare. Plans include the Kaiser Permanente Senior Advantage and the Senior Advantage Basic, which are HMO plans that vary according to the coverage region and plan selected. Most coverage will have low copays for services and prescriptions, with no copay for most preventative services.
For seniors seeking substance abuse treatment, a trained insurance professional at a specialized treatment center can help individuals understand their coverage and how it may be used to pay for services.
. Kaiser Permanente. (2018). 2017 Annual Report.
. Kaiser Permanente. Fast Facts About Kaiser Permanente.
. Kaiser Permanente. Experience the Kaiser Permanente difference.
. Kaiser Permanente. Get Help by Phone.
. National Institute on Drug Abuse. (2017). Trends & Statistics.
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