A large healthcare company serving over 13 million members, Humana offers group health insurance and Medicare plans for families, individuals, military service members, and veterans. As a global leader with a wide range of products, services, and offerings, Humana has many industry partnerships to provide innovation and comprehensive care for its members and their communities. With resources specific to behavioral health, which includes substance abuse, addiction, and mental health concerns, Humana offers support and coverage to enhance treatment and promote recovery.
Humana members can use their health resources tool to find a behavioral health provider, get information on behavioral health preventative care and screenings, and request member and policy information. Coverage for addiction treatment is included as an “essential health benefit” per the Affordable Care Act (ACA) and treatment parity laws.
Specific individual coverage and benefits can be found by registering and accessing My Humana. Policies and individual insurance plans can differ on what is covered and at what rate. A Humana representative can be a great tool for explaining specific benefits, policies, and coverage information, including how to use Humana insurance to help pay for drug addiction treatment.
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Navigating Humana Insurance
In addition to a Humana representative, substance abuse treatment providers have a lot of knowledge and experience with insurance plans and coverage, and can also aid families in maximizing benefits and coverage amounts. Humana insurance plans include both preferred provider organizations (PPOs) and health maintenance organizations (HMOs) as well as Medicare plans for individuals aged 65 and older, or those suffering from eligible disabilities or other specific criteria.
An HMO plan will ask that members remain in network in order for coverage to be used while a PPO will allow members to seek treatment from providers that are considered out of network. An in-network provider can provide services for lower out-of-pocket expenses for members and are typically covered at higher coinsurance rates. Coinsurance is the amount a member will pay for services after a deductible amount is met. The deductible is an annual amount of money that a person will pay out in medical expenses. Each plan will have a set yearly deductible, and after that amount is reached each year, insurance coverage begins.
Individuals may need to pay a copay at the time of an office visit or other medical treatment or appointment. The copay is predetermined and specific to the individual plan. There is also an annual out-of-pocket maximum; once reached, all covered medical expenses are paid in full by Humana.
To enroll in an addiction treatment program and use Humana insurance, take the following steps:
- Contact the insurer directly to ensure that services are covered and confirm what may be required prior to enrollment.
- Obtain any verification, or preauthorization, before enrolling in an addiction treatment program. In-network providers and Humana can help with this. Some plans require that members get a referral for treatment services from their primary care provider (PCP) before receiving them.
- Pay any copays needed at time of visit and arrange a payment plan to cover coinsurance amounts.
- Discuss whether or not costs are paid up front by the individual and then a claim is filed with Humana for payment, or whether Humana is billed directly for their portion of the covered services.
- Iron out all payment and out-of-pocket amounts prior to enrolling in an addiction treatment program.
Insurance can help to greatly offset addiction treatment costs. Both insurance providers and substance abuse treatment providers can help families and individuals budget for and understand insurance coverage benefits.