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Qualchoice INSURANCE

QualChoice Insurance understands the critical need for comprehensive coverage when it comes to addressing alcohol and substance abuse. With a commitment to supporting individuals on their journey to recovery, QualChoice offers a range of coverage options that encompass prevention, treatment, and ongoing support for policyholders facing these challenges.

Does QualChoice Insurance Provide Coverage for Drug and Alcohol Addiction?

Certain plans provide coverage for residential mental health or substance use disorder treatment facilities. Care for mental health or substance use disorders in a residential treatment facility is covered only when part of a treatment plan pre-authorized by QualChoice. For CHI members, see BI208 CHI Residential Treatment Program. Certain plans may cover cognitive (neurological) rehabilitation; see BI456 Cognitive Rehabilitation for details. Residential treatment for other services is not covered.

How Can You Check Your QualChoice Rehab Coverage?

The best way to do this is to sign into your online account on the QualChoice Website. Here you can review your claims and view your benefit booklet.

What Does QualChoice Insurance Cover Under Drug and Alcohol Addiction Rehab?

QualChoice Insurance covers a wide range of services under drug and alcohol addiction rehab to ensure comprehensive support for individuals seeking treatment. Here are some of the key areas that their coverage includes:

Inpatient Treatment: QualChoice Insurance provides coverage for inpatient rehabilitation programs, which offer a structured and intensive environment for individuals with severe substance abuse disorders. Inpatient treatment typically includes detoxification, medical supervision, individual and group therapy, counseling, and various other evidence-based interventions.

Outpatient Treatment: QualChoice covers outpatient rehabilitation programs, allowing individuals to receive treatment while living at home and maintaining their daily routines. Outpatient treatment may involve counseling, therapy sessions, medication management, support groups, and other services tailored to meet the individual’s needs.

Partial hospital: An intensive, non-residential level of care where multidisciplinary medical and nursing services are required. Care is provided in a structured setting, similar in intensity to an inpatient setting, meeting for more than four hours and generally, less than 8 hours daily. Such care is appropriate for substance use disorder treatment when provided in conjunction with ambulatory detoxification or when medical co-morbidity or other complications make less intensive levels of care unsafe or inadequate.

Medication-Assisted Treatment (MAT): QualChoice recognizes the effectiveness of medication-assisted treatment in managing certain substance use disorders. They provide coverage for FDA-approved medications that can help reduce cravings, alleviate withdrawal symptoms, and support long-term recovery.

Aftercare Support: Recovery from drug and alcohol addiction is an ongoing process. QualChoice offers coverage for relapse prevention programs, support groups, and peer recovery support services. 

It’s important to note that the specific coverage details and benefits may vary based on the policy and plan selected by the policyholder. Review your policy documents or consult with a representative from QualChoice to understand the exact coverage available under drug and alcohol addiction rehab.

Will QualChoice cover my Substance Abuse Treatment?

Residential Treatment Detoxification for Substance Use Disorder

Member’s symptoms or condition must meet the diagnostic criteria for a DSM Axis I or ICD Substance Dependence diagnosis for residential treatment detoxification. All services must meet the definition of medical necessity in the member’s plan document.

Residential Treatment Center for Substance Abuse Disorder

Member’s symptoms or condition must meet the diagnostic criteria for a DSM Axis I or ICD Substance Abuse and/or Dependence diagnosis for residential treatment center treatment. All services must meet the definition of medical necessity in the member’s plan document.

Aftercare and Support

Recovery from alcohol and substance abuse is a lifelong process that requires ongoing support. QualChoice Insurance extends coverage for aftercare services, including relapse prevention programs, support groups, and peer recovery support services. This support network plays a crucial role in helping policyholders maintain their sobriety and successfully navigate the challenges of everyday life.

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At True Self Recovery in Arkansas, we offer free insurance verification for our clients who feel they need some help. When you contact us, we will carry out the thorough analysis of your addiction problem, and then recommend a workable Aetna drug treatment program. Next, we will contact your insurance provider on your behalf and verify your benefits. We will also let you know if you will be responsible for any out-of-pocket expense not covered under your plan.

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