Introduction to Beacon Health Options
Beacon Health Options is one of the leading rehab insurance providers in the country. They serve over 40 million people and work with over 260 employers and government health plans nationwide.
If you’re one of them, it’s important to know how your Beacon plan works and how to have addiction treatment covered.
About Beacon Health Options
Beacon has taken the Stamp Out Stigma pledge to overcome public misperceptions and shame around substance use and mental health disorders. The company is committed to recognizing, re-educating and reducing the stigma that follows mental illness and addiction.
Because of the company’s focus on recovery and behavioral health awareness, Beacon Health Options is a common healthcare plan choice for people who may need:
- Medication-assisted treatment programs
- Residential treatment programs
- Inpatient treatment programs
- Detox programs
Like with any rehab health insurance coverage, you can’t know what your addiction treatment coverage is without checking with your provider. The details are different with every plan and policy, including:
- Whether you must use an in-network provider
- Which treatment providers are in-network
- Which programs are covered
- How much of the cost of treatment is covered
- Whether you need a referral or pre-authorization
- The cost of treatment that you’re responsible for covering
It’s important to call Beacon Health Options to get the exact details on your coverage.
Before you do, take the time to get to know the insurance coverage process by reading ahead. When you know the basics of how to pay for addiction treatment with Beacon Health Options, the process is much easier.
Questions About Beacon Health Options
Will My Addiction Treatment Be Covered By My Beacon Health Options Insurance Plan?
Many Beacon Health Options plans cover addiction treatment, either partially or in full.
That includes most long-term Beacon Health Options plans through:
- Your employer
- The Healthcare Marketplace
- Medicare
- Medicaid
The Affordable Care Act of 2010 says that healthcare insurance providers like Beacon must cover treatment for pre-existing conditions such as substance use disorder.
The condition is that the treatment must be medically necessary.
In most cases, that means:
- You need a referral from your primary care provider,
- You need a referral from a behavioral health specialist, or
- You need a pre-authorization, which means your provider must show why the treatment is medically necessary
As long as you meet the specific conditions of your plan, you’re likely to have your treatment covered.
Beacon Health Options does not cover addiction treatment with short-term plans. That’s because substance use disorder is considered a pre-existing condition, and short-term plans don’t have to cover those.
However, the majority of insurance plans are long-term policies. Short-term policies are meant to bridge a temporary gap in insurance and they aren’t used often.
Does Beacon Health Insurance Cover Treatment 100%?
Beacon Health Options plans can cover treatment 100% in some cases, but that’s not always the case. It’s important to check with Beacon about your exact coverage before you make decisions about treatment.
The amount of coverage that you receive can depend on:
- Whether your plan is an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization)
- Whether your treatment provider is in-network or out-of-network
- Your plan’s deductible, coinsurance and copay policies
Beacon Health Options is required to cover your medically-necessary addiction treatment if you have a long-term plan and follow their policies. But that doesn’t necessarily mean they’ll cover treatment 100%.
How to Check Beacon Health Options Addiction Treatment Coverage
Health insurance coverage can be complicated, especially for addiction treatment. When you confirm your coverage before beginning the process, you’ll know what to expect before going in.
There are a few ways you can check your coverage, including:
- Checking MemberConnect online
- Calling Beacon Health Options
- Contacting your treatment center of choice
Check Your Benefits on MemberConnect
MemberConnect is the online self-service portal that you can use if you’re currently covered by Beacon Health Options.
With MemberConnect, you can check your benefits online, including:
- Types of programs covered
- Details for partial coverage
- Coinsurance and copay policies
- Requirements for coverage
Call Beacon Health Options to Check Your Coverage
You can reach Beacon Health Options by phone when you call the phone number on your insurance card. Be prepared to give your plan and policy numbers, which are also on the card.
Contact Treatment Admissions About Your Coverage
The treatment center that you’re going to attend can check your coverage for you. They’ll call Beacon Health Options and confirm that:
- They’re an in-network provider
- Their programs are covered
They’ll also find out whether you need a referral or prior authorization, whether you have partial or full coverage, and the amount of your financial responsibility.
To find out about your coverage this way, just contact admissions at your treatment center. They’ll take your insurance details and get back to you quickly with a response.
