Rehab Centers that Accept Molina Healthcare Insurance

When seeking addiction treatment, many people worry about costs. Molina Healthcare may help cover those expenses. Coverage depends on several factors, including your plan type, network status, prior authorization, medical necessity, location and benefit design, so it’s important to be well-informed when choosing a program.

Finding out whether your insurance company will cover your treatment can feel overwhelming, but it doesn’t have to be complicated. This guide explains how Molina Healthcare benefits cover addiction care and how to verify coverage.

Many Molina insurance plans cover drug and alcohol addiction treatment, but how much they cover depends on your unique plan. In most cases, you’ll get the most coverage by choosing an in-network provider, but if in-network options don’t meet your needs, many plans offer limited coverage for out-of-network providers.

Different types of plans offer different benefits. Common plan types include health maintenance organizations (HMOs), preferred provider organizations (PPOs), exclusive provider organizations (EPOs) and point of service (POS) plans.

Depending on your plan, you may need to meet certain prerequisites for your treatment to be covered, such as prior authorization, a referral or a formal diagnosis. You may also need to meet your deductible or out-of-pocket max before your plan starts covering addiction services.

Most Molina Healthcare plans have separate coverage buckets for inpatient and outpatient addiction treatment services. The requirements for coverage often differ between these buckets. For example, you might need to pay a co-pay before your plan covers your outpatient services, while inpatient services may not be covered without prior authorization or until you’ve met your deductible.

Mental health and substance use disorder treatment are required benefit categories, which means many plans cover these services, but details vary between plans and networks. Parity rules prevent insurance providers from imposing discriminatory restrictions regarding addiction treatment benefits.

Everyone has a different experience with addiction, and a person’s treatment should be tailored to their needs. What your Molina insurance policy covers might differ depending on the level of care.

Medical Detox

Detox services provide medical supervision during withdrawal to enhance comfort and safety. Depending on the modality of detox (inpatient or outpatient), you may have to pay a co-pay, meet your deductible or obtain prior authorization for Molina to cover this service.

Inpatient or Residential Rehab

Inpatient programs offer a variety of treatment services in a supportive, controlled environment with 24-hour care. Most Molina plans offer coverage for inpatient care, but they may require prior authorization and coinsurance after you’ve met your deductible.

Medication-Assisted Treatment (MAT)

MAT uses U.S. Food and Drug Administration-approved medications to treat addiction by managing cravings, withdrawal symptoms and reducing the effects of addictive substances. Your Molina plan may cover some medications used for MAT, while others may require prior authorization.

Therapy and Counseling

Individual and group therapy and counseling are a part of many addiction treatment programs, allowing individuals to reflect on their recovery progress. Many Molina plans cover outpatient therapy and counseling with a co-pay. Prior authorization may be required for inpatient therapy and counseling.

Dual Diagnosis Support

Dual diagnosis treatment addresses substance addiction and co-occurring mental health disorders simultaneously to enhance recovery success. Molina plans may require prior authorization to cover dual diagnosis treatment, particularly if it takes place in an inpatient setting.

Aftercare and Continuing Support

Aftercare or continuing support services help people who’ve completed addiction treatment ease their transition out of care and prevent relapse. Many Molina Healthcare plans cover certain aftercare services, such as outpatient care, therapy and MAT. You may need prior authorization for certain aftercare services.

Insurance coverage can vary between in-network and out-of-network care. Choosing an in-network provider often results in lower cost-sharing, as these providers have negotiated rates with your insurer. Out-of-network providers aren’t contracted and usually result in higher coinsurance, a separate deductible and balance billing in certain situations.

Some services may involve outside providers, such as labs, so it’s important to verify who will bill for each service. Verification helps prevent surprise bills if an outside provider isn’t in-network.

Even with insurance coverage, you’ll likely have some out-of-pocket costs for addiction treatment. Your share of the bill depends on your deductible, which is the amount you must pay before your insurance kicks in. Co-pays are a fixed rate you pay at the time of service, and coinsurance is the percentage of total costs you’re responsible for.

Your out-of-pocket maximum will also affect your costs, which refers to the maximum amount of money you’ll have to pay out-of-pocket in a single plan year. Other factors to consider include the timing of your admission and how it lines up with your benefit period, your length of stay, any changes in level of care and pharmacy costs for medications when needed.

Molina offers a variety of health insurance plans. To find your plan type, you can check your insurance card, member portal or Summary of Benefits and Coverage.

Molina plan types include:

• Molina Medicaid
• Molina Medicare
• Molina Integrated Medicaid/Medicare (Duals)
• Molina Marketplace HMOs

DIY Verification Steps (Member)

1. Call the member services number on the back of your Molina Healthcare card.
2. Ask if the rehab is in-network or out-of-network for your plan.
3. Confirm authorization requirements for the level of care you need.
4. Confirm the deductible, coinsurance, co-pays and out-of-pocket max for your plan.
5. Ask about coverage limitations, such as the number of days, visit caps or medical necessity requirements.

Fastest Option: Let a Rehab Verify for You

You can also verify your benefits through the rehab provider. All you’ll need to do is call and provide your insurance company’s name and your policy number. From there, the rehab should be able to tell you if they’re in-network or out-of-network for your plan.

The rehab should also be able to confirm what your benefits cover. Keep in mind that your insurer determines final coverage, so verification through a rehab provider is strictly informational.

If your coverage is limited or denied, don’t give up. Ask why it was denied and gather information about the Molina Healthcare appeals process.

In some cases, denials may result from missing documentation. Ask for the required documentation list to ensure you provide all necessary paperwork for approval.

You may need a professional to help in other cases. Medical professionals can do a peer-to-peer or clinical review in certain situations to help explain why you need this treatment.

If your coverage gets denied because the provider is out-of-network, ask whether it’s possible to get a single-case agreement, which is a one-time contract between your insurer and the rehab to provide services at negotiated rates.

If you’re considering addiction treatment and want to find out if your insurance plan covers it, Help.org can help. Call us today, and we’ll help you understand your benefits and find a rehab program that meets your needs. Make sure you have your member ID, group number, date of birth and plan type handy.