Addiction Treatment Covered by SelectHealth Insurance

A local not-for-profit healthcare insurance company, SelectHealth offers coverage for members residing in Utah and Idaho. Serving around 800,000 members, SelectHealth is integrated with Intermountain Healthcare to offer a full continuum of care for its policyholders.

SelectHealth Plans

SelectHealth offers a range of plans at different levels, such as Gold, Silver, Expanded Bronze, and Bronze. Gold-level plans have the highest monthly premiums and lowest out-of-pocket expenses, and bronze-level plans are the reverse of this. Types of SelectHealth insurance plans include:

• Catastrophic plans: These plans are for people under 30 or those who qualify for a hardship exemption. They typically offer coverage with high deductibles and out-of-pocket costs in the case of a medical need, but with low monthly premiums to keep regular costs low.
• Benchmark plans: While being less costly than a traditional plan, these plans provide coverage only for essential health benefits (EHBs), which are defined by each individual state. Behavioral healthcare and addiction treatment are considered to be an EHB via the Affordable Care Act (ACA).
• HealthSave plans: These plans are often combined with an HSA (health savings account) and generally offer low monthly premiums and higher deductibles. An HSA is tax-exempt money that can be used to pay for medical expenses. HealthSave plans are flexible, allowing members to spend healthcare dollars as needed.
• Traditional plans: Offering a wide range of choices, these plans provide coverage for preventative care, medical services, and prescription drugs, often through providers within the network.

Drug detox and rehab services may be included through SelectHealth insurance. Members can use the My Health tool to better understand their personal coverage, plan information, benefits, what may be covered and to what extent, and how to use insurance coverage to pay for treatment services.

Navigating SelectHealth Insurance

The first thing to do when looking into insurance coverage for substance abuse treatment services is to connect with the insurer directly. A SelectHealth representative can walk individuals through their benefits and how to use their coverage effectively as a form of payment. Another great resource is the individual substance abuse treatment provider. Individuals should look into insurance coverage prior to enrolling in a substance abuse treatment program as often at least some of the services will be covered to an extent.

SelectHealth policyholders may need to obtain verification for services before receiving them in order for coverage to be used. This may come in the form of a referral from a primary care provider (PCP) or other in-network professional or from a preauthorization form obtained from SelectHealth. Substance abuse treatment services must often be deemed clinically or medically necessary first before coverage can be used.

Often, outpatient treatment programs need to be attempted first before inpatient treatment services are covered. SelectHealth insurance holders may need to remain in-network to obtain specialty services such as addiction treatment. Depending on the specific plan held, providers that are out of the network may still be an option, albeit for a higher rate.

Members are responsible for keeping up with monthly premiums in order for coverage to remain current, and often, a deductible will need to be reached prior to coverage kicking in. A deductible is a yearly amount that policyholders will pay out of pocket and includes all medical expenses. Once a person has reached this annual deductible, coverage begins.

Members are still responsible for any copays (a set amount paid to the provider when services are rendered) and coinsurance after the deductible is reached. Coinsurance is the rate that individuals pay after insurance pays the rest. A coinsurance rate may be 20 percent, for example, which means that after SelectHealth covers 80 percent of the cost of eligible services, the member pays the remaining 20 percent of the costs.

Services may have an “allowable” amount, too, which means that SelectHealth will pay for these services up to a certain amount, and the member is responsible for the remainder. There is a cap on the amount a policyholder can pay out of pocket each year; after this maximum is reached in a calendar year, any other eligible medical expenses will be covered in full.

Substance abuse treatment services, such as detox, therapy, life skills training, educational programs, and recovery support, may all be at least partially covered through health insurance. Both the insurance provider and treatment provider can help families learn how to maximize coverage to minimize their personal costs.