Medical Mutual Insurance Coverage For Substance Abuse Treatment

Medical Mutual of Ohio is one of the oldest insurance companies in this country, serving people for more than eight decades. It is Ohio’s largest insurance company, with some 1.6 million customers. It is also one of Cleveland’s largest employers. Those who have Medical Mutual insurance and require rehab treatment are in luck. Most of the company’s insurance plans cover both detox and rehab. However, there is likely to be some sort of deductible and coinsurance that you have to take into consideration.

Medical Mutual and Rehab Coverage

All of the standard insurance plans that Medical Mutual offers cover at least some of the costs of inpatient and outpatient rehab facilities. In fact, you could even go to a provider that is not within their approved network, although you need to get a confirmation before you get the treatment. What you will have to pay will depend on your plan, your copay, and your deductible.

Treatment Options Under Medical Mutual

If you suffer from an addiction, then you will require treatment if you want to achieve sobriety. Through this treatment, you will learn about setting future goals and coping techniques. This treatment is absolutely necessary, regardless of how much it costs. Naturally, having good coverage will help substantially towards getting the treatment that you need.

Mental health and substance abuse treatment has become a priority for the country’s healthcare system because so many people are now affected by such issues. People who are affected are changing and new drugs are emerging. As a result, Medical Mutual, and other insurance companies, have started to offer various kinds of coverage as well.

Exactly what Medical Mutual will cover depends on the plan, the state, and more. However, almost all services are covered and the copay is usually minimal. For outpatient services, the average payment by Medical Mutual is 60% of the program. For other types of care, inpatient, alternative treatment and holistic treatment are usually covered similarly. Sometimes, the plan will treat an inpatient rehab stay in the same way as a hospital stay, and therapy will be treated similarly as well, although there is a limitation on how many sessions can be offered.

Additionally, if you have a dual diagnosis or co-occurring disorder, Medical Mutual is also likely to cover that. If, for instance, you have an alcohol addiction as well as a mental illness, the two will be treated alongside each other with neither being more important than the other. People with a dual diagnosis are often treated in hospitals, but also in a traditional rehab center. As a result, it is often easier to bill for insurance, and other mental and behavioral illnesses being covered in the same way.

Once you have complied with your deductible, there is generally no further charge through Medical Mutual. Before your deductible, you will usually have to pay a percentage of the charge for the service, or perhaps for an entire day. Although there are many variations in the different plans and the different geographical locations, you will generally find that a large part of your treatment will be covered.

How to Find Treatment

According to the National Institute on Drug Abuse (NIDA), some 23.5 million people in this country abuse alcohol or drugs. Each of these requires treatment in order to be able to recover. NIDA has stated that if people are offered personalized treatment in the correct treatment facility, the chance of recovering and leading a life of sobriety is greatly increased.

As such, Medical Mutual covers a number of different treatment options, including:

  • Appropriate medical treatment
  • Family therapy
  • Counseling and group therapy
  • Cognitive behavioral therapy
  • Outpatient treatment
  • Long term inpatient treatment
  • Short term inpatient treatment

Addiction recovery under Medical Mutual will vary depending on your personal goals and your policy. If you have become addicted due to a mental health disorder or medical ailment, you will be able to receive appropriate treatment from addiction centers. Sometimes, this means having to take some medication in order to help you recover. This medication is designed to help improve overall well-being and health, instead of harming it. This is because it addresses the condition that led to your addiction. In other cases, you may be provided talking therapies only, and no medication, in order to help you reach your goals.

Every individual is unique, with unique needs and requirements to help them achieve a life of sobriety. Those covered under Medical Mutual are provided with a lot of help to reach their long term goals. They have high standards under all their policies, which are beneficial to those who hold them.

How Long Can You Be Under Treatment with Medical Mutual?

How long you can stay in treatment and have it covered by Medical Mutual will depend on what you actually need. If you require inpatient treatment and have only the most basic plan, you will usually be covered for 20 days of treatment per year. If you require outpatient treatment on that same plan, you will usually be covered for 20 individual visits for each benefit period.

Medical Mutual and Specialized Drug and Alcohol Treatment

A lot of people feel that they would be better served by a luxury or executive treatment facility. These rehab centers are more exclusive in nature. Medical Mutual may pay for some of this, although it is likely that you will have to pay a higher percentage yourself. Hence, you should look into the different specialty facilities that are out there and what they offer that is so important to you, before contacting Medical Mutual to find out what level of coverage you will receive.

Inpatient or Outpatient Treatment

When you have to choose between inpatient and outpatient treatment facilities, make sure that you follow the recommendations of an addiction specialist. It is possible that you will consult with a representative from Medical Mutual. Once a treatment plan has been created, you will need to ensure that the provider is approved. The company has its own network of pre-approved providers, but you can also ask for someone out of their network to be approved. In many cases, you will have to attend an inpatient facility and then move to an outpatient facility later on.

