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Providence Health Insurance Coverage for Drug & Alcohol Rehab

Providence Health insurance provide a variety of health services through a portfolio of integrated health care plans and related services. Those with Providence insurance may have confusion about what their insurance plan covers when it comes to substance abuse and mental health services. This page is intended to help you figure out what your Providence healthcare does and does not cover when it comes to drug and alcohol addiction treatment.
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Providence Health & Services is the third-largest non-profit health system in the country, which serves over 375,000 people throughout the state of Oregon and in southwest Washington.1 Providence Health insurance covers individuals, families, and recipients of Medicaid and Medicare. If Providence Health is your insurance carrier, your policy covers some or all of your costs for drug and alcohol addiction rehabilitation and treatment. Your specific coverage depends on the plan you have. Read on to learn more about Providence Health & Services insurance for substance use disorder (SUD) treatment as well as what to do if some or all of your treatment isn’t covered.

What is Providence Health Insurance?

Providence Health & Services is the third-largest non-profit health system in the country, which serves over 375,000 people throughout the state of Oregon and in southwest Washington.1 Providence has been around for more than 160 years and is a not-for-profit healthcare collective that serves people in the pacific northwest. Providence Health Plan offers commercial group, individual health coverage and ASO services.1

What Are Providence Health Plans and Coverage?

Providence Health Assurance is an HMO, HMO‐POS and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Health Assurance depends on contract renewal.1

Providence Health insurance plans are offered in a variety of packages and tiers. They are divided into 3 primary types: Connect, Standard, and HAS Qualified plans.2

  • Connect Plans: Connect plans combine a medical home model of care with a large interconnected provider network in the Pacific Northwest. You can select your own medical “home” of your choosing, which gives you access to a team of healthcare providers that support you in all your health needs, including SUD treatment. There are no out-of-network benefits, so it is important to choose in-network providers with this package.
  • Standard Plans: Providence’s Standard plans are determined by the state of Oregon, and your provider network is chosen for you based on the county you live in. Standard plans for substance use disorder treatment do not include out-of-network benefits. Standard plans have low copays, which makes them an excellent option for those who need frequent medical care. A referral is needed to see a specialist and for drug and alcohol rehab.
  • HSA Qualified Plans: Providence HSA-qualified plans have high deductibles but very low monthly premiums. With the high deductible, these plans mean that you will pay more out-of-pocket for drug and alcohol rehab until you meet your deductible. However, if you’ve already met your deductible, coverage kicks in for the rest of the costs. Out-of-network and specialist referrals are required with HSA plans.

Providence Health Plan Medicare Coverage

Providence Health plan Medicare offers both Medicare Advantage and Medicare Supplement plans. Medicare Advantage covers hospital bills and doctor visits and may also cover prescription drugs.3 Also, additional coverage can be added for items not included in standard Medicare.3

Providence Medicare Supplement plans provide individuals with the freedom to choose any Medicare provider or specialist nationwide and reduces out-of-pocket costs.3

Does Providence Cover Addiction Treatment?

Yes. The Mental Health Parity and Addiction Equity Act (MHPAEA) mandates that insurance providers must cover mental health and SUD treatment.4 The MHPAEA states that mental health care and substance use disorder are among the 10 basic health benefits that all insurance plans must cover in the United States, including Providence Health Plan policies.

If you have a Providence Health plan, some or all of the cost of your or your loved one’s treatment will be covered by insurance. The amount covered depends on your specific plan. To learn whether you qualify for addiction treatment coverage through Providence Health, call the phone number on the back of your insurance card or contact one of our admissions navigators.

The amount of coverage you have can vary widely based on your state of residence, whether the facility is in- or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol addiction treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.

What Different Types of Addiction Treatment Does Providence Cover?

There are several different types of rehab and treatment facility options to choose from once you’ve decided to get sober. Your Providence Health insurance plan helps cover the full spectrum of care for addiction treatment services, including:3

  • Medically assisted detox: Depending on the substance(s) you’ve used, you may need medication to help you safely detox. Withdrawing from drugs and alcohol can be an uncomfortable experience, and medical detox helps you safely withdraw. Medical supervision is provided, and licensed medical staff may prescribe medications to help you with withdrawal before you move on to the next stage of rehab.
  • Inpatient rehab: Inpatient rehab is a residential live-in facility that provides drug and alcohol treatment. Inpatient programs require individuals to live on-site for anywhere from 15–90 days, depending on your needs and the program you are enrolled in.
  • Partial hospitalization (PHP): Partial hospitalization programs allow you to live at home while attending treatment during the day. PHP programs are sometimes referred to as “day treatment.” This is a commitment similar to a full-time day job and lasts anywhere from 15–90 days.
  • Intensive outpatient: Intensive outpatient programs require you to attend treatment programs/meetings a few times a week. You may live at home and work during the day and then attend required treatments in the evenings. These programs are often preferred for people who are unable to take time off work.
  • Outpatient treatment: Many people who completed inpatient rehab then transfer to outpatient addiction treatment to continue to receive care while on their path to sobriety. You can live at home and are required to attend treatment for 10–12 hours a week, visiting the rehab facility for therapies.
  • Sober living: Sometimes referred to as transitional living arrangements, halfway houses, or recovery residences, sober living homes offer an in-between option for individuals after completing a treatment program and before returning to their homes and lives.
  • Aftercare: Aftercare describes any ongoing or follow-up treatment for substance abuse that occurs after an initial rehab program. Aftercare goals include maintaining recovery and strategies for preventing relapse.

