Avera Health Insurance Rehab Coverage

Avera Health plans include service coverage for addiction treatment, including services offered at the Avera Behavioral Health Center. Their plans and coverages vary depending on plan type and treatment facility.

When a person is searching for a drug and alcohol treatment program, the first step is usually finding out what their insurance covers regarding the cost of treatment. Avera Health Plans in Sioux, South Dakota, supply health insurance to over 100 communities in the Midwest. They offer rehab coverage, addiction coverage, and general mental health coverage.

Avera Health offers comprehensive health insurance, including mental health insurance and rehab insurance to employers, families, and individuals. They also provide a supplement to Medicare, as well. If you are looking into insurance plans to cover drug and alcohol treatment, Avera Health does generally cover these types of treatment programs.

Avera Drug and Alcohol Detox Services

As a supporter of integrated care, Avera Health will most likely cover drug and alcohol detox at one of their rehab network facilities. Avera representatives collaborate with several centers located throughout the coverage area. They do this to help policyholders find detox services that will be covered under their plan.

Detox programs help people with their withdrawal symptoms when they stop using a particular substance such as alcohol or heroin. In most cases, medical supervision is required during the detox process because withdrawal symptoms can cause dangerous side effects. Some withdrawal symptoms include but are not limited to the following:

  • Muscle cramping
  • Fevers
  • Nausea and vomiting
  • Seizures
  • Headaches
  • Chills
  • Sweating
  • Anxiety
  • Hallucinations

Withdrawal symptoms can be mild, moderate, or severe. It usually depends on the type of drug used, how long someone has been using it, and the severity of their addiction. Sometimes, withdrawal starts only a few hours after the individual has consumed their last drink or used a particular drug. Withdrawals can last for many days, even a few weeks. During this time, it is essential for the individual to be monitored by medical staff to ensure they stay as comfortable as possible. Medical professionals can also provide a variety of medications that can help the patient get through detox, as well. After the detox process is complete, the patient will generally go through a transition and be admitted into a drug and alcohol rehab program. Once in a rehab program, they will take part in therapy and learn relapse prevention skills.

Many insurance providers, including Avera Health, consider detox to be the beginning of a successful addiction treatment program. This is why they usually cover some of the cost of detox services. However, how much of the cost they will cover varies depending on the policies in your plan and the facility where you will be treated.

Avera Health and Rehab

One commonly asked question about Avera is, Does Avera Health pay for drug rehab? The answer is that Avera may pay the cost of drug rehab, but it will depend on the type of plan you have obtained from them. There also might be other factors that come into play in figuring out how much they will cover. Sometimes, an insurer will also need to have rehab pre-authorized or submit medical documentation in order to get the company to cover rehab costs.

Avera Health also offers coverage for inpatient treatment programs. However, the amount they will pay towards these programs may vary from individual to individual depending on their plan, if they use a Medicare supplement, and the kind of treatment program.

It is likely Avera will request a copayment or coinsurance fee. Copayments are fees a patient needs to pay for each day or each admission. Some plans require a copay of $250 per day for the first 5 days a patient is being treated at an inpatient facility. This means the patient is required to pay $1,250 out of their own pocket. If your benefit plan summary states a flat copay without specifically mentioning a per-day requirement, it is probably safe to say the payment is per admission. This would mean the insurer is required to pay a $500 copay, which also would mean they have to pay $500 every time they enter a rehab treatment program.

Coinsurance works a little differently. Coinsurance fees are figured as a percentage of a bill. For instance, a 35% coinsurance fee means the insured person is held responsible for 35% of the treatment cost. So, if your bill is $5,000, you would be responsible to pay $1,750 of it. Avera Health coinsurance fees range between 30 to 50%. In addition, plans which have a large deductible may or may not require the insured to have a copay or coinsurance fee for inpatient rehab treatment. For instance, the Avera 6500 plan covers inpatient rehab with 50% co-insurance after the insured meets their deductible, as long as the treatment is preauthorized and performed at an in-network facility.

Overall, most of the plans offered by Avera allow a person to seek treatment at out-of-network facilities but charge a 30-50% coinsurance fee. Preauthorization is typically necessary for out-of-network and in-network treatment programs.

Avera and Inpatient Rehab

Avera Health does offer plans which may cover inpatient rehab, but some of these plans require a copay or coinsurance fee. However, some plans with high deductibles most likely will not require either one. Inpatient rehab offers addiction treatment for people who are addicted to alcohol, drugs, or other harmful substances. It is provided in a residential setting. It allows people the chance to live in a safe environment alongside other people who are facing some substance abuse addiction.

One of the greatest things about inpatient rehab programs is that people get the chance to learn how to handle and avoid the triggers which get them using in the first place. It also helps them learn how to cope when life gets tough. Many inpatient treatment facilities offer services which include the following:

  • Housing
  • Medication, when needed
  • Initial Assessment
  • Medial exams
  • Therapy
  • Co-occurring disorders

In most cases, an initial clinical assessment will be administered to allow the treatment provider a chance to look into other issues the individual may be facing such as mental health problems. It is common for someone who is entering into drug rehab to suffer from mental health issues. Many face depression, bipolar disorder, and anxiety issues and may need medication to help them relieve the symptoms associated with their particular problem.

Avera and Outpatient Rehab

Avera does offer plans which include coverage for outpatient alcohol and drug rehab, but the amount they pay will depend on the plan you choose to carry. Generally, Avera outpatient treatment plans require a copayment for facility and even office visits. Co-pays may run between $25 and $50 per session. Some types of outpatient programs may require you to pay coinsurance fee. Most coverage regarding outpatient care is offered for both in-network and out-of-network providers. Of course, the amount that out-of-network treatment will be different than in-network treatment facilities. Typically, the amount Avera pays for out-of-network treatment runs about 40%. There are many formats regarding outpatient treatment some of them include the following:

  • Individual therapy office visits
  • Group therapy office visits
  • Peer support groups
  • Day programs

Many people struggling with an addiction can benefit from entering into an outpatient treatment program. It allows them to get the treatment they need while living at home.

Avera Health does offer rehab coverage, mental health coverage, and many other types of coverages. To learn more about them you should speak to an Avera Health agent. They would be happy to assist you.

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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