How Does Beacon Health Options Rehab Coverage Work?
Beacon Health Options works in the same way as other health insurance plans. Any time you’re seeking rehab coverage, you must:
- Confirm that there’s a medical need for treatment
- File a claim with your insurance company (Beacon Health Options in this case)
- Confirm your cost and coverage
Confirming Medical Necessity
The first step to getting insurance to cover your addiction treatment is confirming that treatment is medically necessary.
Beacon Health Options can let you know what your plan and policy requires for this process. Most likely, you’ll need to:
- Get a referral from a primary care doctor,
- Get a referral from a behavioral health doctor, or
- Get a pre-authorization for treatment
Filing a Claim
Once you can show that treatment is medically necessary, the next step is filing a claim with Beacon Health Options.
In nearly all cases, your treatment provider will handle the claims process for you. That includes all the paperwork and any necessary phone calls to the insurance company.
Determining Your Cost
After Beacon Health Options processes your claim and applies coverage, you’ll receive an explanation of benefits in the mail or digitally. This outlines:
- The provider’s billed cost of treatment
- The services Beacon Health Options is covering
- Any services not eligible for coverage
- The amount of coverage, if partial
- Your financial responsibility, which is the difference between the billed cost of treatment and your coverage through Beacon Health Options
If you have questions about your financial responsibility for treatment costs, call the phone number on your Beacon Health Options insurance card.
Beacon Health Options Employee Assistance Program for Drug and Alcohol Abuse
Beacon Health Options runs an Employee Assistance Program for employees and their families, serving over 14.5 million people in the United States.
The Employee Assistance Program offers free counseling and education for people who struggle with alcohol or substances.
If your employer works with Beacon Health Options for employer-sponsored health insurance, then you’re eligible to receive free services from the Employee Assistance Program.
In addition to substance abuse, you can receive counseling that covers a variety of other areas that are commonly an issue for people in your situation.
That includes counseling for:
- Family and marriage problems
- Financial and legal issues
- Work-related concerns
- Trouble balancing work, life, and family
- Personal development
If the EAP’s clinicians conclude you would benefit from continuing treatment, they can refer you to your Beacon Health Options benefits to help you find a covered program and provider.
Do Beacon Health Options Insurance Plans Cover Addiction Treatment?
Under the Affordable Care Act, all long-term Beacon Health Options insurance plans must cover treatment for substance use disorder if:
- Your healthcare plan is a long-term policy, not a temporary, travel, or short-term plan
- Treatment is medically necessary
- You choose a covered provider and program
- You and your provider follow procedures for prior authorization
Your treatment may be covered partially or fully, depending on your policy and whether you choose an in-network provider (you’ll learn more about in- and out-of-network providers as you read on.)
Beacon Health Options Coverage for Detox Rehab Treatment
To get the exact details on your detox insurance coverage, call Beacon Health Options. Beacon covers most detox treatment programs, but whether the coverage is full or partial depends on your program.
How Much Does Beacon Health Options Insurance Pay for Detox Rehab?
The amount of coverage that you get varies depending on your plan and policy. It’s impossible to predict what Beacon will pay without calling them to confirm your coverage.
How to Cover Detox When Beacon Health Options Insurance Won’t
If your plan doesn’t cover 100% of detox costs, you may be able to appeal the decision by calling Beacon. If that doesn’t change your cost, you can:
- Reach out to social services
- Apply for rehab scholarships
- Talk to treatment admissions about financing
Verifying Beacon Health Options Coverage and Finding the Best Detox Services
If you can’t locate your own coverage information on MemberConnect, you can call the phone number on your insurance card to verify your coverage. The Member Services team can help you locate the best detox services near you that accept Beacon Health Options.
Beacon Health Options Coverage Estimates for Detox Rehab Treatment
Beacon offers three types of plans, and your coverage for detox varies depending on the one you have:
- Bronze Plans
- Silver Plans
- Gold Plans
- Platinum Plans
Bronze tends to have less coverage, but more affordable premiums (the amount you pay each month to stay covered). Platinum has the most coverage, but the costliest premiums.
Service and Costs
Beacon Health Options Coverage for Inpatient/Residential Rehab Service and Costs
Beacon Health Options covers most inpatient and residential rehab programs. Your out-of-pocket cost can vary depending on your plan type and other factors.
