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Prominence Health Plan Coverage for Drug and Alcohol Rehab

As a subsidiary of Universal Health Services, Inc., Prominence Health Plan has been helping patients obtain healthcare coverage for over 25 years, including coverage for behavioral health needs.1 This means that if you have a Prominence Health Plan, you may be able to get drug and alcohol treatment fully or partially covered under your insurance.

What Is Prominence Health Plan Insurance?

Prominence Health Plan is an insurance company providing a variety of health plans, including employer-sponsored group health insurance, Medicare Advantage, and self-funded administrative services.1 Operating in Florida, Nevada, and Texas, Prominence Health Plan offers coverage for employers and individuals.1

For eligible individuals, Prominence Health Plan offers Medicare Advantage (also referred to as Medicare Part C).2 Medicare Advantage can help eligible individuals to get Part A, Part B, and Part D Medicare coverage. However, plan designs can vary, so it’s important to review what options may be available to you.3

Prominence Medicare Advantage plans include:4

  • $0 premiums
  • $0 primary care provider appointments
  • $0 virtual visits
  • $0 lab tests
  • $0 prescription medications
  • Dental, vision, and hearing aid coverage
  • Over-the-counter medications
  • Fitness perks

Other employer-sponsored plans may include:5,6,7

  • Health maintenance organizations (HMO): With this type of plan, members typically must get care from providers in-network to use their coverage plan.
  • Preferred provider organizations (PPO): This type of plan presents cost savings to those who use doctors, hospitals, and other facilities within the plan’s network. Members can typically receive care outside the network at a greater cost.
  • Point-of-service (POS): These plans combine the lower costs of an HMO plan with the flexibility of a PPO, and Prominence POS plans operate with a three-tier benefits package.
  • High deductible: High deductible health plans have low premiums but a high annual deductible. They can help employers manage high health care costs while offering flexibility to employees.

Does Prominence Health Plan Cover Drug and Alcohol Rehab Treatment?

Your Prominence Health Plan will provide coverage that is specific to your health plan details. However, under the Affordable Care Act (ACA), there are essential health benefits that health plans in the United States must cover.8 One essential health benefit is mental and behavioral health, which means that drug and alcohol rehab treatment may be partially or fully covered under your PHP health insurance plan.9

Coverage specifications vary based on your plan, your location, and the facility at which you receive care. Be sure to talk to an insurance representative to confirm your coverage details before seeking treatment whenever possible to avoid surprise medical bills.

Types of Addiction Treatment that Prominence Health Plan May Cover

Several treatment types may be covered by your Prominence Health Plan, including:

  • Medical detox: Medical detox is often the first step in addiction treatment. In this treatment, medical staff provides medication and support to mitigate withdrawal symptoms, helping a patient rid their body of a substance safely.
  • Inpatient programs: Also referred to as live-in or residential programs, inpatient rehab involves a patient staying overnight in a facility for any number of days, weeks, or months to receive around-the-clock care and support in overcoming their addiction.
  • Outpatient programs: With standard outpatient rehab, a patient comes to a facility a few times a week to receive care while living at home.
  • Intensive outpatient programs: Typically designed for those who are transitioning out of inpatient care but still need more support, IOPs often involve a patient receiving treatment around 3 times a week for 2 to 3 hours each treatment session.
  • Partial hospitalization programs: These programs are also referred to as day programs and involve patients meeting 5 to 7 times a week for several hours of the day to receive both medical and nonmedical rehab treatment.
  • Aftercare: Aftercare programs are designed to help patients maintain recovery by finding ways to prevent relapse and achieve a fulfilling life free from substance use. Aftercare may include ongoing counseling or treatment after attending inpatient or outpatient rehab.

Check Your Prominence Health Plan Coverage

Finding a rehab center to meet your unique needs and that is in-network with your Prominence Health Plan can feel overwhelming. The good news is, several rehabs may cover some, if not all, of the cost of rehab. Knowing exactly what is covered can provide you peace of mind so you can focus on what matters. To learn more about what your Prominence Health Plan covers, you can call the number on the back of your insurance card, verify your insurance online, or fill out the form below.

What Rehab Centers Take Prominence Health Plan Insurance?

Finding a rehab center that takes your insurance policy can make it easier when accessing treatment and can provide comfort knowing that you are financially secure while you focus on your recovery. AAC has rehab centers across the U.S. including the Desert Hope Treatment Center which accepts Prominence Health Plans as of January 1, 2022. Located in Las Vegas, Nevada, Desert Hope Treatment Center provides individualized rehabilitation treatment.

Do Rehab Centers Need to Be In-Network?

To ensure that your addiction treatment is at least partially covered by your Prominence Health Plan, it’s a good idea to select a rehab facility that is in-network. In-network simply means that your insurance company has a contract with the rehab. This generally translates to lower health care costs for you. If your plan does happen to cover out-of-network providers, it will likely do so at a lower rate, resulting in higher health care costs for you.

Does Prominence Health Plan Cover Mental Health Treatment?

The ACA mandates coverage for mental and behavioral health services in some capacity.9 Specifically, most health plans must provide some level of coverage for treatment of substance use disorders (SUDs), inpatient mental and behavioral health services, psychotherapy, and counseling.9 This mandated coverage makes it possible for those who need both stand-alone and co-occurring treatment to get the care they need. For the millions of Americans with co-occurring substance misuse and mental health disorders, treating both disorders may be an effective path to recovery.10 The ACA’s mandate helps make that possible by requiring plans to cover the cost of care.

Does Prominence Health Plan Cover Private and Luxury Rehabs?

Some patients may prefer facilities with specific amenities such as private rehab or luxury rehab. These programs often come at a higher cost, but your Prominence Health Plan may provide some coverage. Whatever rehab you choose, verifying your benefits ahead of time can help you know what will and will not be covered.

How Much of the Rehab Cost Does Prominence Health Plan Cover?

How much of rehab is covered by your Prominence Health Plan will vary on several different factors, including your selected plan, where you live, the extent of care you need, and where you receive that care. Verifying your benefits ahead of time with your insurance company or rehab center can make a big difference in determining what your out-of-pocket costs—if any—will be. Call the number on the back of your insurance card or contact AAC at to learn more.

What Should I Do if the Cost of Rehab Is Not Fully Covered?

Your health plan may not cover the cost of rehab, but you shouldn’t let this deter you from seeking treatment. If the cost of treatment isn’t covered, there are other options to help pay for your out-of-pocket expenses including crowdfunding, fundraising, loans, payment plans, and scholarships. Many facilities also offer sliding scale options which can help cover the cost of treatment.

Learn More About Your Rehab Options

AAC is dedicated to helping individuals struggling with drug or alcohol addiction connect with treatment programs and rehabs that can help them. If you want to learn more about addiction treatment or have questions about your Prominence Health Plan coverage, you can contact us 24 hours a day at or sign up for personalized text support if you’re not ready to talk.

 

More resources about Prominence Health Plan Coverage for Drug and Alcohol Rehab: