(Please note: Rehabs.com strives to provide you with the most updated information on each carriers' addiction insurance coverage but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. Rehabs.com is an informational site only and is not affiliated or sponsored by Kaiser.)
At Kaiser Permanente they understand that struggles with drug use including Opiates or Opioids impacts every aspect of life. These addictions impact home life, work life, social life as well as the user's health. Signs that there is a drug problem include the following:
- Constantly thinking about them even when they are not actively being used.
- The inability to quite even when great effort it made to make changes.
- Using more than planned.
Opiates or Opioids are often in the form of prescription medications for pain that is not caused by cancer. With prescription use of pain on the rise, the cases of addiction have also been on the rise. These addictive drugs are subject to misuse, particularly by patient who suffer from other illnesses like depression and anxiety. These patients have a higher rate of misuse and a higher rate of multiple prescriptions which can lead to stronger addictions. It is estimated that 1.9 million people in the US are addicted to opiates which includes heroin and prescription drugs. Opiates and Opioids have been used for chronic pain for decades. As the addictive nature of the drugs and the awareness of the side effects, which include heart disease, damage to the immune system and higher risk of infections are becoming more well-known doctors and insurance companies are reducing the use of these drugs for pain treatment. This means many patients who have been using the drugs for an extended time must now enter treatment for addiction.
Does Kaiser Permanente Insurance Cover Treatment for Opiates/Opioids?
Kaiser Permanente does cover treatment for opiates and opioids. This addiction is often brought on through addiction to prescription medications for patients who suffer from chronic pain. As policies are changing in the medical field and doctors and insurance companies are reducing the level and number of patients using these drugs, the addiction recovery services are being inundated with patients. The other issue is that this strong addiction is creating a black market for the drugs. As doctors reduce prescription strengths to help patients overcome their addiction to these drugs, while patients are looking for relief on the streets. That can create a dangerous situation for the patient and as a result deaths through overdoses have quadrupled in recent years. It is estimated that from 2004 to 2009 there was a 20 percent increase in the dependency of the use of opiates and opioids. This has created a growing market and a growing demand for drugs like heroin that are particularly difficult to treat.
Type of Rehabs Kaiser Permanente Will Pay For
Kaiser Permanente offers different treatment options depending on the severity of the addiction and the policy of the individual. Treatment options for opiates and opioids addictions could include working with a medical doctor to reduce usage and dependency. Reducing the strength of the current medical treatment or changing to less addictive treatment programs that are effective for those without long term use. 12 step recovery programs have also proven effective. Often those with long term use and strong addictions an inpatient or outpatient treatment program may be necessary. Working with the medical doctor and the insurance company to determine the best form of rehab is the best course of action for the user.
How Much of The Cost of Rehab is covered by Kaiser Permanente?
Kaiser Permanente covers rehab at various levels as determined by the individual's policy. Working with the doctor to determine the appropriate level of treatment is the first step. Care within a doctor's office is treated with similar coverage levels as other treatments. The doctor will make recommendations and the medication is covered as the policy covers all levels of pain medication. If advanced treatment is required, most policies will treat inpatient care much like a hospital stay, with its accompanying deductibles and co-pays. There are also limits for per day coverage and coverage per incident written into most policies. These factors will determine the level of coverage available to the individual.
Can I Pay Above What My Insurance Will Provide to Receive Treatment?
Each policy is different and the levels of coverage will vary depending on the coverage that was selected at the time the policy was taken out. Coverage generally includes co-pays and deductibles that must be met before the insurance will begin to make payments for treatment. These out of pocket expenses must be covered by the patient. Additional out of pocket costs could be incurred if the maximum per day or per occurrence costs are exceeded. Other factors that need to be considered are in network versus out of network doctors or treatment facilities. Out of network facilities or doctors will lead to higher out of pocket expenses for the individual.
Inpatient Opiate/Opioids Treatment vs. Outpatient Therapy
"Opiates or Opioids are often in the form of prescription medications for pain that is not caused by cancer. With prescription use of pain on the rise, the cases of addiction have also been on the rise. "
Inpatient treatment programs are often required for those with severe addictions in need of intensive detoxification to encourage recovery. These programs can last from 10 days to several months. The treatment includes meeting with both medical doctors and counseling. Counseling is in the form of group and one-on-one sessions. Outpatient programs offer similar services to the inpatient programs, while the user is able to remain at home during recovery. The patient is able to schedule doctor appointments and therapy sessions around their daily activities. This is best for those with an addiction, but a firm commitment to overcome that addiction and responsible enough to maintain the treatment activities that will lead to recovery.
