When it comes to reaching out for help with a substance use disorder, it’s only natural to feel awkward, vulnerable, and maybe even frightened. After all, someone making the decision to change their life for the better marks the beginning of a big transition. However, having the appropriate support—whether it be personal, emotional, or even financial—can go a long way toward making that transition easier.
On the other hand, questions of cost, coverage, deductibles, and provider networks can feel overwhelming, so much so that reaching out for help might feel impossible. Fortunately, many of our most pressing questions about GEHA coverage for addiction treatment can be found here. For those searching for GEHA-covered rehab in Orange County, Pacific Sands Recovery may be just what they’re looking for.
About GEHA
GEHA stands for Government Employees Health Association. GEHA is a nonprofit member association that provides health and dental insurance to more than 2 million federal employees and retirees, military retirees, and their families. Offering one of the largest medical and dental benefit provider networks available to federal employees in the U.S., the 1,600 employees of GEHA ensure health and wellness for its members by being committed to their communities.
Headquartered in Lee’s Summit, Michigan, GEHA has gained distinctive civic recognition as one of the top 100 healthiest workplaces in America. It was also recognized in 2022 as a Nonprofit Champion of Diversity for the Greater Kansas City Chamber of Commerce. That same year, GEHA signed the CEO Action Pledge, furthering its commitment to diversity, equity, and inclusion.
Levels of GEHA Coverage
Because so many rehab facilities offer so many different services, it is essential that one know before going in what type of care they may need. Yes, physical and behavioral health care is essential, but issues like length of stay, comfort, and quality of a given facility is just as important.
Perhaps unsurprisingly, the more comfortable a rehab facility appears, the more one may be required to pay out of pocket. Fortunately, GEHA members enjoy a “cap” placed on the total amount of out-of-pocket expenses they are required to pay each year. Therefore, if a GEHA plan covers special treatment, then the out-of-pocket costs will never exceed a certain limit. This eases personal budgeting for healthcare-related expenses.
The cap for out-of-pocket expenses for various GEHA insurance plans are as follows:
- Standard Plan: $5,000
- Standard Out-of-Network: $7,000
- High option: $4,000
- High option out-of-network: $6,000
- High Deductible Health Plan (HDHP) option for individuals: $5,000
- High Deductible Health Plan (HDHP) option for families: $10,000
The amount of coverage one might have can vary, depending on the state of residence, whether the facility is in-network or out-of-network, the length of stay, and one’s specific insurance plan level. Also, the cost of any treatment varies from person to person, depending on the rehab center, the type of program, and the kinds of services received.
Does GEHA Cover Addiction Treatment?
Coverage of specific addiction treatment services like detox tends to vary, depending on the specifics of one’s plan. However, under the Affordable Care Act, passed in 2010, mental and behavioral health treatments must be covered as essential benefits under all health plans. These benefits include detox, therapy, mental health, and addiction treatment. In other words, the chances are excellent that most if not all GEHA plans cover rehab in Orange County.
Regardless of one’s specific needs, GEHA provides coverage for the following types of care:
- Detox. Medically-assisted detox involves patients being monitored during the withdrawal phase of their treatment, which typically lasts between three and 10 days. Medical professionals ensure patients’ safety and comfort during this time.
- Inpatient treatment. This includes counseling, physician oversight, and round-the-clock monitoring through the completion of the program.
- Partial hospitalization programs (PHPs). Partial hospitalization represents a “step down” from inpatient treatment. It includes scheduled visits to the facility most days of the week for most of the day.
- Outpatient (OP) programs. Outpatient programs call for patients to visit the facility for therapy regularly, usually two or three times per week.
- Intensive outpatient (IOP) programs. Like outpatient programs, IOP requires participation in an outpatient program, though for longer and more frequent sessions than most outpatient programs.
- Aftercare. Aftercare programs support sustained sobriety following rehab. Support groups, individual and group therapy, and community programs all characterize aftercare.
GEHA requires its in-network providers and facilities to meet certain standards of accreditation. Pacific Sands Recovery meets these standards through the Joint Commission of Addiction Healthcare Organizations (JCAHO). It should be noted that not all GEHA plans cover all costs associated with rehab. How much is covered depends on the member’s specific coverage type, as well as whether the facility is in-network or out-of-network.
Will I Have to Pay a Deductible With My GEHA Coverage?
A deductible is the sum of costs a GEHA member must pay out of their own pocket before the insurance coverage begins. Whether someone will have to pay a deductible with GEHA for rehab in Orange County, depends on the plan. It also depends on whether the provider is labeled in-network or out-of-network.
In-network providers are those healthcare providers who have a contract with GEHA to offer services at a set price. This means out-of-pocket expenses will typically be lower for GEHA members who choose those providers than if they decided treatment with an out-of-network provider.
GEHA members are advised to seek treatment with an in-network provider. In some cases, if an in-network provider is unavailable, GEHA members may be able to work out a payment plan with another facility for treatment. In any event, it is wise to reach out to a GEHA representative to discuss payment and plan options.
Find GEHA-Covered Rehab in Orange County
At Pacific Sands Recovery in Orange County, we believe no one should have to continue living with a substance use disorder. That’s why we’ve partnered with GEHA so members can partake of our treatment options at the lowest cost possible. Don’t hesitate to contact us and change your life.
For more information, contact us today.