How to Find the Best Treatment and Verify Your Coverage

One of the most important things you will do in terms of becoming sober again is choosing the right facility for you. NIDA has reported that those who attend appropriate treatment have a 200% better chance of actually achieving recovery. This means that it is vital that you find the right treatment center. In fact, this is even more important than whether or not Medical Mutual covers it.

Medical Mutual’s Other Benefits

There are a wealth of advantages to having a plan with Medical Mutual, above and beyond being covered for alcohol and drug addiction treatment. If you are a policy holder, you should make sure that you use your plan to get the most out of it. Hence, do download the Medical Mutual phone app, or navigate to their website in order to:

  • Find out about money saving tips and tools
  • Find out about offers exclusive to members
  • Visit the payment center
  • Check on the status of your claims

On the website, you can also use a facility to help you find a physician. This is a very good feature, as it tells you which doctors are within their network and how these specialize in the conditions that you are interested in. Furthermore, through Medical Mutual, you can access lots of information and tips on how to live a healthy lifestyle, including issues such as preventative care, lifestyle, dieting, nutrition, and fitness.

The Effect of the Affordable Care Act (Obamacare)

Under Obamacare, all commercial insurance plans in this country now have to offer coverage for treatment. These include Medical Mutual, which offers at least a degree of coverage for addiction treatment. Under the Act, substance abuse disorder is one of the ten elements of health benefits that are essential. This means that a substance addiction is classed like a disease or illness like kidney disease or cancer.

The Problem with Prescription Drugs

According to NIDA, some 52 million people in this country abuse prescription medication at least once in their lifetime, which is an indication of the seriousness of the problem. Anyone who abuses prescription medication will require a period of medically supervised detox, followed by a rehab program, if they are to have any chance at improving their well-being and health.

Medical Mutual understands the extent of this program and does offer coverage for those addicted to prescription medication. The medical challenges linked to the abuse and the type of plan you have, are the greatest determinants in terms of how much coverage you receive. Some of the plans offered by Medical Mutual do not cover prescription drug treatment, however. This is why you must properly evaluate your policy before you agree to start treatment.

In most cases, the policy covers a number of sessions for psychological evaluation, tests, and assessments, as well as any required medical treatment. Usually, behavioral health concerns are covered. However, the options available for prescription drugs addiction do vary, so you must contact the insurance provider first.

Those addicted to prescription drugs receive the information and tools that they need to stay clean in future when they undergo rehab. The reason why prescription drug addiction is complex, however, is because it often doesn’t start with illicit abuse. Hence, whether or not you receive treatment and how much will be covered often also depends on what caused your addiction.

When you go through detox from prescription drugs, you may require medical intervention to help you deal with the period of withdrawal. You may experience anger, irritability, paranoia, hallucinations, seizures, insomnia, loss of appetite, nausea or vomiting, muscle and joint pain, and flu symptoms. Different types of prescription drugs affect the mind and body in different ways. Hence, the exact withdrawal symptoms will vary as well. However, if you have severe reactions, such as hallucinations or seizures, then medical treatment will be required. By going to rehab, you will have the chance to improve your well-being and health. For this to be covered by Medical Mutual, you will usually have to receive pre-certification and a referral from your physician. Make sure, therefore, that you check your policy and never assume that you will receive coverage.

There are a number of solutions available through Medical Mutual for addiction recovery and behavioral health concerns. However, each of the policies is different in terms of coverage. Sometimes, behavioral health treatment is not offered at all, and detox is only covered in a very limited way. All this information should be included in your policy.

Gender-Based Drug Rehab Facilities

A lot of people prefer to go to a rehab facility that is geared specifically to their gender. This is in part due to the fact that men and women generally become addicted in different ways, and therefore also require different forms of treatment. Most women who enter treatment have gone through serious trauma in their past, such as domestic violence and sexual abuse. In men, it is usually down to a drive to succeed and how society defines what makes a man.

Getting Treatment Helps to Lower Your Costs

While you may have to pay some of your treatment yourself, this should not be a barrier. In fact, if you were to calculate how much you pay on your chosen substance, you will quickly find that going into treatment is usually far less expensive. As such, by opting for treatment even if you have a huge copay or deductible, or if you have no insurance at all, you need to see rehab as a long term option.

How to Take Care of the Costs Mutual Medical Doesn’t Cover

You will always have to pay your deductible and generally a percentage of your actual treatment. This means that you do need to consider just how much money you need to have yourself. Unfortunately, this can easily go up to thousands of dollars. Luckily, most treatment facilities do offer payment plans that you can take advantage of so that you won’t be financially crippled by your bill.