MultiPlan Insurance Coverage for Rehab

How to Use MultiPlan Insurance (PHCS) for Detoxification, Rehab, and Dual Diagnosis Treatment

Know your rights. Call 1-800-270-1389 to get help today!

What is MultiPlan Insurance?

MultiPlan is a facilitator of preferred provider organization (PPO) networks operating in certain areas of the United States. MultiPlan isn’t a company that directly provides insurance to members. Instead, members access MultiPlan health insurance services through an administrator of a health plan or the payer of medical bills. MultiPlan offers discounted rates on providers and they also connect people with nearly a million PPO healthcare providers not only in the southwest but also in Wisconsin and other states throughout the country.

MultiPlan also offers services for government and commercial healthcare programs. When someone has insurance through one of the insurance payers and carriers that work with Multiplan, their coverage is considered part of the MultiPlan network.

With a PPO there is typically more flexibility as compared to health maintenance organization (HMO) plans, and there are fewer restrictions on seeing providers outside of the network. While a PPO may cover the costs of non-network services and providers, they will usually do so at a lower rate.

Does MultiPlan Cover Drug & Alcohol Detox?

The insurance plans that are part of MultiPlan’s network will cover a broad range of services. The provision of drug and alcohol detox and addiction treatment was also significantly expanded by most insurance companies following the enactment of the Affordable Care Act. The Affordable Care Act requires marketplace insurance plans to cover mental health and substance abuse treatment as essential health care services.

If someone has insurance through companies that are part of the MultiPlan network, they may have coverage not only for drug and alcohol detox but other types of addiction treatment including:

Benefits Offered from MultiPlan for Addiction Treatment

While MultiPlan isn’t a health insurance provider, the company has created a network of health insurance programs and products. Thus, direct insurance carriers can use the MultiPlan network to provide PPO coverage to their customers. By contracting with Multiplan, the insurance carriers have access to a greater provider network.

In terms of substance abuse, mental health and addiction treatment, how much coverage you may be eligible for depends on your network, your plan and the state you live in.

With PPO health insurance, you will often have the ability to work with the provider you choose without a referral, although they may need to be in-network to pay lower out-of-pocket costs.

If you do have a network through Multiplan, you can’t contact them to learn more about your coverage. Instead, you need to contact 1 Method (or another trusted agency) and we can help you, or you can directly contact the benefits administrator for your health insurance plan. Then, you can learn more about the exact level of coverage available to you for addiction treatment.

Will MultiPlan Cover Long Term Addiction Treatment?

Technically, since MultiPlan isn’t a direct health insurance provider, they don’t cover any of the stay for addiction treatment. However, addiction treatment centers that are part of their network may be covered if your plan is part of Multiplan. There are two factors that determine how much addiction treatment is covered:

  • Where you live
  • What you’re responsible to pay out-of-pocket.

Most insurance plans cover some or all of the cost of addiction treatment, and 1 Method works with many of the primary insurance providers in the country.

How to Navigate the MultiPlan Insurance Network

1 Method Center has helped many families find substance abuse, dual diagnosis, and mental health treatment programs that work with their MultiPlan insurance policy to provide affordable rehabilitation services.

MultiPlan has roughly 890,000 health care providers under contract. Additionally, nearly 70 million people currently access MultiPlan’s network products, and about 40 million claims are reduced annually through the insurer’s network and non-network solutions.

This New York-based insurer offers regional PPO networks in Wisconsin and the Southwest. It specializes in commercial and government health plans, while also offering solutions in workers’ compensation and auto-related medical bills.

MultiPlan customers often have little trouble using their insurance policy to help them find excellent health care services. What we specialize in is taking their insurance policy and seeing which SUD/AUD treatment facilities accept their insurance coverage.

For help navigating this extensive network contact us for help.

The Cost of Rehab: Paying for 1 Method

We accept most major PPO insurance plans to help cover the cost of treatment. In fact, we have years of experience working with insurance companies and will handle all of the back and forth with them to determine the specifics of your coverage. We work directly with your insurance company so you can focus your energy on treatment and recovering.

The cost of treatment at 1 Method is based on each client’s level of care, individualized needs and treatment plan. Contact admissions at 1 (800) 270-1389 for an estimate of treatment costs based on a confidential consultation.

1MC works with many PPO insurance plans to help offset the cost of treatment, including MultiPlan. Your insurance plan may cover a large portion of the treatment for alcohol and drug addiction, dual diagnosis, and mental health disorders. Submit your insurance online for a quick and easy insurance benefits check. We’ll do all of the legwork so you can focus on getting better.

Insurance FAQs: What You Need to Know

Here are answers to some frequently asked questions about insurance coverage for alcohol, drug, and mental health treatment.

What does “In Network” mean?

Healthcare providers that are “in network” with your insurance company typically will be more affordable, as they have negotiated agreed upon rates for care with physicians, therapists, or mental health and substance abuse facilities. For example, an outpatient therapist who usually charges $120 per session might be contracted with an insurance provider to only charge them $70 per session. The insurance company is able to pass the savings along to its members. In-network providers are also known as preferred providers or participating providers.

