Rehab Centers that Accept CareSource Insurance

Asking for help with a substance use disorder takes courage, and once you take that first step, it’s common to wonder how you’ll pay for it. If you have CareSource insurance, your plan may cover rehab and other types of addiction treatment.

This guide explains how CareSource typically covers services related to substance use disorders. You’ll also learn how to verify your benefits and determine how a facility’s in-network or out-of-network status can affect your out-of-pocket costs. CareSource may have additional requirements related to medical necessity or prior authorization, but your preferred rehab can help with documentation.

In some cases, CareSource covers drug and alcohol rehab. However, the exact answer often depends on your plan type and design.

Network status also plays an important role. If a facility is in-network with your plan, it has agreed to accept negotiated rates. As a result, choosing an in-network rehab may lower your out-of-pocket costs.

CareSource doesn’t typically cover out-of-network care. If you choose an out-of-network rehab anyway, you may have to cover the full cost yourself. Additionally, CareSource only offers HMO (health maintenance organization) plans, so you may need a referral for any type of specialty care.

It’s also important to understand your plan’s requirements for prior authorization and medical necessity. You may have to submit documentation proving that you require a certain level of care. On top of these considerations, your coinsurance rate, deductible and out-of-pocket max all influence your costs.

CareSource usually processes addiction treatment claims under a plan’s behavioral health benefits. Services are often classified as inpatient/residential or outpatient.

Your CareSource plan may include coverage for these services:

• Medical detox
• Residential or inpatient rehab
• Individual therapy
• Group counseling
• Medication-assisted treatment (MAT)
• Aftercare support

Mental health parity rules also influence CareSource rehab coverage. That means insurance companies must treat medical and mental health services the same way. They can’t limit services related to substance use disorders if they don’t impose the same limits on medical and surgical services.

That doesn’t mean every service is covered, but your CareSource plan may cover some types of addiction treatment.

There’s no one-size-fits-all approach to addiction treatment. Some people might need medical detox to manage severe withdrawal symptoms, while others can begin therapy right away. Understanding how CareSource covers each treatment type can help you feel more prepared to make decisions.

Medical Detox

Medical detox is often the first step to healing from a substance use disorder. CareSource may cover detox when it’s considered necessary for your safety. For example, you may be able to demonstrate that you need detox to help you avoid withdrawal complications.

Even if your plan covers detox, you may need to get approval before you begin treatment. CareSource may also conduct a length-of-stay review to determine if you still need this level of care.

Inpatient or Residential Rehab

Inpatient rehab offers a highly structured environment with 24/7 support. Due to the intense nature of these services, they tend to cost more than other types of addiction treatment.

When treatment falls into a higher cost category, CareSource may require prior authorization. An insurance representative may also review your stay to determine if you still need a high level of care.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment helps some people recover from opioid addiction. Opioids are drugs that change the way you perceive pain. MAT uses medications and behavioral therapies to reduce cravings and minimize the risk of relapse.

Because MAT has two parts, CareSource may split your coverage. Medications typically fall under a plan’s pharmacy benefits, while other therapies are considered medical or behavioral.

CareSource may also have a formulary, which is a list of covered drugs. If a medication isn’t on the formulary, you may have to take a covered alternative.

Therapy and Counseling

Therapy and counseling are at the heart of addiction recovery. Individual therapy, group counseling and other evidence-based approaches are usually classified as behavioral health benefits.

CareSource rehab coverage often allows for ongoing participation in therapy. However, there may be a limit to the number of sessions you receive in a benefit period.

Dual Diagnosis Support

When you have a substance use disorder and another mental health disorder at the same time, it’s called a dual diagnosis. Many rehab centers don’t offer standalone mental health treatment, but they may provide care for anxiety, depression and other co-occurring disorders.

CareSource may cover this type of treatment, but it depends on your plan. It’s also common for insurers to have medical necessity criteria.

Aftercare and Continuing Support

When you finish rehab, it’s helpful to have ongoing support. Typical aftercare services include outpatient therapy, peer recovery groups and step-down programs.

CareSource rehab coverage for aftercare varies. Therapy is often billed through your insurance. Other services may be billed as part of a support program instead of individually.

In-network rehabs usually have lower out-of-pocket costs, especially with CareSource. This company only offers HMO plans, which don’t cover nonemergency care provided by out-of-network facilities. Denying out-of-network claims helps keep costs low.

During your treatment, you may receive services from multiple providers. Some of these individuals are employed by the rehab, while others work for third-party companies. Verifying who’s billing for each service may help you avoid unexpected out-of-pocket costs.

Your out-of-pocket costs depend on the way your plan is structured. If you have a deductible, you usually have to pay it before your insurance covers part of your treatment. With coinsurance, you have to pay a percentage of the cost of each approved service.

It’s also important to know your out-of-pocket maximum. This is the most you’ll pay for covered services in a plan year. Once you reach the out-of-pocket max, CareSource typically pays the rest, as long as each service is covered by your plan.

Costs also vary based on:

• Length of stay
• Benefit periods
• Level-of-care changes
• Medications for MAT (if applicable)

CareSource offers several types of HMO plans. An HMO requires a referral from a primary care provider every time you need specialty care. There’s also no coverage for nonemergency services delivered by out-of-network providers.

If you have CareSource insurance, you may have one of the following plan types:

• Marketplace
• TRICARE
• Managed Medicaid
• Medicare Advantage

Your plan type is available on your member ID card, in your CareSource online account or in the Summary of Benefits and Coverage (SBC) documents.

DIY Verification Steps (Member)

Follow these steps to verify your CareSource rehab coverage:

1. Find the phone number on the back of your ID card and call CareSource.
2. Find out if your preferred rehab is in-network or out-of-network.
3. Ask whether there are any authorization requirements for the level of care you need.
4. Confirm your potential out-of-pocket costs, such as your deductible, coinsurance rate and out-of-pocket max.
5. Determine if there are service limits, medical necessity requirements or any other limitations on substance use treatment coverage.

Fastest Option: Let a Rehab Verify for You

It’s even quicker to verify your benefits if you let a rehab center do it for you. Generally, you just have to provide your policy number and the name of your insurer. The rehab can confirm its network status and tell you what your benefits cover.

CareSource determines your final coverage, so verification isn’t a guarantee that your plan will pay for every service. It’s simply an informational tool.

If you run into unexpected denials or limitations, there are a few things you can do:

• Find out the reason for the denial and request information on the CareSource appeals process.
• Get the list of the required documentation.
• Request a peer-to-peer or clinical review, if available.

Consider asking if a single case agreement (SCA) is possible. This is a temporary contract for CareSource to cover out-of-network services as if they were delivered by in-network providers.

You’re brave enough to ask for help, so insurance confusion shouldn’t stop you from beginning your recovery. Help.org can help you understand CareSource rehab coverage and find a treatment center that meets your needs.

Call us or fill out the online form to find a rehab that works with your plan. You’ll need your member ID, group number and date of birth.