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Geisinger Health Plan Insurance Coverage for Drug and Alcohol Rehab Treatment

Table of Contents

Does Geisinger Insurance Cover Alcohol and Drug Rehab?

The Geisinger health system can provide coverage for drug and alcohol rehab with its plans through Marketplace, Medicaid, and Medicare. Geisinger Marketplace caters to families lacking employer coverage and individuals under age 65, offering a variety of plans to meet your needs.1 If you live in Geisinger’s service area of Pennsylvania and qualify for Medicaid, Geisinger has comprehensive healthcare options available too.1 Those with Medicare are about to access healthcare benefits through Geisinger Gold.1

If you’re uncertain about what your plan entails, you can have a rehab center check your coverage for you based on the plan information you provide. You can also call the phone number on the back of your insurance card to learn more about your plan’s specifics.

Check Geisinger Insurance Coverage for Addiction Treatment

Geisinger health plan options can cover some or all of your stay in rehab depending on the level of coverage you have. As part of their behavioral health support services, Geisinger offers addiction coordinators who can help when you are in the hospital, emergency room, medication-assisted treatment (MAT) clinic, or in a rehab facility.2 (“Addiction coordinators”) Certified peer support is also available for those with substance use disorders, as are certified recovery specialists who are stable in recovery from their own addictions.2 (“Certified peer support”; “Certified recovery specialist”)

Bear in mind that different plans carry different copays and deductibles. For example, the Select HMO Plan 20/40/300 has a $20 copay per visit to in-network outpatient services while there is a $250 copay/admission fee for in-network in-patient services.3 (Page 3). Out-of-network services are not covered.3 (Page 3) If you don’t know whether your chosen rehab is in-network you can use the form to enter your information and immediately see if they are in-network or out-of-network. You can also call the American Addiction Centers (AAC) helpline to have a representative check your insurance coverage right over the phone.

What Is Geisinger?

Geisinger started in 1972 as a rurally centered, prepaid health plan offered as a pilot program for Geisinger Medical Center’s employees as well as residents of the five counties that surround its central location in Danville, Pennsylvania.4 (“Our beginnings”, paragraph 1) Geisinger received its Certificate of Authority to function as an HMO in 1985 under the directive of the Pennsylvania Health Maintenance Act of 1973. 4 (“Our beginnings, paragraph 2)

Since the beginning, Geisinger has strived to keep healthcare affordable. They now offer several coverage options and have received national recognition for their ways of effectively managing medical cost and bettering outcomes for the people they cover.4 (“Keeping healthcare affordable”, paragraphs 1-2)

What Will Geisinger Insurance Cover?

As part of their coverage, Geisinger insurance covers multiple types of rehabilitative services.5 You may receive inpatient/residential rehab treatment, outpatient addiction treatment, intensive outpatient programs (IOP), or partial hospitalization programs (PHP).5 They will provide coverage for medication-assisted treatment (MAT), which can be used to help reduce cravings as you start your rehab treatment.6

As part of outpatient addiction treatment, you can get consultations and assessments if you have a history of addiction or have pain and addiction.5 IOP is included with group therapy, but you can also get access to individual therapy, minor withdrawal management from a specialist, and peer support groups.5

Does Geisinger Insurance Cover Inpatient Mental Health Care Facilities?

At any given moment, there are about 9.2 million American adults with co-occurring disorders—a coexistence of a substance use disorder and at least one mental health condition.7 (Paragraphs 1-2) There isn’t a precise combination of these two disorders that prevails, but anxiety and mood disorders, bipolar disorder, and major depressive disorder are considerably common co-occurrences with substance use disorders.7 (Paragraph 5)

Upon enactment of the Affordable Care Act, Medicaid coverage was expanded, and increased coverage was established by providing subsidiaries for coverage purchase in the non-group market. 8 (“The Affordable Care Act and Behavioral Health”, paragraph 1) This enabled more people with co-occurring substance use disorders who were then eligible to seek help from rehab facilities. 8 (“Medicaid Expansion”, paragraph 4) What this means is that health insurance providers had to make provisions in their plans for treating co-occurring disorders.

How Long Does Geisinger Insurance Cover Rehab?

Geisinger coverage and costs will vary depending on how long you remain in rehab, and your stay itself will be beholden to your recommended treatment plan. Research demonstrates that positive rehab outcomes are associated with a sufficient treatment period.9 Participation of 90 days or longer is shown to be more effective than stays lasting for a shorter period, illustrating that lengthier rehab stays help generate and maintain more positive outcomes.9 (Paragraph 1)

Since Geisinger has multiple plans and tiers to choose from, you must learn what your plan covers before you schedule your stay in a rehab facility. You can use the information on your insurance card to look up your plan’s coverage details.

What if My Geisinger Policy Does Not Cover Rehab?

Geisinger behavioral health coverage might not cover the entirety of your stay in a rehab facility, but there is the possibility that financial assistance through scholarships, grants, or other types of special funding can help. You can also check with local faith-based charities and churches to see if they are able to offer any assistance. You might also want to contact the facility of your choice to see if they offer financial assistance.

Waiting to get treatment will clearly not help you right now and reaching out for help only takes a few minutes, even starting with searching “Geisinger near me.” That is why it is important to know what your plan covers and how much you should expect to pay out-of-pocket.

Geisinger In-Network vs. Out-of-Network Rehab Centers

Geisinger has coverage for detox and rehab centers found in-network. The term “in-network” essentially means that these facilities already work with Geisinger. A rehab center that is out-of-network does not currently take Geisinger’s plans. You can check to see if your selected rehab facility is in-network or not by checking with your insurance provider, with the facility, or by letting AAC validate your health insurance coverage for you.

Geisinger Plans

Geisinger plans provide some degree of coverage for addiction treatment, including inpatient addiction treatment services like full detox, group therapy, and specialized dual-diagnosis services. Geisinger plans can cover stays in other rehab facilities. You will need to check your insurance to learn more about its Geisinger mental health and substance use disorder coverage details.

Sources:

  1. (2021). Plans.
  2. (2021). Behavioral health.
  3. The Health Plan. (2021). Geisinger health plan: Select HMO plan 20/40/3000.
  4. (2021). History.
  5. (2021). Addiction treatment.
  6. (2021). Medication-assisted therapy.
  7. Substance Abuse and Mental Health Services Administration. (2021). Co-occurring disorders and other health conditions.
  8. Frank, R.G., Beronio, K., and Glied, S.A. (2015). Behavioral health parity and the Affordable Care Act. Journal of Social Work in Disability and Rehabilitation, 13(0): 31-43.
  9. National Institute on Drug Abuse. (2018). How long does drug addiction treatment usually last?