Sierra Healthcare Insurance Coverage For Substance Abuse Treatment

If you, or someone you care about, has a drug or alcohol abuse problem, you will need to look for treatment solutions, which can be a daunting task. There are many different issues to take into consideration, not in the least how you will pay for it. If you are covered under Sierra Health and Life, and you are looking for a center that will not just accept the plan but will also offer you the treatment options you need, you may feel quite restricted in your options. Luckily, and mainly thanks to the Affordable Care Act, it is possible for you to find the right substance abuse treatment facility for your needs, while using your insurance so that you can reduce how much you have to pay out of your own pocket.

Coverage Offered by Sierra Health and Life for Rehab

Almost every personal health insurance plan offered by Sierra Health and Life includes benefits for at least some substance abuse treatment. However, not every rehab facility will accept the coverage, and not every facility is covered by Sierra either. As such, your first port of call should be with Sierra Health and Life itself, so that you can find out what your plan offers, and which providers are within its network.

About Sierra Health and Life

Sierra Health and Life (SHL) is a popular health insurance provider that has operated for over a century and now has a presence in Nevada as well as 43 other states. Its goal is to offer all policy holders appropriate, necessary, and timely patient care. Hence, for patients who are admitted to a rehab center or other inpatient facility, their care will be monitored through an initial review, and further reviews as well. In so doing, SHL ensures that people receive appropriate care that is medically necessary and offered in the right settings. Each patient is assigned a case manager who will be able to conduct the review at the facility, or via telephone with the health care providers at the center.

It is also possible to go to a non-contracted facility, or to go to facilities that are outside the service area of SHL. However, in this case, it is likely that they will complete a retrospective review as well, in order to make sure the medical care received, the treatments, services, and other procedures were fully appropriate. To do this, SHL will review the presenting symptoms, the admitting diagnosis, and medical records.

Choosing a Provider with SHL
SHL offers benefits to Preferred Plan Providers (PPP), which ensure that patients have a wide selection of options to choose from. These have set co-pay options for standard services. If the services are non-routine, then co-pay will be paid after the annual deductible has been met. By choosing a PPP, people can access a number of benefits including:

  • Gaining access to physicians and other providers registered with the Southwest Medical Associates in Southern Nevada
  • Gaining access to specialist services without a prior referral
  • Low personal costs

It is possible to go outside of the PPP as well, which means policy holders are free to visit any health care provider they like, so long as they are licensed. This is a more flexible benefit level, but it also means people will have higher out of pocket costs. All these services come with both co-pay and a yearly deductible.

It is recommended that people look through the Preferred Provider Medical Plans first. This will enable them to choose what benefit level that they want at the time when they receive the service. In so doing, they are able to have a greater control of their out of pocket expenses while at the same time being able to receive all their health benefits. SHL has provided a full directory of providers that people can choose from in order to help them make the right choice for their needs. The directory, which is available online, is filled with information on what the providers’ specializations are, how they can be contacted, and what certifications they have.

SHL is also committed to ensuring that people are able to have the lowest possible out of pocket expenses. This is why the company recommends that people choose a PPP for their treatment. At the same time, policy holders need to be aware of the fact that they may have to share the cost of any specialty tests that are ordered.

Behavioral Health Services

Substance abuse is now seen as a mental health problem and SHL has implemented this in full through their Behavioral Health Options. This ensures that people can get access to counseling, various online resources, and telephone consultations. This enables people to have a healthy, balanced life and to meet some of life’s bigger challenges. SHL offers confidential counseling services, which includes mental health provider referrals. To access this, policy holders should contact Harmony Healthcare, who is the contracted provider for behavioral issues for SHL.

To receive the lowest out-of-pocket costs for specialty services, make sure you choose a Preferred Plan Provider. Depending on your plan, there may also be a cost share (such as a copayment or coinsurance) for X-rays or tests your provider orders for you.

Harmony Healthcare and Substance Abuse Treatment

Harmony Healthcare is an organization that focuses solely on offering counseling and mental health treatment to adults and children. This includes those who have a substance abuse problem. It only offers its services in Nevada, and generally in an outpatient setting (with exceptions). The organization also offers Employee Assistance Plans, through which people can access private counseling, individual counseling, and group counseling.

Harmony Healthcare also provides extensive coverage for addiction and mental health treatment services in outpatient settings for families, teenagers, and children, although only in the Las Vegas, NV area. They have three clinics available in that geographical area, as well as a core network provider so that a family’s counseling and therapy needs can be met. Within its network, Harmony Healthcare works with licenses psychologists, professional counselors, and psychiatrist. Together, they provide compassionate, high quality care to anyone in need. The addiction and mental health treatment professional team is in place to ensure that every individual and every family is able to identify difficult times, adapt to them, and deal with them in an effective, healthy way. As such, Harmony Healthcare aims to help people get back on track, while at the same time improving their overall quality of care.