How Long Does Beacon Health Options Insurance Cover Inpatient Residential Rehab?
The length of the program that’s covered varies depending on the plan tier (Bronze through Platinum), your diagnosis, and what’s considered medically necessary for your case. Talk to your treatment provider about how to get insurance to pay for a longer treatment stay.
How to Cover Inpatient Residential When Beacon Health Options Insurance Won’t
Inpatient rehab insurance can cover much of the cost of treatment, but there may be a remaining cost out of your pocket.
If your Beacon plan only covers part of the cost of your inpatient rehab program, you may be able to cover the remainder by:
- Talking to treatment admissions about payment plans or lowering the out-of-pocket cost
- Calling social services for local resources
- Applying to rehab scholarships, though these can have long waitlists
Inpatient Rehab Beacon Health Options Insurance Coverage Estimates
It’s hard to predict the amount of coverage that you’ll receive for inpatient treatment. You need to call Beacon Health Options to get an estimate of your coverage, or contact your treatment provider.
The amount of coverage ranges from low to high based on the type of plan:
- Bronze, which has the least coverage but the most affordable monthly premium cost
- Silver
- Gold
- Platinum, which has the most coverage but the most expensive monthly premium cost
Does Beacon Health Options Insurance Pay for Medication-Assisted Treatment Services and Costs?
Beacon Health Options can pay for the costs of medication-assisted treatment. The amount of coverage depends on the plan type, so it’s important to check ahead of time to see your exact coverage.
How Much Does Beacon Health Options Insurance Pay for Medication-Assisted Treatment?
Your plan may cover MAT in full or in part. If your coverage is partial, call Beacon Health Options or check MemberConnect to find the amount of medication-assisted treatment insurance coverage you get. It can vary from plan to plan, so it’s impossible to predict.
Medication-Assisted Treatment Coverage Estimates
There are 4 types of Beacon Health Options plans that can cover MAT: Bronze, Silver, Gold, and Platinum.
Bronze plans have the lowest coverage, so your out-of-pocket cost of treatment may be high.
Platinum plans have the most coverage, so you’re likely to have low out-of-pocket costs.
What Types of Addictive Substances Are Covered By Beacon Health Options Insurance?
When it comes to determining coverage, the type of substance that you use isn’t as important as your diagnosis. As long as the substance can cause dependence and addiction, your treatment can be covered.
Beacon Health Options usually covers treatment for:
- Alcohol use disorder, alcohol abuse, or alcohol dependence
- Stimulant use disorder, stimulant abuse, or stimulant dependence
- Opioid use disorder, opioid abuse, or opioid dependence
Stimulant use disorders usually involve methamphetamine or cocaine, while opioid use disorders include heroin and prescription pain medications like tramadol or oxycodone.
These aren’t the only types of substance use disorders that Beacon Health Options covers; they’re just the most popular ones. Call the phone line on your insurance card for a full look at your coverage for substance use disorder treatment.
Is Alcohol Addiction Treatment Covered By Insurance?
Beacon Health Options covers medically-necessary treatment for alcohol use disorder as long as the program and provider are approved.
The covered treatment programs may include:
- Alcohol detox programs, which include supportive care and monitoring
- Residential or inpatient alcohol treatment programs, which may include cognitive-behavioral therapy, counseling, 12 Steps, and medication
- Medication-assisted treatment programs, which use medications like disulfiram and naltrexone to control alcohol cravings
These aren’t the only covered types of alcohol treatment, but they’re the most common ones. To make sure your alcohol treatment program is covered, check with your treatment provider or Beacon Health Options.
Is Cocaine Addiction Treatment Covered By Insurance?
Beacon Health Options covers medically-necessary cocaine addiction treatment if you have stimulant use disorder, stimulant abuse, or stimulant dependence.
The approved program types for cocaine treatment can include:
- Cocaine detox programs
- Residential or inpatient programs for stimulant recovery
- Other programs, which you can get details about from Beacon Health Options
Medication-assisted treatment programs for cocaine treatment are typically not covered by Beacon Health Options. That’s because MAT is not an evidence-based treatment for cocaine addiction. There are currently no medications approved for cocaine MAT.
