Getting Addiction Treatment Covered as a Federal Government Employee
Seeking treatment as a government employee can seem difficult. Government entities often drug test and have strict rules on what employees can and cannot do outside of work. Failing a drug test can lead to termination of employment and associated health insurance, making it even harder to get the help that you need.
As a federal government employee, though, you are entitled to GEHA drug rehab coverage whether you are seeking treatment for yourself or a loved one.
Keep reading to learn more about GEHA, how it works, and how you can use your GEHA insurance to seek effective addiction treatment at South Shores Detox today!
Does the Government Employees Health Association Cover Addiction Treatment?
GEHA is the Government Employees Health Association. GEHA insurance plans offer medical, dental and vision benefits to federal employees and their families. As essential health benefits, coverage for addiction treatment, behavioral health services, and mental health services must be included.
As a part of this coverage, GEHA does cover treatment programs for drug and alcohol abuse and addiction. Drug and alcohol treatment is considered an essential health benefit. According to the Affordable Care Act, essential health benefits like treatment for mental health disorders, substance use disorder treatment, and prescription drug coverage must be offered by insurance companies.
Other essential services under the Affordable Care Act include preventative and wellness services, chronic disease management, pediatric services, prescription drug coverage, behavioral health services, rehabilitation treatment and devices, newborn care, maternity care, hospitalization, emergency services, and ambulatory care.
What Types of Addiction Treatment Programs Are Covered?
While GEHA health plans do offer coverage for drug or alcohol addiction treatment, the specifics of GEHA insurance coverage benefits for rehab change depending on the plan. However, most plans offer comprehensive coverage for addiction treatment programs.
This means that there should be some coverage for inpatient rehab, outpatient programs and therapy sessions, group therapy, and other rehab services. Dual diagnosis programs that focus on mental or behavioral health challenges should also be covered.
Insurance companies are required to offer this type of coverage under the Mental Health Parity and Addiction Equity Act, which demands insurance plans provide treatment for mental health and rehab services that are as easily accessible as services for surgery or physical health.
Types of GEHA Insurance Plans
Individuals with GEHA insurance coverage choose a plan when enrolling. The specifics of the GEHA insurance plan you choose determine things like monthly fees or associated copays, substance abuse and other services that are covered, and whether the plan covers specialty treatment.
It’s not always easy to track down information about your GEHA health plan. Give us a call at South Shores to learn how GEHA rehab coverage fits into your treatment for drug or alcohol addiction. We can easily verify insurance coverage, making it quick and easy to connect with addiction and mental health services.
Is GEHA the Same as United Healthcare?
GEHA is not the same thing as United Healthcare. However, GEHA works with United Healthcare to provide access to the medical network. This medical network makes it easier for individuals struggling with addiction to access inpatient or outpatient care, therapy sessions, or other treatment options that might not be available otherwise.
However, they are still a Health Maintenance Organization (HMO) plan that requires you to choose from providers within the network, while Preferred Provider Organization (PPO) plans offer more flexibility.
Who Has Coverage Under GEHA?
GEHA health insurance plans are exclusively offered to federal employees and families. Individuals covered under GEHA include all current and retired federal employees and their immediate families.
The specifics of coverage are going to change depending on the particular GEHA insurance plan and benefits offered.
Understanding GEHA Rehab Coverage and Benefits
While the Government Employees Health Association is required to offer addiction treatment coverage for substance use disorder, coverage will vary depending on your plan. In most cases, members of GEHA pay up to a certain amount in co-pays throughout the year. Once you reach that limit, the insurance company assumes all medical costs.
How Long Will GEHA Cover Drug Rehab?
The length of time that GEHA will cover residential treatment services depends on the specifics of your GEHA health plan. It may change based on the out-of-pocket costs you have already paid for the year, the typical length of treatment programs, and whether you are attending inpatient treatment, outpatient treatment, or both.
Do I Have to Choose an In-Network Treatment Center?
Clients can choose either an in-network treatment program or an out-of-network alternative for their insurance provider to cover them. While it is possible to receive treatment services at an out-of-network facility, you often will not have as much coverage for drug and alcohol addiction treatment.
This is not always the case, though, and a confidential call to South Shores can let you know your network status and expected costs, if any.
Will Drug Rehab Cost Anything if I’m Covered?
Some health insurance companies offer total coverage, while others may require members to pay out-of-pocket costs. With a GEHA insurance plan, a drug and alcohol treatment program may not cost anything at all.
However, this also depends on which plan you have chosen, the facility you’d like to attend drug and alcohol rehab at, and the specifics of the treatment process. For example, residential treatment for substance use disorder and medical detox will be more expensive than therapy and other outpatient programs.
Are Behavioral and Mental Health Services Covered with GEHA?
As essential services, GEHA generally covers behavioral health treatments and mental health concerns. This might include individual therapy, group therapy, residential treatment, family therapy, and other programs with the intent of bettering an individual’s well-being and treating underlying mental illness.
Cognitive behavioral therapy is considered one of the more effective methods of treating substance abuse. It can help you identify thought patterns and triggers that drive you to drink or use drugs. From there, you’ll learn how to identify and eventually stop those obsessive thoughts.
