In 2022, around 1,113,000 Arizonians needed treatment for a substance use disorder, but 894,000 did not receive this care. One of the biggest hurdles for people when it comes to seeking this life-saving care is the price tag that comes with it. Some might even be uncertain if their health insurance will cover even part of it. The good news is that many insurance companies, including Kaiser PPO, will cover it. Wolf Creek Recovery works with this health insurance for many of our addiction recovery services. Below, we discuss what options you or a loved one might have if you carry Kaiser PPO insurance.
About Kaiser PPO
Kaiser PPO is a health insurance company that serves 12.4 million members and is one of the nation’s largest not-for-profit health plans. They believe that physicians are responsible for their member’s medical decisions and provide coverage that continuously develops and refines “medical practices to help ensure that care is delivered in the most efficient and effective manner possible.”
The company was founded in 1945 in Oakland, CA, and has several local markets in Northern California, Southern California, Colorado, Georgia, Hawaii, Mid-Atlantic States, Washington, and the Northwest.
They view their Preferred Provider Organization (PPO) plan as one that is not just healthcare coverage but a partnership in one’s health. This means that you can choose any licensed physician nationwide. Benefits that the company includes in all of its plans include:
- Lower costs when you stay within network, including preventative care at little or no cost
- An out-of-pocket maximum that limits how much you’ll spend on most covered services each year
- No paperwork or claims when using in-network providers
- Convenient pharmacy options: use any Kaiser Permanente pharmacy or choose from nearly 60,000 MedImpact retail pharmacies nationwide
- No referrals are needed for specialists
- The choice to see any provider for medical care
Their PPO plan gives you two options when choosing a provider for your healthcare needs: the participating provider option and the nonparticipating provider option. Their participating provider option requires a simple copay for most doctor’s office visits, simple copays for covered services after meeting your deductible, lower out-of-pocket costs, and most preventative care services covered at little or no cost to you.
Their nonparticipating provider option gives you the choice of any licensed provider, including specialists, most preventative care services covered at little or no cost to you, most other services covered at a coinsurance after you reach your calender-year deductible, and easy appointment where you just call the provider’s office.
Does Kaiser PPO Cover Rehab for Substance Use Disorders?
Kaiser PPO helps individuals receive access to quality rehab services for substance use disorders. They recognize that this health condition requires proper care for individuals to build a healthier, more fulfilling life. Common types of services that Kaiser PPO will cover when it comes to substance use disorders include:
- Detox – Recovery from a substance use disorder often starts with detox where the body naturally eliminates the substance. This process can cause discomfort, so healthcare professionals provide a safe environment with support, guidance, and medication when necessary to ease symptoms.
- Inpatient treatment – Individuals stay at the treatment facility during this stage of treatment, giving them the chance to focus entirely on their recovery. They may take medications that support stability while they develop essential coping mechanisms and strategies for managing a substance use disorder.
- Partial hospitalization – Upon completing inpatient treatment, many individuals transition to this level of care where they build upon what they have learned about their recovery. Treatment intensity decreases, with hours adjusted to align with each person’s treatment plan.
- Intensive outpatient – Once partial hospitalization has been completed, many people continue their recovery in intensive outpatient care. This level of treatment requires attending therapy three times a week.
Each plan under Kaiser PPO can differ, which is why it is essential to talk to your insurance provider and Kaiser PPO representative. They can help you develop a better understanding our your coverage for substance use disorder treatment. This representative will guide you through the specifics of your plan and clarify any questions you might have.
Does Kaiser PPO Cover Rehab Out-of-Network?
Kaiser PPO offers out-of-network rehab coverage through their nonparticipating provider option. What this coverage looks like specifically depends on your plan. As coverage policies differ, consulting a Kaiser PPO representative or completing an insurance verification form with Wolf Creek Recovery can help you understand your options.
Although a facility may be considered out-of-network with Kaiser PPO, you may still have some coverage. Keep in mind that it might result in a higher out-of-pocket cost or meeting deductible requirements first. To understand what your options are, talk to a Kaiser PPO representative.
Will Kaiser PPO Cover Multiple Rehab Stays?
Kaiser PPO acknowledges that substance use disorder recovery may require multiple treatment stays. Coverage remains available for additional treatment as long as medical necessity is established. This company believes that physicians are responsible for their members’ medical decisions. This is why it is advisable to coordinate with your healthcare provider to confirm that additional stays are necessary. It is also recommended to consult with a Kaiser PPO representative to ensure a smooth process.
Build a Life You Love With Your Kaiser PPO Insurance at Wolf Creek Recovery
Taking the first step toward recovery can feel overwhelming, but Wolf Creek Recovery is here to guide you. Our compassionate, personalized treatment programs, which include outdoor therapy, help you discover a healthier, substance-free way of life. Call 1-833-732-8202 to check if your Kaiser PPO insurance covers your treatment. Get started with us today and build a life you love.