Besides Sierra Health and Life, Harmony Healthcare also accepts other types of insurance plans. Additionally, it accepts cash pay patients, which may be an option for those who want to keep their overall costs down. Through its services, people can access group therapy, individual therapy, substance abuse programs, medication management, employee assistance program services, crisis management, and inpatient referrals.

Finally, Harmony Healthcare has a support group function in place in West Charleston, Las Vegas, NV. It is important, however, that people check whether this support is covered under their SHL policy. Two programs are offered for those with a substance abuse problem:

1. Acute Stabilization, where people receive a more intensive form of care than they would in a standard outpatient center. It is for those who need to have contact between three or five times per week, and who require more intensive services if they are to avoid an inpatient hospitalization.
2. Chemical Dependence Intensive Outpatient Program, which provides support and help for those who have an alcohol or drug dependency and need help to prevent relapse. A referral is required for this particular support group.

The Rules Under the Affordable Care Act
Sierra Health and Life is not the most comprehensive provider when it comes to mental health and substance abuse. However, it sticks to the rules of the Patient Protection and Affordable Care Act (ACA), which was passed in 2010. Under ACA, addiction treatment is covered and people are offered options to help them pay for treatment. Addiction, according to insurance, is now no longer considered a pre-existing condition.

The ACA implemented significant reforms to ensure that every American is able to access health insurance, offer more choices in terms of health care, lower costs, and effectively improve overall quality of life. The ACA has listed 10 essential health benefits, of which substance abuse disorders are one element. Hence, since 2014, all insurance provided by Medicaid or sold on Health Insurance Exchanges must also include treatment for substance abuse.

Thanks to the ACA, more people will have access to treatment for substance abuse disorders. Exactly which treatment is covered, however, depends on the insurance company and plan. At present, the Department of Health and Human Services is working on standardizing this type of provision.

The Mental Health Parity and Addiction Equity Act

Another important act is the Mental Health Parity and Addiction Equity Act (MHPAEA), which has been created in response to the ACA. It is being administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), which is educating consumers on how the MHPAEA works for them.

What the MHPAEA focuses on is the element of the ACA that ensures people can have access to services for early intervention, prevention, and treatment of mental health and substance abuse disorders. This is classed as an Essential Health Benefit (EHB) that must now be covered.

Put together, the MHPAEA and the ACA have ensured that behavioral health benefits have been expanded for some 60 million people across the country. Programs have also been created under it to make sure that health is promoted and illness is prevented. In fact, many insurance companies now have to cover a range of preventive services without charging a deductible, co-insurance, or co-pay.

Perhaps most important, however, is that SAMHSA has used the MHPAEA to ensure that physical, addictive, and mental conditions can be treated along a continuum, simultaneously, rather than chronologically. This has helped various services integrate better, as well as promote better outcomes for those who require these types of services. SAMHSA is working closely together with the Department of Health and Human Services to ensure that there are proper projections of spending on these types of services.

Final MHPAEA Rule

The MHPAEA has come with a final rule, which has helped to implement it. This rule:

1. Ensures that parity applies to intermediate levels of care, such as treatment received in residential or intensive outpatient settings
2. Clarifies the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law
3. Clarifies that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy
4. Eliminates an exception to the existing parity rule that was determined to be confusing, unnecessary, and open to abuse.

Under the ACA, and together with SAMHSA, the Health Insurance Marketplace has been started. Any insurance company that is listed there must offer treatment options for mental health services, including addiction treatment. It is hoped that insurance companies such as Sierra Health and Life will soon be encouraged to offer wide coverage of treatment, particularly when further regulations are put in place.

What Affordable Health Care Medical Insurance Covers

According to the ACA, addiction treatment coverage has to be complete, just as it should be with other medical procedures. Hence, health care insurance companies must now include the following in their plans:

1. Brief interventions
2. Addiction evaluation
3. Clinic visits
4. Addiction treatment medication
5. Home health visits
6. Alcohol and drug testing
7. Anti-craving medication
8. Family counseling

As you can see, Sierra Health and Life covers for all of these issues. However, what SAMHSA is campaigning for under the MHPAEA is for issues such as medical detox programs and other inpatient services to be also included in the packages.

Overall, the goal of the ACA was to make sure the cost of addiction treatment is reduced, while the options for treatment are increased. Additionally, it ensures that young people can remain on their parents’ health plans for longer. This is one area where Sierra Health and Life excels in compared to other insurance providers across the country.