Humana Healthcare Insurance for Recovery from Addiction

The journey of recovery from addiction starts with finding the best treatment center that’s suited to your unique situation and needs. Health insurance plans, like those offered by Humana, can help cover most or all of the cost of treatment, so that a successful recovery is the main focus.

Brief History of Humana Health Insurance

Humana is a health insurance industry giant that insures 13 million people in the United States. 1 Headquartered in Louisville, Kentucky, Humana is a leading managed health care company. Founded in 1961 by David A. Jones Sr. as a nursing home company, in 1972 the company moved into the hospital business. The company was named Humana in 1974. Humana moved away from the hospital business and into health insurance in the 1980s and completely left hospital business behind by the 1990s.

What Plans Are Offered by Humana? 

Humana offers health insurance to groups via companies where people work. As of 2018, Humana no longer offers individual medical insurance. 2 Also, Humana offers Medicaid and Medicare Advantage Plans, as well as pharmacy coverage.

The following information applies to health insurance obtained through an employer. It does not apply to Medicare or Medicaid plan members. If you have any questions, it’s best to contact an admissions specialist at the treatment center you’re considering for specific coverage details.

Is Treatment Accepted by Insurance?

Humana provides addiction recovery and mental health care services via their subsidiary called Humana Behavioral Health. 3 The behavioral health services Humana provides use a holistic (mind and body) approach to treating a person’s mental and emotional health. A holistic approach fosters faster recovery, improves outcomes, boosts job productivity, and ultimately reduces healthcare costs for employers as well as employees. Another major benefit of having Humana health insurance is that they provide data to encourage employers to address an employee’s behavioral issues early and apply the best treatment methods, which also helps drive down costs. 4

Most people who have Humana medical insurance have substance abuse treatment coverage, and the level of coverage can vary between plans. It’s best to check with Humana or contact an admissions specialist at the treatment center you’re considering to determine the specific level of coverage you have.

Behavioral health benefits are coordinated by Humana Behavioral Health and includes the following services:

  • A participating behavioral health network of individual providers, hospitals, and mental health and substance abuse treatment programs
  • Coordination of treatment and services
  • Provide assistance for questions or concerns involving behavioral health
  • Case management services for people who have undergone multiple hospitalizations or have behavioral health requirements that call for frequent and continuing assistance.

Humana Plan Coverage for Addiction Recovery Treatment 

Your individual plan will specify what addiction recovery treatment services your Humana plan covers. Different factors such as where you live, what is required by law, and the kind of treatment you’re seeking will all play a role in your coverage. Humana offers plans where you can purchase a separate addiction treatment plan if your current coverage doesn’t cover rehab.

Humana uses the American Society of Addiction Medicine (ASAM) as a basis for its guidelines for placement, continued stay, and the transfer and discharge of those with addiction and co-occurring mental health conditions. 5

For substance abuse treatment services to be eligible for Humana coverage, they must be a medical necessity as well as specifically covered. Different treatment service options that Humana plans cover include:

Understanding Costs: How Do I Pay for Treatment? 

When you contact an admission specialist at Silvermist Recovery, we work with you to get the most out of your insurance coverage. To clarify some of the terms we may use, the following are some basic health insurance terms, their meanings and some cost examples.

Claim:

A claim is a bill your health providers, such as a doctor, therapist or treatment center sends Humana to get payment for services they provided to you. When Humana receives the bill, it then becomes a claim. Humana handles your claim and sends you an Explanation of Benefits (EOB) that shows what they paid and what you may owe your provider.

Claim payment:

Typically, when you use an in-network Humana provider, the provider files the claim to Humana on your behalf. There may be times when you pay the provider, and then ask us to reimburse you (make a claim payment) for services covered by your health plan.

Coinsurance:

After any plan deductibles, you may also have to pay for part of the cost of services you receive. This is called coinsurance. For example, if your health plan covers 80% of the cost, your coinsurance payment is the 20% that’s left.

Copayment:

A copayment, also called a co-pay, is the flat amount you are responsible to pay to a healthcare provider or pharmacy at the time of the service. Copayments are determined by your plan and services received. For instance, you may have to make a $30 copay for a doctor’s office visit.

Deductible:

Your deductible is the sum of money you pay toward specific medical expenses before your insurance company covers any costs. Your plan may have different deductibles for different types of services. For instance, you may have one deductible for medical care and another for prescription medications. Also, if your plan has benefits for in-network and out-of-network care, you’ll have separate deductibles for each. Your plan coverage details will specify your deductibles.

Out-of-Pocket Maximum:

Humana plans help safeguard you by providing an out-of-pocket maximum that is the most you’ll pay for medical expenses that are covered within one plan year. The portion of medical expenses that you pay are added to a total for the plan year, such as deductibles and copayments. As soon as you reach the out-of-pocket maximum, your Humana plan pays 100% of covered services. Check your plan details for your out-of-pocket maximums.

Payment to Providers:

Your part of the medical or prescription drug expenses can be paid to your provider by cash, check or credit card depending on what methods of payment your provider accepts. You can also use your Health Savings Account (HSA) to make payments to providers.

Provider:

A provider is a place (such as a treatment center) or a person (such as a therapist or doctor) that gives you medical care. You can find a list of providers in your network on the Humana website.

