Rehab Centers that Accept MVP Health Care Insurance

Looking for a rehab center that accepts your insurance can be overwhelming and difficult to navigate. MVP Health Care offers a variety of plans that may help you cover the cost of your addiction treatment. However, coverage depends on several factors, including plan type, network status and medical necessity.

Finding out whether your health insurance covers addiction treatment shouldn’t be a daunting process. This guide explains MVP Health Care rehab coverage, including how your plan works for treatment and how to verify your coverage.

MVP Health Care covers addiction treatment, but what’s covered and how much depends on a few factors. A big factor in coverage is whether the program you choose is in-network or out-of-network.

Typically, you’ll get the most coverage by choosing an in-network provider, but some plans offer reduced coverage for out-of-network providers, so you have options if in-network providers don’t meet your needs.

Some plans require prior authorization, referrals or proof of medical necessity before covering rehab. Coverage is also affected by your plan type, such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), exclusive provider organizations (EPOs) and point of service (POS) plans.

Depending on your plan structure, you may also need to meet your deductible or out-of-pocket max before your coverage kicks in.

MVP Health Care addiction rehab coverage is often categorized by inpatient and outpatient care. For many MVP plans, the policyholder will owe a co-pay for each outpatient visit and a larger co-pay for the first 5 days of inpatient care.

MVP insurance plans may cover:

• Detox
• Inpatient/residential care
• Therapy
• Partial hospitalization

Most insurance plans cover mental health and substance abuse treatment to some extent because they’re required categories, but the amount of coverage and requirements vary. Fortunately, insurance companies are prohibited from imposing coverage restrictions that discriminate against addiction care benefits under parity laws.

Your treatment plan should be unique to your needs. MVP Health Care may provide coverage for the levels of care below.

Medical Detox

Detox services offer 24/7 care for patients going through withdrawal before treatment. Prior authorization and proof of medical necessity are required for most MVP plans for both inpatient and outpatient detox.

Inpatient or Residential Rehab

Patients who need a higher level of care may choose inpatient or residential rehab, which offers a sober environment and a regimented treatment schedule. Most MVP plans cover inpatient treatment with prior authorization and proof of medical necessity.

Medication-Assisted Treatment (MAT)

MAT can help treat drug and alcohol addictions with the use of medications that reduce cravings and withdrawal symptoms. Proof of medical necessity is often required for coverage.

Therapy and Counseling

Therapy and counseling help patients address their emotions in recovery, build relationships with peers and set treatment goals. Depending on the treatment modality, you may need prior authorization or proof of medical necessity for coverage.

Dual Diagnosis Support

Many people have co-occurring mental health conditions with addiction. Dual diagnosis treatment addresses both conditions together. With many MVP plans, inpatient dual diagnosis may require prior authorization. Proof of medical necessity may be necessary for both inpatient and outpatient care.

Aftercare and Continuing Support

Continued therapy, MAT and sober living are a few examples of aftercare treatments used to support individuals transitioning out of rehab. Some continuing care treatments, such as therapy and MAT, may be covered under your MVP Health Care plan with proper documentation.

Understanding the difference between in-network and out-of-network insurance coverage can help you make the most of your benefits. Because in-network providers have negotiated rates with your insurer, patients typically see lower cost-sharing (co-pays, coinsurance, etc.). You may have higher coinsurance, balance billing and a separate deductible to meet for out-of-network care.

Keep in mind that addiction treatment can sometimes involve outside providers that may be out-of-network, even if your rehab facility is in-network. Asking who will bill your insurance for these services can help prepare you for what you might owe.

Although your treatment may be covered by insurance, you’ll most likely still have some out-of-pocket costs for rehab.

Factors that can affect your share of the costs include:

• Deductible: The deductible is a set amount you’ll need to pay for covered services each year before your coverage kicks in.
• Co-pay: Some services have a flat fee (or co-pay) that you’ll owe for each visit.
• Coinsurance: Coinsurance is the percentage of the total cost of treatment you’re responsible for after insurance.
• Out-of-pocket maximum: This is the most money you’ll have to pay out of pocket for the year.
• Admission timing/benefit period: The timing of your admission may affect your costs, depending on how it lines up with the benefit period. If it’s a new period, your deductible/out-of-pocket max may reset.
• Length of stay/level of care: Longer stays and changes in level of care may increase or decrease your out-of-pocket costs.
• Pharmacy costs: If you are receiving MAT, the cost of your medication may affect your share of the bill.

MVP Health Care offers several types of insurance plans. If you’re unsure of your plan, you can check your card, Summary of Benefits and Coverage or your member portal.

MVP plans include:

• MVP Medicare
• MVP Medicaid
  • Medicaid Managed Care
  • Harmonious Healthcare Plan
  • Child Health Plus
  • Essential Plan
• MVP Dual Access
• MVP Individual and Family Plans
  • HMO
  • PPO
  • POS

DIY Verification Steps (Member)

1. Call the member services number on the back of your MVP Health Care 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. Ask about the deductible, coinsurance, co-pays and out-of-pocket max for your plan.
5. Confirm coverage limits, such as number of days, visits or medical necessity reviews.

Fastest Option: Let a Rehab Verify for You

The fastest route is to have the rehab facility verify your plan. Call the treatment center and ask whether it’s in-network for your policy. You’ll need to have your insurance card on hand to provide plan details.

You can also ask what services your benefits cover. However, MVP Health Care makes the final call regarding coverage, so verification is for informational purposes only.

Coverage for certain services may be limited or denied, but that doesn’t mean you’re out of luck.

Ask the insurance company why they denied your coverage and then:

• Appeal the decision: Start the appeal process to have your insurance review your submission a second time.
• Request a required documentation list: Ask for a list of required documentation if your coverage was denied due to missing information.
• Ask for a clinical review: A peer-to-peer or clinical review involves a healthcare professional speaking with the insurance company to explain why your treatment is a medical necessity.
• Request a single-case agreement: If you were denied coverage due to choosing an out-of-network facility, ask for a one-time contract with negotiated rates.

If you’re not sure whether MVP Health Care will cover your treatment program, Help.org can help you verify your coverage and understand your benefits. Call us today with your insurance details. We can help you find a rehab treatment center that works with your insurance and meets your needs.