How do I know if my insurance covers residential treatment?

If your insurance plan covers residential treatment for mental health disorders and addiction, it will include a component called “mental health and substance abuse coverage.” The easiest way to determine what type of mental health and substance abuse insurance coverage you have is to submit your insurance online. Once you provide your insurance details, we’ll call your insurance provider and work with them directly, to determine exactly what mental health and substance abuse benefits you’re eligible for under your plan. We then reach back out to you to discuss how the benefits are applicable for care in our program, as well as deductibles met, co-insurance and out of pocket expenses not covered under your plan.

What are “Out-of-Pocket” costs?

These are costs not covered or reimbursed by your insurance company.

What happens when I call for an insurance benefits check?

We’ll assist you in managing the logistics – the process is swift, simple and free:

  1. Phone consultation – Speak with a licensed counselor about what’s been going on, so they can recommend treatment options that fit your needs and preferences.
  2. Benefits check – Once you decide which treatment option you prefer, a team member will contact your insurance company to determine the details of your coverage applicable, including deductibles met, co-insurance, out-of-pocket expenses or applicable non-covered care.
  3. Estimate – Using the information from the conversation with your insurance company, we’ll provide a treatment cost estimate which considers any out-of-pocket costs (outstanding deductibles, co-insurance, non-covered care). An insurance deductible is the amount your insurance requires you to pay before they begin covering the costs for care: For example, if your deductible is $2500, you’ll pay for the first $2500 of treatment service costs before your insurance starts paying their portion.
  4. Treatment reviews – All services we provide must be authorized by the insurance company. This, however, is not a guarantee of insurance payment, as all payment is subject to eligibility and other terms of the benefit.
  5. Concurrent review and continued stay certification – Most insurance policies today require ongoing communication from the treatment facility utilization management team and the managed care review department at your insurance company. This is done to ensure your healthcare dollars are being used appropriately. This communication may be required weekly or daily and is contingent upon the requirements of your insurance policy.
  6. Medical necessity for care – All insurance policies have their own policy requirements, which may allow them to certify an admission or continuation of care. Each insurance policy is unique and governs how treatment stays are initially reviewed after admission and subsequently certified. Please understand that admission authorization or concurrent treatment certification is not a guarantee of payment to the treatment facility. All care is governed by insurance policy requirements, insured and dependent eligibility, and terms of the contractual agreement between the insurance company and the person insured.

Will my insurance benefits cover my entire length of stay?

It depends on your insurance provider and what it considers “medically necessary.” Our treatment team will conduct a thorough review when you enter treatment to assess your physical and mental health. We’ll then make a recommendation on the length of stay we feel is appropriate based on the severity of the presenting symptoms. We’ll communicate with and submit all the required documentation to your insurance provider. Please note that each insurance company has different requirements about what is considered “medical necessity.” Our recommendation for how long you stay is not a guarantee your insurance company will approve the same length of stay.

Do I need to submit insurance claims for treatment?

No. Our billing department will handle all the paperwork. We submit bills directly to your insurance provider. We can also provide you with a Superbill if you request one.

Will I know out-of-pocket costs before entering treatment?

After we determine your insurance coverage for SUD and mental health treatment, we’ll provide a detailed estimate of any out-of-pocket costs you are likely to incur. We’ll also keep you updated throughout your stay should that amount change. Please note that an estimate is not a guarantee of costs.

What if my insurance won’t cover treatment?

If you don’t have insurance coverage or your insurance provider does not cover mental health and addiction treatment, you have a couple of options:

  1. Self pay – You may pay costs out-of-pocket at the self pay rate.
  2. Step down level of care – We can help you determine if your insurance provider will help pay for outpatient treatment.

We encourage you to discuss this with admissions. We have relationships with many facilities and providers throughout the nation and are solution-focused. Our commitment is to help you find the next best treatment solution should your insurance benefits or financial ability not cover the cost of residential care in our facility.

What if I decide to use my insurance later?

You may request to use your insurance upon discharge. Our central billing office will provide a comprehensive statement (Superbill) to the address provided as a courtesy to you. However, once treatment has begun, it is unlikely to receive certification for services to be covered. It is best to work with you and your insurance company at the beginning of your treatment and increase the possibility for coverage for your care.

Do You Have More Questions About Insurance?

Navigating your insurance plan to determine what type of substance abuse coverage you qualify for can be overwhelming. Our insurance specialists are available 24 hours a day to assist you.

Contact 1 Method Center if you’re seeking help with any of these mental health, dual diagnosis, or alcohol and drug rehab-related services:

  • Detoxification
  • Inpatient Treatment
  • Short or Long-Term Residential Care
  • Intensive Outpatient Treatment and Aftercare

We can help you review your insurance benefits and then recommend which steps you should take next.

