Using Kaiser Permanente for Addiction Treatment & Detox
Headquartered in Oakland, California, Kaiser Permanente is one the largest not-for-profit health plans in the United States, serving over 8 million Californians. The Kaiser Foundation Health Plan, Inc. is a subsidiary of Kaiser Permanente and offers a variety of health insurance plans and policies for individuals, families, and employers all over America.
Does Kaiser Permanente Cover Drug & Alcohol Rehab?
Yes, most Kaiser plans will cover various behavioral health services, including substance use disorder treatment. You can check your benefits in just minutes using
Kaiser Permanente plans cover services at the best rates when individuals use a provider that is considered in-network. An in-network provider contracts directly with the insurance provider to offer discounted services. Some plans only cover in-network providers.
To use Kaiser health insurance to pay for drug addiction treatment, individuals may need to obtain verification, or a preauthorization. Plans may not require a referral from a primary care provider (PCP) in order to see a specialist, but verification is needed to ensure that services are deemed medically necessary.
What Types of Addiction Treatment Does Kaiser Cover?
Covered addiction treatment services through Kaiser Permanente may include some or all of the following types of treatment:
- Diagnostic evaluations.
- Individual and group therapy sessions.
- Outpatient treatment.
- Crisis intervention and stabilization.
- Medication evaluation and management.
- Detoxification services.
- Partial hospitalization programs (PHPs).
- Intensive outpatient programs (IOPs).
- Inpatient treatment programs.
Inpatient and hospital alternative services may require prior approval from a plan mental health or substance abuse physician, which means that a person will need to see an eligible physician approved by their specific plan prior to enrollment in a drug rehab program. Generally inpatient services have a coinsurance rate (e.g., you may pay 20% while Kaiser pays 80%). Outpatient services often require a copay at the time of service.
Insurance plans generally have an out-of-pocket maximum amount each year, and after individuals reach this amount, the rest of the approved treatment service costs are paid in full by the insurance provider.
How To Use Kaiser Plans to Cover Substance Abuse Treatment in California
Examples of Kaiser Permanente coverage offered to Orange County residents and the rate of coverage for substance abuse treatment services are outlined below:
- Deductible Catastrophic plan: This is a minimum coverage plan with a high annual deductible and out-of-pocket costs. It is only open to those under 30 or people demonstrating hardship. The first three mental health and/or substance abuse treatment office visits are covered, and the rest will be covered after the deductible is met. Inpatient care is covered in full after the deductible is met.
- Copayment Gold plan: This plan has no deductible amount to be reached first, and mental health visits cost $25 a visit. Inpatient mental health treatment is covered at 80% with the policyholder being responsible for the remaining 20 percent up to the low annual out-of-pocket maximum amount.
- HSA Bronze plan: With higher annual deductibles for individuals and families, this plan covers mental health and substance abuse services at 60% after the deductible is met, meaning that the policyholder is responsible for the remaining 40% of the cost until the annual out-of-pocket maximum amount is met.
- Deductible Silver plan: This plan has a low deductible amount per year, and once met, 80 percent of inpatient mental health services are covered. Mental health office visits are $35 a visit.
The summary of benefits can provide coverage details if you’re unsure exactly what your plan entails. You can also verify your Kaiser benefits and see what your plan may cover by filling out the two-step online, HIPAA-compliant form below.
About Kaiser Plans
Offering HMO (health maintenance organization) plans, HSA (health savings account) plans, high-deductible and catastrophic minimum coverage plans, and participating in Medi-Cal (California’s version of Medicaid), Kaiser insurance plans feature a lot of options and comprehensive coverage choices for its members.
In Orange County, Kaiser Permanente insurance plans for families and individuals include different levels of coverage, such as low monthly premium (the amount paid each month for coverage) and high-deductible (the amount that must be reached for coverage to begin), bronze-level plans, and higher monthly premium with lower deductible platinum-level plans.
Coverage is different based on the specific policy a person has. For help understanding your coverage and how it may apply to treatment, call an admissions navigator at .