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HealthScope Insurance Coverage for Alcohol and Drug Addiction Treatment

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Does HealthSCOPE Insurance Cover Alcohol and Drug Rehab?

HealthSCOPE is a third-party administrator company in the United States that administers claims for self-funded clients in all 50 states throughout the nation.1 (1st para) HealthSCOPE insurance plans may cover all or at least part of your costs of alcohol and drug rehab. The exact amount covered depends on your specific insurance plan. Because HealthSCOPE provides its services to members throughout the country, you may be able to attend rehab in any state, as long as the rehab facility you choose accepts HealthSCOPE insurance.

To learn more about HealthSCOPE coverage in regards to addiction treatment, call the number on the back of your insurance card to speak with a customer service agent.

Check HealthSCOPE Insurance Coverage for Addiction Treatment

There are a few ways you can check your insurance coverage for addiction treatment with HealthSCOPE. Options include:

  • Call HealthSCOPE. Call the number on the back of your insurance card to speak with a customer service agent who can walk you through the details of your plan.
  • Log in to the HealthSCOPE member portal. Log in to your account on the HealthSCOPE website to read about what your plan covers, as well as any copays and deductibles you are responsible for paying.
  • Call the American Addiction Centers hotline. Call us at to speak with one of our admissions navigators. They can verify your insurance for you on the phone.
  • Complete our online form. Fill out our two-step form with your insurance and contact information, and we’ll email you within minutes with details about your insurance coverage and what treatments are available to you.
  • Chat online. Use our chat box feature on our website to talk live with an admissions navigator, who can verify your insurance and answer any questions you have.

What Is HealthSCOPE?

HealthSCOPE is a healthcare management company that provides services for over 650,000 self-funded members across the United States.1 They help members navigate the sometimes complicated healthcare system to find appropriate care, including addiction treatment. The company is the third-largest benefits-only TPA in the United States.1 (About Us, 2nd paragraph)

Founded in 1985, the organization is headquartered in Arkansas and has seven offices and a network of remote team members across the country to provide service to its clients.1 (About Us, 1st paragraph) HealthSCOPE recently joined the UnitedHealth Group family of companies in order to provide even more benefits and services to its clients.2

HealthSCOPE Plans

HealthSCOPE is a third-party administrator (TPA), meaning the company handles the claims, processing, and reporting components of a self-funded health benefits plan. This means that HealthSCOPE offers various administrative services on behalf of a health insurance plan. 1 Essentially, HealthSCOPE processes health insurance claims for an employer benefit plan. If your employer self-funds their health insurance, they contact a TPA like HealthSCOPE to provide services for the benefit plan. They offer vendors and services, rather than healthcare insurance plans themselves.

Because HealthSCOPE is a member of the UnitedHealth Group, their insurance plans and benefits are tied to UnitedHealthcare. Plan options include:3, 4, 5, 6

  • UnitedHealthcare Choice. Choice plans offer fixed copay amounts, and you can see a healthcare specialist as long as they are in-network with UnitedHealth. Working with an out-of-network provider under this plan will mean you pay for the services out-of-pocket.
  • UnitedHealthcare Choice Plus. Members can use both in-network and out-of-network providers. Costs are lower when you work with an in-network provider.
  • UnitedHealthcare Options PPO. PPO plans provide savings for members when they get healthcare services from a healthcare provider who is within the preferred provider network.

With HealthSCOPE, you can attend drug and alcohol rehab anywhere in the United States as long as you choose a rehab facility that is in-network with UnitedHealthcare.

Under these plans, there are varying levels of coverage: Gold, Silver, and Bronze: 7(2nd section)

  • Bronze plans. These offer the lowest monthly premiums and have higher deductibles and copays. They are ideal for individuals who do not see the doctor/access healthcare very often.
  • Silver plans. These have slightly higher premiums than bronze plans with lower deductibles. They are ideal for people who occasionally seek out healthcare/doctor visits.
  • Gold plans. These have the highest premiums but the lowest deductibles. Gold plans are ideal for those who plan to visit the doctor often or need a lot of healthcare services.

What Will HealthSCOPE Insurance Cover?

There are many options for addiction treatment. Exactly how much of the cost of rehab and what is covered depends on your specific insurance plan.

The treatment you receive will depend on different factors, including:

  • What substances you are using/addicted to.
  • How long you’ve been using.
  • Your overall health status.
  • Whether or not you have a dual diagnosis/co-occurring disorder.
  • The level of care you require.