You’ll also learn coping skills that you can use when triggered to avoid relapse. This type of therapy is often covered by GEHA insurance, even on an aftercare or outpatient basis.
Does GEHA Insurance Cover Prescription Medications?
GEHA health insurance covers prescriptions so they are available to members at a much more affordable cost. This includes prescriptions prescribed for mental health, substance abuse treatment, or even those prescribed by your physician.
Some prescriptions may have a copay, but even those are at a lower cost than you would pay without GEHA health insurance.
Will GEHA Cover a Dual Diagnosis Treatment Program?
Dual diagnosis treatment programs offer substance abuse treatment to clients who may also need treatment for an underlying mental health disorder. Mental health plays a big role in addiction, particularly for individuals who use alcohol or drugs to self-medicate.
Whether GEHA health insurance covers dual diagnosis depends on the facility and whether it is in-network.
How to Verify Coverage with a GEHA Insurance Plan
It can be hard for members to be sure what GEHA insurance will cover for drug and alcohol rehab, especially if you are unsure of what is included in your plan. The easiest way to start substance abuse treatment is to reach out to our facility directly.
We can quickly reach out to GEHA insurance and find out what treatments are covered at our facility. From there, you can work with a member of our staff to determine your specific substance abuse treatment needs and come up with an effective treatment plan that GEHA covers.
What if My Insurance Won’t Cover Substance Abuse Treatment?
If GEHA insurance or another provider will not cover treatment for drug or alcohol addiction, there are a few options. First, you can appeal their decision. After the paperwork is submitted, an internal review of your case will be done to determine if you are covered. Alternatively, you can have a third party review information and determine whether you should have coverage.
Another option is to pay for the cost of treatment out of pocket. While residential programs may get expensive, we can assist our clients in finding the support they need within their budget by combining different types of treatment.
What to Expect During Substance Abuse Treatment
Not all addiction treatment centers are created equally. At South Shores, we want you to know that you have treatment options.
We’ll work with you to create a plan that makes recovering from substance abuse easier with your schedule and under the guidelines of GEHA health plans.
What to Expect During Inpatient Treatment
During residential treatment at South Shores, you’ll have a safe space to focus on recovering from addiction. For individuals going through withdrawal, inpatient treatment might include assisted medical detox to ease symptoms. Medical detox can also stop life-threatening emergencies that sometimes happen when detoxing from alcohol, opiates, and other drugs affecting the central nervous system.
In addition to helping with withdrawal, individuals will attend individual and group therapy. Individual therapy will focus on understanding addiction triggers, addressing underlying mental illness, and learning coping skills and healthier habits for when you return home.
Group therapy will help you connect with others who struggle with addiction while building social relationships and support. Family therapy may also be recommended for individuals dealing with conflict at home.
Additionally, clients may participate in physical activity, creativity and art classes, music therapy, and other types of therapy during inpatient treatment. GEHA insurance will cover all of these things as part of inpatient drug rehab.
Partial Hospitalization and Intensive Outpatient Programs
Intensive outpatient and partial hospitalization programs are less intensive than residential treatment. While each program will last for several hours each day, you can still go to work and return home at the end of the day. These can be used by individuals entering a rehab program or they can be used to make the transition from inpatient treatment easier.
Partial hospitalization programs and intensive outpatient programs help individuals struggling with substance abuse by keeping them busy when they are most likely to relapse after quitting. You’ll also learn skills while attending individual and group therapy as you attend these programs. GEHA insurance often covers these services.
Outpatient Treatment and Aftercare Services
Outpatient programs can be used to keep individuals on track after leaving an inpatient program. Often, outpatient treatment involves going to group therapy of some kind to build a support system outside of rehab. It may also involve following up with an individual therapist, working with a psychiatrist to treat mental illness, and taking medication as prescribed.
Working with support groups for addiction like Alcoholics Anonymous or Narcotics Anonymous can be very helpful in the early stages of recovery. This is especially true for individuals who have damaged relationships with friends or family because of addiction.
Ongoing Support and a Thriving Recovery Community
Support groups are also helpful for individuals who might be seeking social connection because many of the people that they once were friends with are still actively using drugs or alcohol. Avoiding these people and situations where you may relapse is important, particularly in the early days of recovery.
These resources are also available to individuals who have not attended inpatient rehab. Some people find that having the right support in place (and willpower) goes a long way in helping them quit the substance of their choice.
At South Shores, our program graduates also have access to our alumni and aftercare services to call on for support and for occasional events and reunions.
However, you’ll also have to make healthier life choices such as being physically active, eating a diet that promotes sobriety, ensuring you get enough sleep, and practicing self-care.
Get Support for Recovery Using GEHA at South Shores
Our knowledgeable staff at South Shores is waiting to answer your call. With all the questions surrounding GEHA health plans and coverage, let us assist you in verifying GEHA insurance coverage and determining what your GEHA coverage will pay for.
After verifying insurance coverage, we can set up an intake appointment to discuss substance abuse history, potential mental disorders, life stresses, and goals for treatment. From there, we’ll work together to craft a treatment plan that works for you (or your loved one).
Whether you need substance abuse treatment, mental health treatment, or are interested in dual diagnosis care, we are waiting to help you or your loved one take back control. Give us a call and start the road to recovery today!