Priority Health Insurance Coverage for Alcohol and Drug Rehab

Addiction Treatment Coverage with Priority Health Insurance

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Priority Health is an insurance firm based in Michigan. It’s a unique company as it was founded by a group of doctors in 1986. To this day, their business model is still one of a kind. Their focus is on preventative medicine, while at the same time making sure that any conditions are treated to the highest possible standards. Additionally, they work very hard at ensuring the satisfaction of their members.

Some 600,000 individuals are covered by Priority Health, including some 12,000 employers who take out group plans. Members can choose from a huge range of in network providers, including some 27,000 physicians and other members of the healthcare industry workforce. Each of these has been selected specifically to meet the business model of the insurance company. To date, they have also included 110 different hospitals in their in network provider list.

Where Can You Get Priority Health Insurance Coverage?

As a Michigan based company, Priority Health only covers Lower Michigan. Those who are in that geographical area can access a wealth of specialty services and plans. These include family plans, individual plans, employer sponsored plans, Medicaid and Medicare. Most people are covered under the individual and family plans, which in turn are subdivided into:

  • HMO Plans: The most popular of them all. These come with a range of important benefits, including the ability to choose a preferred primary physician from the wide selection of in network providers. Priority Health offers a range of different HMO plans, including HMO HAS, Standard HMO, HMO Plus, and HMO RxPlus, which is the most expensive one. Additionally, they offer the option MyPriority Vida, which is a form of catastrophic cover.
  • POS Plans: Enables clients to access around 95 percent of the physicians operating in Michigan. With POS plans, members can also choose to access out of network care.
  • PRO Plans: Allow members not to name their primary physician. At the same time, they can continue to access the huge in network provider list.
  • MyPriority Short Term Health Insurance, which is a health plan that can last for a maximum period of six months. Those who have it can access prescription coverage, urgent care and visits to a physician.

All the different Priority Health plans include maternal cover, urgent care, hospital and emergency services, mental health care cover and prescription medication cover. What matters in this particular case is the mental health care cover element. Because the implementation of the Affordable Care Act, substance abuse treatment has to be covered in the same way as mental illnesses.

The Priority Health Insurance Coverage and Detox and Rehab for Alcohol and Drugs

Under all Priority Health plans, specialist treatment visits are covered. As such, when someone requires substance abuse treatment, this will be classed as a “specialist visit”. Because 95 percent of all medical specialists in Michigan are part of the provider network of Priority Health, it is likely that you can go to a qualified drug and alcohol rehab center and be covered under your insurance.

How to Find Out What Is and Isn’t Covered

Exactly what your Priority Health insurance plan will cover will depend on many different things. This is why, if you want to go for rehab treatment, it is important that you have a few questions answered. That being said, regardless of what the answers are to those questions, you should never allow finances to stop you from getting the treatment that you need; other options, including grants, sponsorship’s, loans and payment plans. While you may have some out of pocket expenses,  you need to see treatment as an investment in your life long health and well being.

Generally speaking, if you have chosen a rehab facility that you want to attend, they will be able to perform an insurance check for you, for free and no obligation, to find out what your out of pocket expenses are going to be. You can also find this information in your policy documents, as well as on the Priority Health website. Alternatively, you can contact them directly, and some of the questions you may want to ask them include:

What is the process that you need to follow in order to file a claim? For instance, it may have to be supported by your primary physician and/or a specialist from the rehab facility.

How long it will take before a claim is processed? The rehab facility will need this information so that they know when they will get paid. Should it take a very long time, they may expect you to make some sort of contribution towards the costs first.

Which treatment centers are in the network of providers and have been pre-approved? In terms of insurance payments, it is always easier to go to a pre-approved facility. However, it is more important that you find a facility that meets your particular needs.

Will you have to pay a deductible to got to rehab and, if so, how much? Again, whatever this amount is, it should not stop you from going to rehab. However, knowing what your deductible is will make sure that you can properly prepare yourself for what is to come.

What is the most that your policy will pay towards your treatment, and is there a maximum length of time attached to this? You may, for instance, feel more comfortable in a more luxurious facility, which is also a more expensive one. In this case, Priority Health may not cover as much for you. Similarly, it can happen that, while in treatment, your specialists feel that you should stay longer than originally intended. If so, you need to know if Priority Health will continue to cover you.

Are you a Priority Health Member?

If you are a Priority Health member, you will know how easy it is to use your insurance policy to pay for your care, which include substance abuse treatment. Most rehab facilities in Michigan accept Priority Health, and will state so on their website as well.