Detox & Rehab Covered by Priority Health Insurance
Priority Health is a nonprofit health insurance company that strives to offer quality healthcare options that are affordable and community-based, focusing on improving quality of life for its members.1
The fastest growing health insurer in Michigan, Priority Health has over 1 million members, offering health insurance plans for families and individuals, employers, and Medicare and Medicaid plans to those that qualify.1
This page contains information about Priority Health insurance and how it can be used to pay for addiction treatment.
Does Priority Health Cover Addiction Treatment?
Yes, most Priority Health plans cover treatment for addiction and other mental health issues. In fact, the Affordable Care Act (ACA) and mental health and substance use parity laws require most insurance policies—including all small group plans, government-funded (Medicaid and Medicare) plans, and Health Insurance Marketplace plans—to cover mental health and substance use care to some degree.2,3
Priority Health benefits and the level of coverage offered may vary according to your plan type. You can confirm your benefits and see what your plan may cover with
What Kinds of Insurance Plans Are Offered by Priority Health?
Priority Health offers a variety of healthcare plans based on the type of coverage you’re looking for and at what price point.
Health insurance plans offered by Priority Health will vary based on where a person lives, what type of coverage they are seeking, and what type of policy they want. The main categories of insurance plans offered by Priority Health include:
- HMO (health maintenance organization) plans: Members must receive care from in-network providers and choose a primary care physician (PCP) to coordinate their care. These restrictions help keep costs low.4
- PPO (preferred provider organization) plans: PPOs allow member to seek care from an out-of-network providers (usually at a higher cost than in-network providers) and to schedule appointments without PCP referrals.5
- POS (point of service) plans: A mix between an HMO and a PPO, PPO plans still have members choose a primary care provider (PCP) within a specified network for healthcare, though members can choose to seek care outside of the network if they are willing to shoulder the higher cost.6
- Medicare plans: Mostly for individuals aged 65 and older and those with certain disabilities, Medicare plans are government-funded.7,8
- Medicaid plans: These plans are also government-funded and are primarily available to low-income individuals, the elderly, children, pregnant women, and those with disabilities. 8,9
In most cases, at least a portion of drug rehab services and expenses related to addiction treatment should be covered.
Which Types of Drug & Alcohol Rehab Are Covered by Priority Health?
Most health plans divide mental health and substance use treatment into 2 categories: inpatient and outpatient, the main difference being that inpatient care requires patients to live at the facility until treatment is completed, while outpatient care only requires patients to visit a treatment provider periodically.10
The appropriate setting for addiction treatment varies between individuals based on their unique needs. However, each level of addiction treatment should employ the use of various evidence-based techniques and therapies that have been proven effective at helping someone remain sober in the long term.11
Laguna Hospital offers these services in the following levels of care:
- Inpatient detox. Withdrawal management is often necessary for people that have developed physical dependency to substances, especially substances with severe withdrawal syndromes, like alcohol, benzodiazepines, and opioids.12
- Intensive rehabilitation. This level of care that provides intensive medical monitoring is geared toward those who require a period of medical or psychiatric stabilization.
- Residential treatment. This live-in substance abuse treatment provides structured programming but may not have the level of medical or psychiatric supervision that intensive rehab has.
While Laguna Treatment Hospital does not offer any outpatient services, we do have many sister facilities across the country that offer services from partial hospitalization to standard outpatient therapy. You can call us at any time at to learn more about services at Laguna or another American Addiction Centers facility.
How to Use Priority Health Insurance to Pay for Detox & Rehab
When using your insurance to pay for rehab, it’s important to choose a rehab that accepts Priority Health. In most cases, going outside the Priority Health care network will result in much higher out-of-pocket costs and may even mean treatment is not covered at all.8 Understand that a provider may accept your insurance but may not be in your plan’s network.
You can find out whether your insurance plan covers care at Laguna Treatment Hospital by using the online form below. You’ll need to enter some information, like your:
- Email address.
- (In this case, Priority Health).
- Insurance policy number.
The information you enter is kept private and secure, in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
You can find rehabilitation centers that accept Priority Health by calling the number on your insurance card or reaching out to a specific facility to find out if they accept your insurance plan. Priority Health members can also use the web-based directory.
For certain plans, a referral is often needed from an approved provider for specialty services, which includes drug rehab.13 Other situations may not require a referral for these specialty services and may instead ask that individuals obtain prior authorization for things like drug rehab. Failure to do so, in many cases, may result in your claim being denied.14
Cost of Addiction Treatment with Priority Health Coverage
There are many different variables that affect treatment costs, including your specific plan, the rehab facility chosen, the type of treatment, and more.
Often, insurance begins covering costs once you’ve paid a minimum deductible level for the year (which differs by plan). 15 After this point, you’ll likely have to continue to pay a percentage of the costs—known as a co-insurance rate—while Priority Health covers the rest.16 With some plans, members may owe a co-pay, which is a set amount due when a person receives care for specific services (like visits to an outpatient facility) in lieu of a co-insurance percentage.16
Insurance plans also have annual out-of-pocket maximums; once these set amounts are reached each year, insurance covers any remaining eligible medical expenses during the remainder of the plan year.17
Specific details about your annual deductible, co-insurance rate, co-payments, and out-of-pocket maximum—as well as how these terms apply to treatment at inpatient or outpatient treatment centers—should be contained in your summary of benefits and coverage (SBC) packet.
Representatives for Priority Health can help you understand your specific policy and what your exact coverage entails. The team of addiction specialists, admissions navigators, and medical staff at effective rehab centers can also work with you and your family to optimize your health insurance coverage, explore other ways to pay for rehab, walk you through the treatment admissions process, and set up a care plan for treatment and recovery.