Does MultiPlan Cover the Cost of Alcohol or Drug Rehab?

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July 26, 2021 by
Does MultiPlan Cover the Cost of Alcohol or Drug Rehab?

What Benefits Does MultiPlan Offer For Treating Alcohol & Drug Rehab?

If you or a loved one are searching for “outpatient drug rehab near me?” from suffering from a substance use disorder, it’s never too late to reach out for professional help. The sooner you begin treatment for alcohol or drug addiction, the quicker you will be on the path to long-lasting sobriety and a healthier way of living.

If you or a loved one are struggling with addiction, call WhiteSands Alcohol and Drug Rehab today at 877.969.1993 to learn how we can help.

The costs associated with alcohol or drug rehab are often covered under most health insurance plans. If your health insurance policy works with MultiPlan, chances are that your plan will cover some or a large portion of the fees associated with rehab. Although it’s vital that you don’t delay in getting the help you need to recover from a substance use disorder, it’s also important to find out ahead of time what benefits your MultiPlan will provide. This is particularly true if financial difficulties are part of what may be preventing you from seeking out rehab treatment.

MultiPlan, an independent Preferred Provider Organization (PPO) that has been in existence in the US since the 1980s, offers its members a large network of healthcare providers from across the country. This company presently facilitates PPO networks for more than 65 million people across the US, especially in the Southwest regional areas and throughout Wisconsin.

Your PPO with MultiPlan provides many benefits related to alcohol and drug rehab treatment, but your specific plan may not, for instance, cover the cost of detox services. You may be covered for alcohol detoxification, but not have coverage for drug detox. If you decide to go out of network for detoxification services, none of the services may be covered by MultiPlan, although you may be able to secure discounted rates at some rehab centers through the plan. MultiPlan also connects you with PPO health care providers who can offer reasonable rates.

Does MultiPlan Cover the Cost For Rehab?

Subscribers to MultiPlan are covered for alcohol and drug rehab treatment, with a specific amount of benefits depending upon the individual. Some plans will pay for your rehab treatment in full while others will only cover certain aspects of your treatment plan.

While MultiPlan’s provider network of clinicians, hospitals, and facilities is very widespread, some individuals prefer to use an out-of-network provider. If this is the case with the addiction center you choose, you will likely be responsible for higher out-of-pocket costs.

How To Verify Your MultiPlan Insurance Benefits For Addiction Coverage

Our intake coordinators are ready to speak with you about your MultiPlan benefits for addiction coverage. We can assist you with verification of your coverage for substance abuse disorder treatment and help with any co-existing mental health disorders.

You can also call MultiPlan directly with your questions about your insurance benefits. Call the phone number on the back of your insurance card to reach a representative who can assist you with the information you need.

Tiers of MultiPlan and Benefits of Each Package?

The monthly premiums that MultiPlan subscribers pay are a bit higher than those of a Health Maintenance Organization (HMO). The higher premiums, though, are often offset by lower deductible amounts.

If your rehab needs are deemed a medical necessity by a physician, and if you opt to get treatment at an in-network facility, you may be covered for detox services, outpatient rehab, intensive outpatient rehab, partial hospitalization, and aftercare treatments, depending upon the plan and package to which you subscribe. Deductibles and copays may apply.

MultiPlan health insurance facilitator that works with three major types of insurance plans: PPO, HMO, and Point of Service (POS) plans. The PPO offers the most wide-ranging coverage at in-network providers and their facilities.

HMO plans offer coverage at in-network rehab centers up to a certain level of benefits and reimbursements. POS plans let you choose between different types of HMO and PPO plans. If, for instance, you have a POS insurance policy, you can choose which type of insurance plan for addiction treatment makes the most sense for you to use based on your rehab needs.

If your health insurance provider is part of the MultiPlan network, you can recoup a percentage of the costs for alcohol detox, residential rehab, intensive outpatient treatment, and one-on-one therapy or medication management services.

Does MultiPlan Cover the Cost of Inpatient Rehab?

MultiPlan’s PPO provides you with a wider range of choices than an HMO does. There are typically many inpatient rehab facilities that are in-network for MultiPlan subscribers to choose from. If you have the right plan for your needs and choose an in-network rehab center, MultiPlan should be able to take care of a significant portion of your costs.

When you need to consider exactly how much MultiPlan will be paying for your inpatient rehab, you’ll want to find out what you’re liable for paying out-of-pocket. That will partially depend upon which state you live in and whether the rehab facility is in-network with MultiPlan.

Does MultiPlan Cover Substance Abuse & Mental Health Residential Stays?

MultiPlan does cover both substance abuse and mental health dual diagnosis treatment, but your plan will determine what those limited benefits are. Some variables that MultiPlan may consider when determining your coverage for co-occurring disorders include the medications you may require and the severity of your mental health disorder(s), all of which have an effect on the amount of care you’ll need.

Under the MultiPlan network, you are usually covered for benefits such as mental health education, counseling, and family therapies.

Does MultiPlan Pay For Outpatient Rehab?

Most of MultiPlan’s PPOs let you choose your in-network providers without a referral. But it’s still necessary that your choice is on their list of providers who are in-network if you want to be sure some of your outpatient services will be covered, either partially or in full.

How Long Will MultiPlan Cover the Rehab Stay For?

MultiPlan’s policies provide a variety of coverage levels and plans. Some might cover your rehab stay for 30, 60, or even 90 days. Keep in mind, however, that your substance use disorder treatment must be diagnosed as a medical necessity and be done at an in-network facility.