Your copays, monthly premium, and deductible are contingent on your specific plan, and therefore, your out-of-pocket expenses for each of these rehab services may vary depending on the type of policy you have. With Providence Health, at least some of the costs will be covered by your insurance plan.

Providence Mental Health and Therapy Coverage

Many people who seek treatment for substance use disorders are also struggling with another mental health issue at the same time; this is called dual diagnosis. Dual diagnosis treatment at facilities that provide treatment covered by Providence health plans involves treatment for drug or alcohol addiction as well as another mental health issue, including post-traumatic stress disorder (PTSD), anxiety, and depression.

Types of Therapy Covered by Providence

While in treatment, there are a variety of types of therapy that you may participate in as you work on your sobriety. These may include:5,6

  • Cognitive behavioral therapy: Cognitive behavioral therapy (CBT) is a type of behavioral therapy that aims to change a person’s unhealthy behaviors by providing individualized strategies that teach them to think differently and develop other coping skills.
  • Dialectical behavior therapy: Dialectical behavior therapy (DBT) is a type of therapy that draws from aspects of cognitive-behavioral therapy (CBT) but also incorporates techniques of mindfulness and dialectics, which is the reconciling of two opposing ideas—in this case, change and acceptance.

Do Rehab Centers Need to Be In-Network to Accept Providence Health Plan?

You’ve likely come across a lot of “in-network” and “out-of-network” language in your research to find a drug and alcohol rehab facility. Essentially, a facility that is “in-network” means that Providence Health has an agreement with this particular facility to offer addiction treatment for individuals at a lower rate than other providers. Out-of-network means that Providence Health does not have an agreement with that facility and may or may not cover any or most of the costs.

Whenever possible, it’s best to choose a facility that is in-network to keep your own costs as low as possible. In some cases, Providence may cover out-of-network treatment facilities (e.g., if you live in an area where you cannot find a local rehab facility and have to travel elsewhere to get treatment).

What Should I Do if Providence Won’t Cover the Total Cost of Rehab?

Providence Health & Services policies will cover some, if not all, of your rehab costs, depending on the specific plan you have. If your policy does not cover all of the costs related to drug and alcohol rehab, you will have some out-of-pocket expenses to cover on your own. Depending on your policy, you may be responsible for paying the deductible, copays, and other expenses.

If you are worried about how to financially afford rehab, don’t let that hold you back. Nearly every rehab facility offers payment plans to help you pay back your out-of-pocket expenses over time. Some rehab centers provide scholarships and other financing options to help offset your expenses.

Speak with admissions specialists at any rehab facility you are considering so that you can get a better understanding of what will be covered and what you would be responsible for paying. No matter the cost, what is most important is getting sober. Nothing is more important than your life, so don’t let worrying about money hold you back from getting the help you need.

The following links can help you find information on other ways to cover the total cost of rehab if your insurance policy does not cover all costs.

Understanding how your Providence Health & Services coverage will help cover the cost of drug and alcohol addiction treatments can provide you with peace of mind while you focus on getting and staying sober. Take some time to research what is covered and know that you are not alone. We understand that it can be overwhelming even knowing where to begin. For more information on what your Providence Health Plan insurance covers for rehab, call the number on the back of your insurance card or contact one of our admissions navigators, who can provide you with information, guidance, and support.

Check Your Providence Addiction Rehab Coverage

Knowing exactly what Providence Health & Services plans cover can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Providence insurance plans and to check what your plan covers, call click here, or fill out the form below. You can also use our directories tool to help with finding Providence in-network addiction rehab.

Sources

  1. Providence Health Plan. (n.d.). About us.
  2. Providence Health. (2021). 2021 plan overview.
  3. Providence Health. (2022). Medicare.
  4. Healthcare.gov. (n.d.). Mental health & substance abuse coverage.
  5. American Psychological Association. (2017). What is cognitive behavioral therapy?
  6. Linehan, M.M., & Wilks, C.R. (2015). The course and evolution of dialectical behavior therapyAmerican Journal of Psychotherapy, 69(2), 97-110.
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