An introduction to Kaiser Drug Rehab

The treatment for drug addiction can get really expensive. The costs get even higher when you have a long history of addiction, and you need medications for detox and rehabilitation. In some cases, drug users have to live in rehab centers during treatment, which means the costs go even higher. So, what options do you have if you or your loved one wants to finance their rehabilitation? One of the best payment options you have is insurance.

Most insurance policies don’t cover comprehensive drug addiction treatment, though. You need to make sure that you consult your policy provider to know whether your specific substance use disorder is covered.

With that said, Kaiser Permanente provides one of the best covers for drug addiction treatment. The company is known to provide a myriad of excellent plans that either cover the whole or most of the treatment. They also have plans for both residential and outpatient care.

Who is Kaiser Permanente?

Kaiser Permanente is a leading not-for-profit organization founded in 1945. The organization consists of three organs:

  • Kaiser Foundation Hospitals
  • Kaiser Foundation Health Plan
  • Permanente Medical Groups

As of 2017, the organization had 39 hospitals, more than 680 medical offices, 22,000 doctors, 57,000 nurses, and over 11.8 million members. This goes a long way to show just how massive the healthcare provider is. They’re also spread across 8 states, which include: California, Hawaii, Colorado, Oregon, Washington, Virginia, Maryland, and Georgia. 

Kaiser Permanente Health Plans

Kaiser Permanente has several health plans. These include:

Employer-based plans

These are also known as group plans. The policies are offered to business which provides health insurance to their employees. The premiums for employer-based plans are usually deducted from the employee’s paycheck. 

The following are some of the group plans that you can get from Kaiser Permanente:

Deductible Plans – These are also referred to as traditional plans. The plan has monthly premiums and may require copays at times. The plan participant may also pay the fees until all set deductibles are met.

Preferred Provider Organization Plans (PPO) – Say you live in an area that is out of the 8 states covered by Kaiser Permanente, but you still want to take advantage of their plans. PPO is one of the best ways of doing so. The plan will also allow you to go for a non-preferred physician. The pitfall here is that you’ll have to pay higher rates as compared to in-network plans.

Point of Service Plan – Point of Service Plan blends the HMO and PPO plan. This basically means that you can choose to utilize either out-of-network or in-network facilities and care providers.

Out-of-Area Plan – The plan carters for individuals living outside the areas covered by Kaiser Permanente. Most preventative services are usually covered here while the rest are either cost-shared or subject to deductible amounts.

Consumer-Directed Health Plans – You can find different plans here including Flexible Savings Account (FSA) under which one’s contributions to different medical expenses are considered pre-tax; Health Savings Account (HSA) plan which is tax-free used for paying medical expenses and Health Reimbursement Account (HRA) where employers pay for qualified medical expenses.

Individual Plans

There are many kinds of individual plans which differ based on the copays, deductibles, out-of-pocket expenses, and monthly premiums. These plans can be categorized as Platinum, Gold, Silver, and Bronze, with Platinum being the most expensive and comprehensive, while Bronze is the cheapest coverage. 

Some of the covers that you can get under Individual Plans include:

Copay Plans – Copay plans offer full coverage for preventive services. No deductible amount is required for these services. All other services will require copayments, though.

Deductible Plans – Most preventative services are fully covered under this plan. For extensive coverage, the policyholder will have to pay fees until they hit the deductible amount. Some services may also have copays under these plans.

Health Savings Account (HSA) Plans – HSA plans combine medical and pharmacy plans costs deductibles. All costs are paid out-of-pocket until the deductibles are met. A percentage of the costs will then be covered until one reaches the maximum out-of-pocket cap.

Deductible catastrophic – Deductible catastrophic is a decent option for young individuals or people experiencing financial constraints. The plan covers 3 doctor’s visits per year. Most preventative services are also covered here. All other fees are charged out-of-pocket until the maximum annual deductible amount is reached.

Medicare

Kaiser Permanente has special Medicare plans that offer more comprehensive coverage than Standard Medicare. The plans are aimed at adults aged 65 years and older. The two main Medicare plans offered by Kaiser Permanente are Senior Advantage Basic and Kaiser Permanente Senior Advantage. Both of the plans are HMO, but the coverage will vary depending on the region and the specific plan you select. The copays are usually low here, and they only apply for services and prescriptions and not preventative services.

What Do Kaiser Permanente Cover?

Medical necessity must be demonstrated for the specific drug-related treatment to be covered. This is mandated by the Affordable Care Act. You must, therefore, make an initial visit to a physician to diagnose the condition and determine which treatment is covered under your plan.

Some of the treatments that are covered (could be fully or partially depending on your plan and region) include:

Inpatient Treatment

Inpatient treatment offers intensive care to individuals with substance use disorder. They get 24-hours supervision among several other amenities that promote recovery. For Kaiser Permanente to cover your inpatient treatment costs, a physician must provide enough documentation demonstrating the medical necessity. They are further required to provide some of the goals that the treatment is supposed to achieve. They should then provide updates periodically, showing how well the patient is fairing and how close they are to achieving the set goals.

There are limitations to the Kaiser coverage for inpatient treatment, though. For instance, the plan may only cover the treatment for a specific period e.g., 30 days. In some cases, inpatient treatment cover may only be approved if outpatient treatment was unsuccessful.

Some of the inpatient services that may be covered include group therapy, medication-assisted treatment (MAT), aftercare support, discharge planning, and counseling.

It should be noted that some rehab centers do not accept Kaiser Permanente. You can speak to treatment specialists to determine whether there are facilities in your area that accept the cover.

Outpatient Treatment

Kaiser Permanente can significantly reduce the costs of your outpatient treatment by working with eligible facilities and providers. The plans may cover different outpatient services, including prescription medications, individual and group counseling, medical services for withdrawal, intensive outpatient programs, and partial hospitalization or day-treatment programs.

Medication-Assisted Treatment

MAT combines medication and behavioral therapy to treat withdrawal symptoms and substance use disorder. It is one of the most effective approaches to dealing with drug addiction. Not only does it help with recovery, but it reduces the risk of relapse as well.

Kaiser Permanente plans to cover this treatment, but the extent of the cover will depend on the specific plan you have and other factors. You may want to speak to a Kaiser representative to understand whether your plan covers MAT.

Medical Detox

Kaiser plans may carter for the treatment and management of withdrawal symptoms.

Final Thoughts

Rehab treatment can be very expensive, especially when it is paid out of pocket. The costs are known to discourage so many people from seeking the right treatment. Kaiser Permanente helps to take this financial burden off you. They may not offer full coverage in certain cases, but their covers are still very decent. These don’t just help you save cash, but they also allow you to focus on your treatment and recovery without getting anxious or worrying about how you will pay for your next appointment.

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