Does Health Net Insurance Coverage for Addiction Treatment?

Health Net provides insurance and healthcare benefits to roughly 5.9 million people and is accepted at many drug rehabs, including Elevate Addiction Services. 

Anyone looking for addiction treatment will need to contact their insurance provider for the most accurate information regarding their individual plan’s coverage. Because of their focus on wellness and preventative care, Health Net offers comprehensive drug and alcohol treatment benefits, but the coverage amount will vary based on the policy. 

Health Net Insurance Plans for California Residents

Health Net offers a variety of plans to individuals, including: 

• HMO (Health Maintenance Organization) 
• PPO (Preferred Provider Organization) 
• EPO (Exclusive Provider Organization) 

Each plan will provide different levels of addiction treatment coverage. Similar to other insurance providers like Blue Cross Blue Shield, Health Net offers different level insurance plans, including: 

• Bronze – 40 percent out-of-pocket cost 
• Silver – 30 percent out-of-pocket cost 
• Gold – 20 percent out-of-pocket cost 
• Platinum – 10 percent out-of-pocket cost 

Each level requires individuals to pay a premium out-of-pocket. The Bronze level is the lowest out of pocket cost and the highest deductible, going down in steps to the platinum plan, which has the highest out of pocket cost and the lowest deductible.

California HMO Plans

Health Net doesn’t offer Bronze HMO plans in California. All of the following plans require prior approval to guarantee coverage and do not include out-of-network costs. 

• Silver HMOs – require a 20 percent coinsurance fee. 
• Gold HMOs – 600/day copay for the first five days of treatment. 
• Platinum HMOs – require a $250/day copay for the first five days of treatment. 

Please note that your exact benefits may vary. Contact one of our addiction specialists to determine the details of your plan. 

California PPO Plans

All of Health Net’s PPO plans in California require pre-authorization to grant coverage and will pay 50 percent of out-of-network care costs. Without prior authorization, out-of-network costs are not covered, and there’s a penalty for in-network care. 

• Bronze – 100 percent coinsurance after the deductible has been paid. 
• Silver – 20 percent coinsurance, a deductible may or may not apply. 
• Gold – 20 percent coinsurance 
• Platinum – 10 percent coinsurance with 50 percent coinsurance after the deductible has been paid 

California EPO Plans

Similar to HMO plans, EPO plans require you to go through a primary care provider to see an addiction specialist. Different levels of California EPO plans include: 

• Bronze – 40 percent coinsurance after the deductible is paid.   
• Silver – 20 percent coinsurance 
• Gold – 20 percent coinsurance 
• Platinum – 10 percent coinsurance 

What’s the Difference Between In-Network and Out-of-Network?

Depending on the type of Health Net plan, you have whether an HMO, PPO, or EPO, each will have slightly different definitions of in-network and out-of-network. 

Individuals with HMO or EPO plans are only covered for healthcare services if they remain in the provider network, except in the case of an emergency. If you find a rehab center that you are interested in, contact the rehab directly to determine if they are in your network, then assess your plans coverage details. 

People with PPO plans have more flexibility and can choose services from “in” or “out” of their plan’s network. However, going outside of the network may cost more. 

Questions About Health Net Coverage

1.Will Health Net cover multiple stays in rehab?

Relapse is a common occurrence and doesn’t mean that the individual has failed but needs more treatment. As such, Health Net allows you to have as many treatment sessions as required. Check the details of your plan for the exact number of stays your policy will allow. 

2.Does my Health Net insurance cover aftercare costs?

Aftercare may or may not be covered by your Health Net insurance plan. Although aftercare is covered in many cases, at least in part, you should check the details of your plan to be sure. 

3.Will attending rehab increase my monthly insurance premiums?

No, attending rehab will not increase your monthly premiums. However, you may need to pay your deductible in full to participate in treatment. 

Verify Your Insurance and Find the Right Addiction Treatment for You

Elevate Addiction Services is considered an in-network option for most individuals in Northern California. At Elevate, we believed in a holistic approach to substance abuse treatment. This means that we treat the whole person: body, mind, and spirit. 

If you are looking for a treatment center that isn’t afraid to approach addiction unconventionally, contact Elevate today. You can confidentiality verify your insurance information on our site. Once we receive your information, our admissions team will contact you with the details of the costs to attend treatment with us. 

*The information provided is for educational purposes only. To find out your exact insurance benefits, contact your insurance company or our admissions team directly

Related Links:

• Blue Cross Blue Shield Insurance Coverage for Drug Rehab
• Aetna Insurance Coverage for Drug Rehab
• Cigna Insurance Coverage for Drug Rehab

Sources:

• Drug List for State Health Plan Members
• Glossary of Health Coverage and Medical Terms
• Summary of Benefits and Coverage (SBC)
• Your Most Frequently Asked Questions