Call Us Now To Verify Your Insurance Benefits

Patients come to us from Tampa, Fort Myers, Orlando, Sarasota, Brandon, Gainesville, Drug Rehab Center Naples, and more. Insurance benefits and the various types of plans can be complex to sort out when you’re seeking help for addiction issues. Our counselors at White Sands are standing by to help you navigate your insurance benefits with MultiPlan. Call us today to find out more about the benefits you are entitled to and providers we accept to receive for help with alcohol or drug rehab treatment.

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Frequently Asked Questions

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MultiPlan does not issue health insurance policies directly but instead operates as a cost management and network services company that many health insurers and self-funded employers use. When a health plan uses MultiPlan's network, policyholders can access a broad range of treatment providers, potentially including drug and alcohol rehab facilities, at negotiated rates. Whether your plan covers rehab and what the specific benefits are depends on the underlying health plan that utilizes MultiPlan's network. Contacting your health plan's member services and asking whether MultiPlan is part of your network is the best first step.

The primary benefit of MultiPlan's network for policyholders is access to a large number of health care providers at pre-negotiated rates, which can reduce the cost of covered services including addiction treatment. Health plans that use MultiPlan's network gain access to a wide provider base, expanding coverage options for members in various regions. For individuals seeking rehab, accessing a facility within the MultiPlan network means lower out-of-pocket costs compared to out-of-network care. Understanding how your health plan uses MultiPlan helps you identify which treatment providers fall within your covered network.

Most professional drug and alcohol rehab centers accept a range of major health insurance plans, including Aetna, Anthem, Blue Cross Blue Shield, Cigna, United Healthcare, Humana, and Optum, as well as some Medicaid plans. Some facilities also accept plans that use third-party networks like MultiPlan or networks affiliated with major carriers. WhiteSands Treatment accepts most major insurance plans and can verify your specific coverage before you begin treatment. Checking with a treatment center's admissions team is the fastest way to confirm whether your insurance is accepted.

MultiPlan is a cost management services organization rather than an insurance company, so it does not directly cover addiction treatment. Instead, the health insurance plans and self-funded employers that contract with MultiPlan determine what services are covered under their policies. If your health plan uses the MultiPlan network, you may be able to access addiction treatment facilities at negotiated rates, but coverage and cost-sharing are determined by your specific plan. Contacting your plan's member services to understand how MultiPlan is integrated into your coverage is the recommended first step.

Most insurance plans pay for rehab as many times as it is medically necessary, because addiction is recognized as a chronic medical condition under clinical guidelines and federal law. The Mental Health Parity and Addiction Equity Act prohibits insurers from applying more restrictive limits to substance use disorder treatment than to comparable physical health conditions. Each treatment request is evaluated based on medical necessity rather than a fixed number of covered admissions. Consistent documentation of clinical need by your treatment provider supports coverage approval for each treatment episode.

The cost of 28 days in a residential rehab program varies widely depending on the facility, location, amenities, and level of clinical services provided. Programs can range from several thousand dollars at publicly funded facilities to $20,000 or more at private residential centers with comprehensive clinical services. With insurance coverage, your out-of-pocket costs are significantly reduced, as your insurer pays a portion of the total treatment cost after your deductible and cost-sharing obligations are met. WhiteSands Treatment works with most major insurance plans to make treatment financially accessible and can verify your benefits at no cost.

Insurance rarely covers 100% of rehab costs from the outset, as most plans include cost-sharing requirements such as a deductible, copay, or co-insurance. However, once you reach your plan's annual out-of-pocket maximum, the insurance typically covers 100% of additional covered costs for the rest of the year. The proportion of costs covered depends on your specific plan, whether the facility is in-network, and the level of care. Choosing an in-network rehab facility and verifying your benefits before admission helps you understand your actual financial responsibility.

Insurance companies may deny rehab coverage for several reasons, including a determination that the requested level of care does not meet medical necessity criteria, failure to obtain required prior authorization before treatment began, or the facility being outside the insurer's network. Documentation that is incomplete or does not adequately support the need for the requested care may also contribute to a denial. If coverage is denied, you have the right to appeal, and submitting comprehensive clinical documentation through the appeals process frequently results in reversal. Working with a treatment center experienced in navigating insurance claims significantly reduces the likelihood of denial.

To verify whether a rehab facility participates in the MultiPlan network associated with your health plan, contact your health plan's member services team and ask them to confirm the network and provide a list of in-network rehab facilities. You can also ask treatment centers directly whether they accept your specific plan or the network it uses. WhiteSands Treatment admissions advisors can help verify your insurance benefits and confirm your coverage before you commit to treatment. Having this information in hand before admission prevents unexpected out-of-network charges.

Insurance generally cannot deny rehab solely because you have been to treatment before, as addiction is a chronic medical condition and federal parity laws prohibit insurers from applying limits to substance use disorder treatment that they would not apply to comparable physical health conditions. Each treatment request is evaluated on its own clinical merits, and a documented medical need for care is the primary basis for coverage approval. Having a history of prior treatment may actually support medical necessity for higher levels of care in some cases. Working with a treatment provider familiar with the insurance appeals process ensures your coverage requests are submitted with the strongest possible clinical documentation.

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.

About the Author

is a proud alumni member of WhiteSands Treatment. After living a life of chaos, destruction and constant let downs, Mark was able to make a complete turnaround that sparked a new way of life. He is serious about his recovery along with helping others. At WhiteSands Treatment, we offer support to you in your homes or when you are out living in your daily lives.

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