If you’re worried about your relationship with substances, there is help available. It can be extraordinarily difficult to come to terms with a substance use disorder, but accepting you have a problem is the first step. At Changing Tides, we’re an affordable rehab center, and we work closely with several insurance providers to ensure treatment is accessible. Read on to find out more about Optima Health Insurance drug rehab coverage.

About Optima Health

Optima Health is based in Virginia, and it provides services to individuals and employers. Employer-sponsored plans are Optima POS plans, Optima Plus and Optima Vantage.

Optima Vantage is an HMO plan, which means you get affordable access to medical care provided you work with an in-network rehab clinic. Optima Plus is a PPO plan, which means you can attend an out-of-network facility at an additional cost. POS plans give you the best of both worlds, with extra out-of-network benefits.

Is Outpatient Rehab Included in My Optima Health Policy?

Optima Health Insurance plans usually cover outpatient treatment, whether it’s a step-down from more intensive treatment or your first step. The main caveat is that your treatment is a medical necessity. If you have health insurance with your employer, coverage depends on the tier. Patients either pay a coinsurance fee of between 0% and 40% or a co-pay of between $150 and $300 after they’ve paid deductibles.

If you’re on an individual plan, you’re still responsible for co-pays and deductibles. Depending on your policy, you’ll pay a coinsurance cost of between 5% and 20% or a co-pay of between $10 and $40.

Does Optima Health Insurance Cover Partial Hospitalization Programs?

As long as your treatment is medically necessary, Optima Health insurance should cover all or some of a PHP. If you have insurance through your employer, you’ll need to pay a portion of your co-pays. Coinsurance is equivalent to between 20% and 40% of the costs after deductibles.

On an individual plan, you can expect to pay between 5% and 30% of the costs of a PHP, unless you have the OptimaFit Catastrophic Plan. In this case, the entire duration of your stay at rehab might be covered by Optima Health.

Medication-Assisted Treatment and Optima Health

All Optima Health plans should cover you to some extent for prescriptions. Co-pays and coinsurance depend on the individual policy you have. Out-of-pocket costs vary significantly, from as low as $5 up to 35% of the value of the medication.

It’s crucial that you check what you’re covered for and start preparing your paperwork before you start rehab.

Optima Health Insurance Drug Rehab Coverage Options

Optima Health breaks down its coverage into three categories: bronze, silver and gold. All Optima Health insurance plans contain a deductible.. Your policy will outline what you need to contribute with regards to coinsurance pays and co-pays.

The three tiers of Optima Health insurance are:

  • Bronze: Bronze is the best option for people who are at very low risk of needing health care. Low monthly premiums mean more out-of-pocket costs if you do require treatment.
  • Silver: With a silver plan, you should expect to pay average monthly premiums and moderate coinsurance or co-pays at the point of care.
  • Gold: While you pay a higher monthly premium on a gold plan, you’ll pay less out-of-pocket in case you do need treatment.

Does Optima Health Cover Accommodation?

If you suffer from a severe substance use disorder, you might require intensive treatment in a residential setting. In many cases, your Optima Health insurance will pay some of your accommodation costs. However, unless you have the most comprehensive plan offered, you’ll need to contribute towards your accommodation costs.

In-Network and Out-of-Network

You can use Optima Health insurance for out-of-network services, but the fees are often sky-high. For the best price, seek treatment in an in-network drug rehab clinic.

Find Out What You Need to Know About Rehab Today

Call Changing Tides at 252-715-3905 today if you have any questions at all about your insurance plan and treatment here with us. We’ve helped thousands of people to overcome addiction with affordable, accessible care.