Does HealthSpring Cover Inpatient Alcohol Rehab?

Medicare Advantage plans, like those offered by HealthSpring, will cover various treatment options for substance use disorders (SUD), at least the same services as Original Medicare. But does HealthSpring cover inpatient alcohol rehab? In most cases, yes. However, while coverage is generally available, the extent of insurance coverage for long-term addiction treatment can vary significantly based on the specific HealthSpring plan. Contacting HealthSpring directly or your treatment provider to verify your insurance coverage can provide specific details about your plan and potential out-of-pocket costs.

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Table of contents

» Who Is HealthSpring Insurance For?

» How Do You Check Your HealthSpring Coverage for Alcohol Rehab?

» What Are the Requirements for Getting Inpatient Rehab Approved by HealthSpring?

» Can You Use HealthSpring to Pay for Long-Term Inpatient Rehab?

» Key Takeaways on Does HealthSpring Cover Inpatient Alcohol Rehab?

» Resources

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Who Is HealthSpring Insurance For?

HealthSpring Insurance, a part of Cigna and known as Cigna-HealthSpring, is primarily designed to serve individuals eligible for Medicare. This typically includes senior adults aged 65 and older, as well as younger individuals with a disability, End-Stage Renal Disease, or ALS (also called Lou Gehrig’s disease).

HealthSpring provides Medicare Parts C and D and Medicare supplement insurance, commonly known as Medigap, as highlighted by MedicalNewsToday. These plans include additional benefits beyond original Medicare, such as prescription drug coverage, dental, vision, and sometimes behavioral and substance use treatment services.

While Original Medicare does offer some addiction treatment services for substance use disorders, these are somewhat limited. Medicare Part A covers short-term inpatient treatment, such as medical detoxification and inpatient rehabilitation at either a general or psychiatric hospital. On the other hand, Medicare Part B includes outpatient addiction treatment services, which encompass counseling, therapy, partial hospitalization programs (PHPs), and medications administered in a clinical setting.

Medicare Part C, also known as Medicare Advantage, are plans offered by private insurance companies, like Cigna’s HealthSpring, that Medicare approves. Medicare Advantage provides additional coverage that can be crucial for individuals seeking addiction treatment.

At a minimum, they cover everything that Original Medicare covers, but they frequently extend their offerings to include more comprehensive addiction treatment services like medical detox, both inpatient and outpatient rehabilitation, medication-assisted treatment (MAT), and in certain instances, inpatient alcohol rehabilitation.

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How Do You Check Your HealthSpring Coverage for Alcohol Rehab?

Generally, HealthSpring insurance plans provide coverage for alcohol rehabilitation; however, it is crucial to review your individual policy to understand the extent of care covered and any potential out-of-pocket expenses you might face while attending addiction centers in Florida that accept insurance. If you’re thinking about alcohol rehab and have a HealthSpring insurance plan, follow these steps to confirm your coverage:

• Review Your Insurance Card and Policy Documents: Start by locating your HealthSpring member ID, which contains essential information, such as your member number and the customer service phone number.
• Call the Member Services Number: This is often the quickest method to confirm your insurance benefits. When you talk to a representative, specifically inquire about your mental health and substance use disorder benefits, including both inpatient and outpatient alcohol rehab. They can provide details on what alcohol rehab services are included in your plan, the differences between in-network and out-of-network requirements, prior authorization information, and your deductible, copay, and coinsurance amounts.
• Use the Online Member Portal: If you have access to the HealthSpring/Cigna member portal, you can log in to review your plan specifics, look for in-network providers, and see what types of treatment are included in your behavioral health benefits.
• Contact the Treatment Center of Your Choice: If you have a particular alcohol rehab facility in mind, they likely have a dedicated team to verify your HealthSpring coverage. By sharing your insurance details, they can contact HealthSpring on your behalf to clarify your benefits and any out-of-pocket expenses related specifically to their treatment center. This is also an excellent opportunity to ask about their treatment programs, whether they bill HealthSpring directly, and to initiate the admissions and preauthorization process as soon as possible.

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What Are the Requirements for Getting Inpatient Rehab Approved by HealthSpring?

When addressing the question, “Does HealthSpring cover inpatient alcohol rehab?”, the answer usually hinges on individual plans and whether inpatient alcohol rehab is considered medically necessary. This entails demonstrating that inpatient care is the most suitable and effective treatment option for your unique circumstances.