Young Adult Coverage:

If your child needs addiction treatment and has no coverage, even if he or she is no longer a minor, you can add your adult child (under 26 years old) to your health plan to cover rehabilitation expenses. Under current law, when your Humana plan coverage includes children, your child can be added or kept on your health insurance policy up until they reach 26 years old. 6 Children can be added or stay on their parent’s health plan even though they’re attending school, not residing with their parents, married, not dependents of their parents, or eligible to join their own employer’s plan.

What Services Are Covered by My Humana Plan?  

To get maximum coverage from Humana, see if the provider you’re considering is in your network. A network is all the providers in an area that are contracted with Humana. All providers within the Humana network agree to give healthcare services at lower costs for Humana clients.

In-network providers submit your claims to Humana on your behalf. Out-of-network providers may be more expensive, and you’ll possibly have to file your own claims. Some Humana plans don’t cover any out-of-network providers, except in the case of serious emergencies. Check your plan or call Humana customer service for specific details about network coverage details.

How Can I Verify My Insurance Will Cover Treatment?

At Silvermist Recovery, we are committed to providing the highest level of service to all our clients, and that starts with the admissions process. Our team of admissions specialists make the insurance verification and admissions process as simple and convenient for you as possible.

Our admissions team will verify your benefits and provide you with the information on any potential out-of-pocket expenses. Besides in-network insurance, we also accept self-payment as well as out-of-network insurance.

Contact our team any time of the day or night, we’re available 24/7. We’re here to answer your questions and help you get started on your journey to recovery.

What Do I Need Before Entering Treatment? 

Once you’ve confirmed your entry date with your treatment center, it’s time to take a few simple steps, so you can enter rehab with less worries and stresses. You might feel stressed about leaving your job and family and worry about paying your bills while you’re in treatment, but a little preparation can help you deal with these issues.

  • Let your employer know as soon as possible about your decision to enter treatment. If you’re eligible for the Family and Medical Leave Act (FMLA), you’re allowed up to 12 weeks of medical leave, so your job will be protected during your stay in treatment. FMLA applies to employees of public agencies, public and private elementary and secondary schools, and private companies with 50 or more employees.
  • If you have children or pets, ask family members or friends you trust to help look after them. You could also look into paid options for temporary care. You’ll be more at ease knowing the people and pets you love are in good hands while you’re away in recovery.
  • Tackle your bills by prepaying whatever you can before you enter rehab or signing up for automatic payments. If you have someone you trust, you can leave the bill paying to that person.
  • Get together what you’ll need to bring to rehab. Treatment centers have strict policies about what you can bring with you to treatment. Silvermist Recovery will give you a checklist of permitted (and prohibited) items.

Is There a Difference Between Public and Private Treatment? 

Not everyone has the same financial resources to pay for substance abuse treatment. Some people with insurance can go to a private treatment center, because their plan covers some or all of the costs. Others don’t have any type of insurance or assistance and must depend on government resources.

What Is Private Treatment?

Private treatment provided by a nonprofit or for-profit organization places the responsibility of paying for the total cost of treatment on the client. Private drug and alcohol rehab ranges from affordable to luxury, so if you choose private treatment, you’ll have a wide range of choices.

There are several advantages in choosing a private substance abuse treatment center:

  • Since you’re paying, you’ll have more options and input over your course of treatment.
  • Many private rehab facilities take you right away with no waiting.
  • More holistic options are available in private rehabs such as yoga for recovery, exercise workouts, nutritional and meal planning support, equine therapy and art therapy.
  • Private rehabs have a smaller number of patients, so you can receive more personalized care. At Silvermist Recovery, we have a 1:5 clinician-to-client ratio.

What Is Public Treatment?

Insurance or financial assistance offers you more treatment choices, but if you don’t have insurance, you can enter public treatment programs run by the state, a nonprofit organization or a private organization. These programs have made significant impacts in getting people away from substance use and abuse and onto the path of recovery using public funding and/or donations.

Public addiction treatment is open to anyone, but mostly people with no insurance attend this type of rehab. Public treatment facilities typically have waiting lists, and it can take time to be accepted into a program. If you go to detox but then must wait for treatment, this gap can cause a relapse back into drug or alcohol abuse.

Public treatment can differ from private treatment centers. Group meetings and counseling are offered by both types of programs, but the personalization of care in public programs may not be as high as private treatment. Also, there are typically no extra perks that you’d find at a private rehab. If the public treatment center has many clients, to accommodate everyone, rehab will probably focus more on the group rather than the individual.

Since public rehab facilities are funded by the government, there are usually less accommodations and staff. You may have to share a room with four or more people. Certain therapies may not be offered because of budget limitations. Many of the people who are court-ordered to attend treatment end up at public rehabs, so not everyone is as committed to recovery as they would be at a private center where they’re paying to be there.

How Can I Pay for Private Treatment? 

If you or a loved one is struggling with addiction, you will probably find it best to enter private treatment, because the high level of personalized care you’ll receive may make the difference in getting and staying sober. The best approach is to work directly with the facility of your choice and determine the options available to you.

Silvermist Recovery accepts several insurance plans. Depending on your plan and insurance carrier, treatment may be covered in full or partially. Silvermist offers high-quality, premium care at an affordable cost. Contact our team any time of the day or night, we’re available 24/7.