How Your MultiPlan Benefits Cover Addiction Treatment

If you call 1 Method Center and tell us you have MultiPlan insurance, we’ll start with a thorough review of your policy. What we’ll look for is:

  • Whether you’re covered for behavioral and mental health services (such as addiction and substance abuse treatment)
  • How long will you be covered for treatment (30, 60, 90 days, etc.)?
  • How much can you expect to pay out of pocket?

Knowing what your MultiPlan policy will cover can open the door to more options and give you the information you need to make a more educated decision.

What we’ll then do is identify which drug and alcohol rehab centers accept your insurance coverage. Do you want to stay in state for inpatient or outpatient treatment, or do you need to break out of your current bubble? Your answer will help us narrow down the list, and we may even weed out a few others that don’t meet our standards.

Once you’ve chosen a rehab facility to start your alcohol or drug rehab treatment program of choice, 1 Method Center will make a professional referral to the treatment center and help you get started in rehab in a matter of days.

Understanding Coverage for Alcohol and Drug Detoxification

When it comes to getting treatment for substance abuse, many people immediately think of inpatient rehab, therapy, and other parts of the treatment process. But, for most people, the road to recovery begins with detoxification. This process, commonly known as detox, is usually the first step toward a life that is free from addiction.

Often, individuals who have become dependent on alcohol or drugs have difficulty when they attempt to stop using the substances they’ve been using for a while. This is because their bodies have grown used to functioning under the influence of drugs or alcohol. So, when people try to stop using these substances, their bodies experience many intense and uncomfortable symptoms. This is called withdrawal and the symptoms can be very difficult to work through.

Sometimes, the withdrawal process can even be dangerous if individuals try to stop using drugs or alcohol abruptly. This is why professional detox programs are so important. People who go through licensed detox programs like 1 Method Center can end substance use in a much more comfortable and safe way.

After detoxing from alcohol or drug use, many individuals transition into inpatient (residential) treatment programs. During this time, people develop the skills they need in order to avoid relapse, become more comfortable living without substance use, and even develop interpersonal skills. Some may then enroll in an outpatient program as they transition to life outside of treatment.

If you or a loved one needs treatment for addiction, it’s best to find out how your insurance company can help you cover the costs of treatment. Since MultiPlan isn’t an insurance company, it won’t directly provide coverage for treatment. However, insurance companies that have partnered with MultiPlan may offer at least partial coverage for detox and treatment services.

Understanding Coverage for Mental Health Treatment

Often, behavioral and mental health disorders co-occur with addiction problems. This is known as dual diagnosis and individuals who suffer from both addiction and mental health concerns need treatment that addresses both. Professional dual diagnosis treatment programs can help individuals to overcome the addiction and work through the effects of mental and behavioral health problems.

Finding the best treatment for co-occurring disorders can sometimes be difficult. So, it’s helpful to have an understanding of the options are available and how your insurance policy can help you.

The 1 Method Center Difference

1 Method Center takes a unique, three-fold approach to your treatment. First, we carefully design a tailored plan of care to meet and match your needs. This includes but isn’t limited to 1-on-1 therapy, evidence-based services (e.g., psychiatry, mental health screening, medication mgmt., etc.) and holistic treatments. This plan is continually fine-tuned to attend to all your needs – mind, body, and spirit. Second, we adhere to the Stages of Change model in timing service provision. We don’t try and fit square pegs in round holes or believe in a ‘one size fits all’ path. Third, we are the only program in the nation that employs a specialized health and fitness program with specific protocols for addiction, dual diagnosis, and mental health issues. This is customized to your needs and based on cutting-edge neuroscience, Applied Breathing Science, and empirically based measures from the field of Integrative Biology and Physiology. Utilized in synergy, these approaches are transformational and help you unlock your full potential as a human being.

While other programs and even the insurance company itself can certainly review and tell you about your benefits, the difference with 1 Method Center is we have worked exclusively in the behavioral health field for more than two decades. In doing so, we’ve built a rapport with many insurance providers, rehab centers, and treatment facilities across the country.

Such familiarity with various treatment centers helps us in two areas:

  • Knowing which facilities provide exceptional treatment and which ones fall short, which helps us narrow your list down more quickly
  • Speeding up the referral process so you can get admitted ASAP, thanks to the relationship we’ve built with so many of these facilities

Learn More

Many aspects of the 1 Method approach are endorsed by leading mental and behavioral health professionals. What sets us apart from traditional rehabs is that we know how critical they are for effective treatment of addiction, dual diagnosis, and mental health issues. A few that call for deeper understanding and exploration are:

Call us with any questions or send us a message. We’re here for you anytime. Always.

Cassidy Cousens

Cassidy Cousens

Cassidy Cousens is the founder of 1 Method Center. He’s worked in behavioral health treatment for over 20 years. Cassidy specializes in the Integrated Model of Care and is widely viewed as an expert in behavioral health. To talk with Cassidy call 1-310-254-9479.