Should I Choose a Residential Rehab Program?
Opiate addiction can be very difficult to conquer. As patients use the drugs over a long period of time the dependency grows stronger and the detoxification and treatment program can be more intense. Drug addiction changes the way the brain works so the patient will often not recognize the extent of the addiction and the intense need to fill the void when they are coming off the drug. In these cases a residential program is the best option. There are many medications that are serving as substitutes and helping addicts break their dependency. If these methods of treatment fail then a residential or inpatient program may be necessary.
Will Kaiser Permanente Pay for Local Rehab and Out-of-State treatment?
The payment for the treatment programs will be determined by the network for the policy. Each insurance policy will have a network of doctors and treatment programs that are considered in network. These doctors and facilities will pay at a higher rate than out of network options because they have a specific agreement with the insurance company. For those facilities that are out of network, the patient will have higher out of pocket costs. The facility will also need to be approved by the insurance company. Working with the facility in connection with the insurance company will provide the best options and an understanding of out of pocket expenses before treatment begins.
Does Kaiser Permanente Pay for Private or Luxury Treatment?
Kaiser Permanente covers private and luxury treatment in many policies. The individual needs to read and understand what is covered before any treatment begins as each policy may be different. Some policies specify what type of rooms are covered and others cover a specific dollar amount each day. By understanding the specific policy you will know upfront how much will be covered. Private rooms and luxury treatment programs offers additional amenities above what standard treatment programs offer. These can include spa services, gourmet meals and activities like golf. Additional amenities help residents stay with a treatment program for its full duration which increases the chances of a full recovery.
What Does Executive Treatment Offer Over Other Rehabs?
Executive treatments are available to inpatients who have outside obligations that must be maintained while in treatment. This can include business or home responsibilities. The executive treatment programs include the standard treatment program services. In addition they include work areas and time to complete work projects. This includes access to computers, phones, faxes and other work needs on a limited basis.
What Treatment Lengths Will Kaiser Permanente Pay For?
The length of treatment coverage will depend on the policy, the facilities program and doctor recommendations. Doctors must refer patients to a treatment program and after the facility evaluates the patient they will make a recommendation for program length. This can be anywhere from 10 days and 6 months. Longer stays are available for those with sever addictions. For many cases medication and therapy is an effective form of treatment. This includes changing the medical treatment to less addictive forms and reducing dependency over time. If these treatments fail, then a doctor can refer the patient to either an inpatient or outpatient program for a more intense detoxification to eliminate the chemicals that are causing the addiction, from the body.
What If I Have No Insurance?
12 step programs are offered in most communities and these are free to addicts. For those without insurance this is a good place to start. Since willpower will rarely cure an addiction, seeking medical help is often necessary. Many doctors and programs offer financial assistance, payment plans and will otherwise work with the patient to obtain the treatment necessary to break free from the addiction.
Using Our Helpline to Determine Kaiser Permanente Rehab Options
Many patients are frustrated that chronic pain and treatment causes a situation where a drug addiction occurs. Regardless of the reason, getting help right away is always the best course of action. The longer the addiction prolongs the harder it is to successfully get through the detoxification process. Calling us at 1-888-341-7785 today and learning about what options are available is the first step toward recovery.
Questions and Answers
Will Kaiser Permanente Cover Multiple Rehab Stays?
Coverage will depend on the individual's policy and the state of residence.
Does Insurance Pay for Aftercare?
Each policy is different and follow up care is generally included at some level. Doctor visits, adjustments to medication and other forms of after care will be spelled out in the policy. Many policies will also cover therapies which might include both group and individual counseling.
Could Rehab Make My Insurance Premiums Higher?
Generally a single claim will not affect premium prices. Insurance premiums are established through a spectrum of factors. Policy use is only one. The overall cost of care for the group or the market will be the largest factor, rather than an individual claim.
Has The Affordable Care Act (Obamacare) Affected Opiates/Opioids Addiction Coverage?
The Affordable Care Act has impacted treatment programs and often results in expanded coverage for treatment programs for addictions.
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