With health insurance, you can be assured that at least some of your treatment costs will be covered by your plan, no matter what type of treatment you access. Types of treatments that may be covered include the following:8

  • Detoxification
  • Medication-assisted treatment
  • Inpatient rehab or residential rehab
  • Outpatient rehab
  • Partial hospitalization programs
  • Intensive outpatient programs

Does HealthSCOPE Insurance Cover Mental Health Care?

Under the Affordable Care Act, all health insurance providers must cover mental health care, just as they would provide coverage for physical health needs (e.g., cancer treatment, broken bones, etc…).9 This law ensures that everyone who needs mental health treatment is able to access it.

Many people with substance use disorder/addiction also have other mental health conditions, such as anxiety, depression, or PTSD. This is known as having a co-occuring disorder, or dual diagnosis.10 Many rehab facilities offer treatment for both addiction and mental health disorders in order to provide the best care for those who are seeking treatment.

Even if you do not have a dual diagnosis, standalone rehab (e.g., treatment for heroin addiction), should be at least partially covered by your insurance plan.

How Long Does HealthSCOPE Insurance Cover Rehab?

How long you stay in rehab depends on your specific needs and the level of treatment you require. Insurance companies are mandated to at least provide partial coverage for rehab and other addiction treatments. 9 The duration of your stay and how long insurance coverage helps offset the costs depends on the specific plan you have.

Call the number on the back of your insurance card to learn how long you can expect your insurance to cover addiction treatment. Ask for information about what treatments are covered and for how long. You may also want to ask about any out-of-pocket expenses you will have, such as deductibles and copays.

You can also call our hotline at to speak with one of our admissions navigators. They will answer your questions, verify your insurance while you’re on the phone, and discuss treatment options.

What If My HealthSCOPE Policy Does Not Cover Rehab?

At least some of the cost of rehab should be covered by your health insurance plan. However, you may still have out-of-pocket costs that require you to pay for some services and reach your deductible. Attending rehab is a financial hardship for many people, but there are payment options available to help you access care without worrying about money. What is most important is getting treatment, getting sober, and living a long, healthy life. Options to help pay for rehab include:

  • Personal loans or lines of credit from the bank or credit union.
  • Payment plans. Many rehab facilities offer payment plans to clients, allowing you to pay back your out-of-pocket expenses over time.
  • Scholarships and grants. Some rehab facilities and government agencies offer scholarships and grants to low-income individuals who need assistance paying for rehab.
  • Fundraising and crowdfunding. Websites such as GoFundMe allow you to ask your community for financial support in your journey to sobriety.

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

“In-network” rehab facilities have contracted with your insurance company to accept discounted rates for addiction treatment. You typically pay less out of pocket when you choose a rehab center that is in-network. 11(p. 3, 2nd para)

Out-of-network rehab facilities do not have a contract with the insurance company to provide services at a discounted rate. This generally means higher costs for you. Depending on your health insurance plan, the rehab costs may not be covered at all if you choose an out-of-network rehab center. 11(p. 3, 2nd para)

Keep in mind that just because a rehab facility accepts your insurance doesn’t necessarily mean it is in-network.12 (points 4, 6, 8) A facility may accept Kaiser, BlueCross BlueShield, and UnitedHealthcare insurance, for example, but that does not mean that the rehab is an in-network provider for your insurance carrier.

It’s often up to you to determine whether a rehab facility is in-network for your insurance plan.

The best way to check is to call the number on the back of your insurance card to verify the rehab’s network status. Or you can call us at to speak with an admissions navigator who can help you find rehab facilities that are in-network with your insurance plan.

Sources

  1. (2021). What we do.
  2. (2021). Benefits.
  3. UnitedHealth Group. (2021). Group benefit plans.
  4. UnitedHealth Group. (2021). UnitedHealthcare Choice.
  5. UnitedHealth Group. (2021). UnitedHealthcare Choice Plus.
  6. UnitedHealth Group. (2021). UnitedHealthcare Options – PPO.
  7. UnitedHealth Group. (2021). Individual and family Marketplace plans.
  8. (2021). Alcohol, chemical and/or substance abuse: Detoxification and rehabilitation.
  9. gov. (n.d.). Mental health and substance abuse coverage.
  10. Medline Plus. (2021). Dual diagnosis.
  11. gov. (2021). What you should know about provider networks.
  12. Maryland Insurance Administration. (n.d.). Frequently asked questions: In-network vs. out-of-network providers.
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The editorial staff of Projectknow.com is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed thousands of pages for accuracy and relevance. Our reviewers consistently monitor the latest research from SAMHSA, NIDA, and other reputable sources to provide our readers the most accurate content on the web.
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