Here’s a summary of the standard requirements and factors that HealthSpring evaluates for approving inpatient alcohol rehab:

• Medical Necessity: This is the core requirement. As stated by VeryWellHealth, medical necessity involves a determination by your health plan that your treatment, test, or procedure is essential for maintaining or restoring your health or addressing a diagnosed medical issue. Generally, individuals who qualify for inpatient rehab are those at risk for severe withdrawal symptoms, have co-occurring mental or physical health issues, are susceptible to relapse, reside in unsafe environments, or have experienced relapse after outpatient treatment.
• Prior Authorization: HealthSpring almost always requires prior authorization for inpatient alcohol rehab. The treatment facility must contact HealthSpring for approval before admission, providing detailed records that justify the need for 24/7 medical supervision and structured therapy. A clinical team from the insurance company will assess whether the inpatient level of care meets their medical necessity criteria.
• In-Network vs. Out-of-Network: Certain HealthSpring plans may exclusively cover in-network facilities, while other plans might extend coverage to out-of-network rehab centers. You may face higher out-of-pocket costs when choosing these facilities.

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Can You Use HealthSpring to Pay for Long-Term Inpatient Rehab?

Long-term inpatient rehab refers to treatment lasting 60 to 90 days or more. According to the Center for Medicare Advocacy, Medicare Part A covers long-term inpatient alcohol rehab in a general hospital’s psychiatric unit or a standalone psychiatric hospital for addiction. However, it may not extend coverage to substance abuse treatment offered in specialized residential treatment centers for addiction.

Fortunately, HealthSpring plans can cover extended stays in these facilities, which offer more comprehensive and personalized care. However, the level of coverage you receive will depend on your specific plan and the type of treatment facility you choose. It’s also crucial to note that coverage might be limited or require prior authorization to access effective interventions for alcohol addiction.

Moreover, like most insurance companies, HealthSpring doesn’t pre-approve a set duration upfront. Instead, they approve treatment in blocks of days based on the medical necessity of continued inpatient care.

HealthSpring will regularly assess your progress based on reports from the treatment facility. If you demonstrate adequate progress and your medical necessity for inpatient care diminishes, HealthSpring may suggest and approve a transition to a lower level of care, such as Partial Hospitalization Programs (PHP) or Intensive Outpatient Programs (IOP).

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Key Takeaways on Does HealthSpring Cover Inpatient Alcohol Rehab?

• Cigna-HealthSpring, formerly known as HealthSpring, generally offers plans that cover inpatient alcohol rehabilitation, though the details can vary based on your specific plan.
• HealthSpring Plans are intended for people eligible for Medicare, mainly seniors aged 65 and over or individuals with certain disabilities, End Stage Renal Disease, or ALS.
• Medicare Advantage (Part C) plans, like those from HealthSpring, deliver more extensive and inclusive benefits for substance use disorder treatment compared to Original Medicare. This includes services such as medical detox, outpatient and inpatient alcohol rehab, and medication-assisted treatment.
• Before beginning treatment, it is crucial to verify your benefits by contacting the member services number, accessing the online portal, or having a treatment facility confirm your coverage.
• Approval for HealthSpring inpatient alcohol rehabilitation is based on medical necessity and typically requires prior authorization before admission.
• While long-term inpatient alcohol rehabilitation may be covered, it is subject to approval in blocks of days and only if ongoing medical necessity is established through regular reviews.

If you’re asking, does HealthSpring cover inpatient alcohol rehab? Our expert admissions team at WhiteSands Treatment is here to verify your coverage and clarify the specifics of your policy, including any potential out-of-pocket costs you might incur.

We collaborate directly with insurance companies such as Cigna and HealthSpring to make the process seamless and stress-free, allowing you to concentrate entirely on your recovery. Our clinical team creates tailored treatment plans that align with your insurance coverage and cater to your individual needs.

For a confidential consultation and to check your HealthSpring insurance coverage, call WhiteSands Treatment in Florida today at 877-855-3470.

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Resources

• MedicalNewsToday – HealthSpring and Medicare: An overview
• VeryWellHealth – The Definition of Medical Necessity in Health Insurance
• Center for Medicare Advocacy – Medicare Coverage of Mental Health and Substance Abuse Services

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.