Guide to Medical Mutual Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023

Author
Matt Esaena
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Clinically Reviewed
Andrew Lancaster, LPC, MAC
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All of the information on this page has been reviewed and certified by an addiction professional.

Addiction Is A Disease. Medical Mutual Insurance Can Cover The Treatment You Need.

Click Here for a confidential benefits check or call (866) 578-7471 to speak to a addiction specialist.

Alcohol and drug addiction devastates the life of those who are addicted and that of their loved ones and entire communities. Addictions are considered family diseases because they destroy the lives of everyone around the person suffering from addiction. If treatment is not received, people slowly but surely destroy their health, social contacts and professional life, often eventually dying. Addiction continues to be a taboo subject with a strong stigma surrounding it. As a result, many people often find it difficult to find treatment. The financial aspect is also a significant issue, with many worrying that they cannot afford it. However, if you have Medical Mutual insurance you may be able to afford the help that you need.

The Substance Abuse and Mental Health Services Administration completed a study in 2009 that demonstrated that some 23.5 million Americans over the age of 12 had a drug or alcohol abuse problem. This equates to 9.3 percent of the population. Yet only 11.2 percent of those needing help could receive it. One of the reasons for this is because many people simply do not know how much their health plan covers. They don’t know what their out of pocket expenses will be, and how they will meet those expenses, and they often don’t know which centers they can go to, or which treatment they can receive.

Does Medical Mutual Cover My Treatment?

If you are a member of Medical Mutual, you will be happy to know that most of your drug or alcohol treatment will be covered. Even on the standard plans, inpatient and outpatient treatment coverage is available. In fact, you may even be able to go to an out of network provider. How much you will pay yourself will depend on the provider you go to, your deductible and your copay.

How Long Will I Be Covered For?

How long of a stay your Medical Mutual policy will cover depends on the type of treatment you want, and on your plan. If you have a basic plan, you will usually be covered for 20 days per year in an inpatient facility. For outpatient facilities, you should be covered for 20 consecutive visits under that same plan.

Finding Treatment and Getting Sober

You can access a comprehensive list of in network providers through Medical Mutual. Their collective goal is to make sure you can get the help you need to recover. In network providers include public and private rehab facilities, including luxury and executive ones. You should be able to find the facility that is just right for you.

Signs and Symptoms of Addiction

If you want to know whether Medical Mutual will cover you for drug or alcohol treatment, it is likely that you already know that you have a problem. However, you may be concerned about a loved one, and you will want to know that they need treatment before you contact Medical Mutual. Some of the signs and symptoms to be aware of include:

  • That they require more of the substance to feel any effect
  • That they are unable to stop using their substance even if they want to
  • That they experience withdrawal symptoms when they cannot use the substance
  • That they are preoccupied with getting more of their substance
  • That their substance abuse interferes with their personal, social, professional, and/or educational responsibilities
  • That they feel ashamed or guilty when they use their substance or just after
  • That they lie about how much or how often they use the substance
  • That they become physically ill as a result of their drug use
  • That they use the substance all day, on their own.

Getting Help for Addiction

The exact treatment that you will receive depends on your Medical Mutual policy and the recommendations of your primary care physician. They offer coverage for:

  • Inpatient rehab, whereby you will live in a residential facility so that you can be away from the distractions, temptations, and influences that led to your drug abuse in the first place. You can build a plan about how you will achieve sobriety.
  • Outpatient rehab, whereby you continue to live at home, but you will have to attend counseling and therapy, often on a daily basis. This is often used after inpatient care as well.
  • Transitional housing, which gives people the opportunity to gradually return to the “real world” and the temptations that exist in it.
  • Counseling and therapy, including group, family, and individual therapy. This is particularly important for those who have co-occurring mental health disorders.

Overall, Medical Mutual is committed to making sure its members can live a happy, healthy life.

Other Things to Think About

Drug and alcohol rehab always starts with a period of detox. If you are ready to take this step, there are a few things that you need to think about, such as the fact:

  • That you may need to be referred by a primary care physician before you can get treatment
  • That you may need pre-certification, which means Medical Mutual grants you express permission to seek treatment
  • That you may have a cap on your financial responsibilities. Usually, there is a maximum out of pocket attached to your policy. If you reach this, then you won’t have to make any further payments during that year.

Mutual Medical has very wide ranging insurance policies. This is why you should check your documents or contact the insurance company directly to find out exactly what you are covered for.

About Medical Mutual

Medical Mutual is a popular, full service insurance company that offers several plans. Due to the new requirements in the 2010 Affordable Care Act, many of their plans cover addiction treatment and this includes detox. Exactly what is covered will depend on your plan. There are a number of variables that will affect your coverage, including:

  • The structure of your plan. There are HSA compatible plans, copay only plans, PPO plans, and so on. They all have different rules and regulations.
  • Your cost-sharing requirements. Usually, you should a part of the treatment expenses yourself. Exactly how much depends on the provisions of your plan, your copay and coinsurance levels, and your deductible.
  • The network requirements. Some plans that Medical Mutual offers will require you to choose an in-network provider to get full coverage.

By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.