Drug abuse is a major problem in our society. Unfortunately, a lot of people suffering from this issue refrain from getting the necessary help because of the stigma attached to this problem. With the growing number of drug rehab facilities and the availability of health insurance, it has become easier for everyone to get the much-needed help and recover from the problem. If you are covered under TRICARE, here’s how the insurance can cover your drug rehab treatment.
Does TRICARE Cover Inpatient Treatment?
Individuals must meet certain criteria if they want TRICARE to cover their inpatient treatment at a TRICARE-approved drug rehab. These criteria include the following conditions:
- The individual needs to have a formal substance use disorder diagnosis
- The individual has severe withdrawal symptoms that require the intervention of a physician
- The individual struggles to function in everyday life
When these conditions are met, TRICARE will cover inpatient addiction treatment for both emergency and non-emergency cases. In emergency treatment, where the individual requires immediate medical attention, TRICARE will cover the costs of detoxification, stabilization, and other medical complications.
For non-emergency treatment, you need prior authorization from TRICARE before coverage is provided. Here, coverage typically includes detoxification and stabilization. Depending on the plan, it may also include treatment for additional co-occurring mental health conditions.
Does TRICARE Cover Outpatient Rehab Treatment?
Outpatient rehab is appropriate for individuals who need treatment for drug abuse but do not require 24/7 medical assistance and supervision. TRICARE offers coverage for this type of rehab as well. People usually go to outpatient rehab after completing an inpatient treatment program, as it allows them to step down or transition from a more intensive treatment program.
The basic concept of outpatient rehab allows patients to live in their homes or in a sober living environment during rehab. Depending on the nature of treatment, there are two major forms of outpatient options available in the US:
- Partial Hospitalization Programs (PHPs): Also referred to as the halfway point between inpatient and outpatient rehab, PHPs are intensive and highly structured outpatient treatment programs. The evidence-based therapies and care in this outpatient rehab are similar to those in the inpatient option, but the level of care is slightly lower.
- Intensive Outpatient Programs (IOPs): In this form of outpatient treatment, therapies are usually similar to inpatient treatment but less intensive. They also have fewer sessions per week than those on PHPs.
It is important to note that the coverage limitations, preauthorizations, and out-of-pocket costs vary depending on TRICARE plans, facilities, and other factors. Having said that, TRICARE covers all outpatient rehab treatments, including standard outpatient rehab, PHP, and IOP.
Do Drug Rehabs Need to Be In-Network?
TRICARE usually offers full coverage for the treatment centers approved by the insurance provider. These in-network rehab centers have a pricing agreement with TRICARE for billing addiction treatment services. Individuals undergoing addiction treatment at these in-network rehab facilities only need to pay a small portion of the cost as an out-of-pocket expense.
Patients covered under TRICARE plans, such as TRICARE Select, Reserve Select, Retired Reserve, Young Adult Select, Family Health, and Prime Remote, are allowed to use the out-of-network provider for drug rehab treatment. In such scenarios, however, they may need to file individual claims and pay a higher percentage of the service cost.
In some cases, out-of-network providers may charge you up to 15% more than the allowable limit. Some TRICARE clients may also need to cover the full cost of out-of-network services and then seek reimbursement from the insurance provider once the treatment is completed.
How to Pay for the Costs Not Covered by TRICARE?
As long as you choose a TRICARE-approved rehab center, you are only required to pay a minimum amount outside the TRICARE coverage. However, you will have a higher out-of-pocket cost when you choose a non-network provider. You can work out a payment plan with the rehab center to cover the remaining cost. It is wiser to determine your coverage, benefits, and additional expenses by speaking with a TRICARE representative.
Wrapping Up
TRICARE insurance covers a majority of the expenses related to your drug rehab treatment as long as you satisfy certain criteria. If you are covered under TRICARE, it is better to choose an in-network provider for your drug addiction treatment. However, you can pick an out-of-network facility for your treatment if you are willing to pay a larger sum out of your pocket.