Is Heroin Addiction Treatment Covered By Insurance?
Beacon Health Options covers medically-necessary heroin addiction treatment if you have opioid use disorder, opioid abuse, or opioid dependence.
Your approved programs for heroin treatment may include:
- Heroin detox programs, which can include comfort care and monitoring
- Residential or inpatient opioid programs, which can include medications, cognitive-behavioral therapy, and dialectical behavior therapy
- Medication-assisted treatment programs, which can include the use of buprenorphine, naltrexone, or methadone to control opioid cravings and reduce the likelihood of relapse
The exact programs that are covered depend on your policy and plan. Call Beacon Health Options or log into Member Connect to get a full picture of your coverage for heroin treatment.
Is Meth Addiction Treatment Covered By Insurance?
Beacon Health Options covers medically-needed treatment for methamphetamine addiction if you have a diagnosis of:
- Stimulant use disorder,
- Stimulant abuse, or
- Stimulant dependence
Typically, Beacon Health Options covers programs including stimulant detox and residential inpatient treatment. Call Beacon Health Options to hear details about your policy’s specific coverage, since it’s different for every plan.
Beacon does not usually cover medication-assisted treatment for meth. That’s because the evidence does not show that MAT works for stimulant use disorders. Most insurance companies only cover treatments that are evidence-based.
Is Prescription Drug Addiction Treatment Covered By Insurance?
Your exact program coverage depends on your policy and plan. Still, most Beacon Health Options plans cover treatment for prescription drug addiction if:
- It’s medically necessary, and
- You have substance use disorder, substance abuse, or substance dependence
It’s most common for Beacon to cover treatment for:
- Prescription opioid abuse, including tramadol, oxycodone, hydrocodone, morphine, and fentanyl
- Prescription stimulant abuse, including amphetamine salts (Adderall), methamphetamine (Desoxyn), and methylphenidate (Ritalin)
While those are the most common drugs that patients seek coverage for, they’re not the only ones. Call Beacon Health Options to get the details on your treatment coverage for prescription drug addiction.
Do Treatment Centers Need to Be In-Network?
Whether you need to choose an in-network provider depends on your policy type. There are two main types of health insurance policies with Beacon Health Options:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
Each type has its own policies on in-network and out-of-network providers. An in-network provider is simply a treatment center that your insurer has pre-approved for coverage.
Health Maintenance Organization
If you have an HMO plan, you don’t have to choose an in-network provider.
HMO plans are flexible in that you can choose out-of-network providers.
Your treatment with an out-of-network provider may be covered at a lower rate than treatment with an in-network provider.
Preferred Provider Organization
If you have a PPO plan, you need to choose an in-network provider.
PPO plans only cover treatment that you receive from an in-network provider.
It’s important to make sure that your treatment provider is in-network if you have this type of plan. Otherwise, you can be liable for the entire cost of treatment.
You can find in-network providers for your PPO plan by checking MemberConnect or calling Beacon Health Options.
How Can I Pay the Costs Not Covered By My Beacon Health Options Plan?
If your Beacon Health Options plan covers treatment partially, you may be wondering how to cover the remaining costs.
You may be able to cover partial treatment costs by:
- Appealing to Beacon Health Options to reconsider full coverage
- Contacting treatment admissions to discuss payment plans, financing, or out-of-pocket discounts for the remaining balance
- Applying to rehab scholarships such as 10,000 Beds, though these programs are competitive and waitlisted, so you may be waiting for a long time
- Calling your social services office for a list of local addiction and recovery resources
Why Bedrock Recovery Center?
Bedrock Recovery Center can be the start of a lifetime of recovery. At our tranquil Canton, Massachusetts campus, you can find:
- 5-star nutrition to fuel your recovery with energy- and nutrient-rich foods
- Amenities such as on-site laundry, Starbucks, yoga, outdoor recreation, indoor gym, and more
- Compassionate clinicians with experience working in the substance use disorder population
- Detox, residential, and inpatient programs to follow you through the full treatment journey
- Evidence-based treatment that includes therapy, counseling, and medication
- Medication-assisted treatment programs for continuing recovery maintenance
Our admissions team is standing by to confirm your insurance coverage and help you navigate this part of the journey. Call Bedrock Recovery Center today to get started!
