Medical Mutual is the largest and oldest Ohio insurer, having served Ohio for more than eighty years. While the company proudly performs several charitable acts in their communities throughout Ohio, Medical Mutual provides residents with Health Maintenance Organization (HMO) and Point of Service (POS) plans.
Medical Mutual HMO plans are best for Ohio residents who do not anticipate high health care costs and would like to maintain a low monthly premium. Only offered in select counties in Ohio, Medical Mutual HMO plans do not require the selection of a primary care physician (PCP), and the company partners with Mercy Health System, ProMedica, and OhioHealth, which serve select counties within the coverage area of Medical Mutual HMO plans.
The POS Health plans from Medical Mutual are also only available in select counties in Ohio, and work similarly to PPO (Preferred Provider Organization) plans.
With the current opioid crisis hitting Ohio especially hard, the need for addiction treatment covered by health insurance continues to soar. Ohio ranked second worst in the nation for opioid overdose death rates in 2017. This disturbing statistic has not yet improved, thereby only deepening the need for effective addiction treatment and insurance resources for families to provide essential care to those who are struggling with substance abuse and addiction.
Medical Mutual health insurance provides several different kinds of insurance plans—both individual and through the insurance marketplace—that vary widely in their access to and coverage for addiction treatment services.
Recently, there may be some concern regarding the enforcement of the Mental Health Parity and Addiction Equality Act (MHPAEA), signed into law by George Bush in 2008. The law requires insurers to provide mental health and addiction treatment coverage which is on par with coverage for other illnesses and diseases. Concerns have been raised especially due to Ohio’s high opioid overdose death rates.
Although information about Medical Mutual’s efforts to combat Ohio’s devastating opioid crisis is notably missing from their community initiatives, the company does offer case management for any one of fifty serious injuries or illnesses. Most health insurance providers include substance abuse and addiction in their list of conditions that make a member eligible for case management. Case management provides a nurse who works with you and your primary care physician to coordinate ongoing care for your chronic illness.
This program typically includes things like:
Whether or not case management is appropriate for your substance abuse or addiction circumstance, there are many addiction treatment programs in Ohio that will accept your health insurance through Medical Mutual.
If you select a provider in network, the cost will be covered at a higher level than it will for a provider out of network. Depending on your particular plan, be it HMO, PPO, or POS, your network of providers will vary. Medical Mutual allows you to check the facilities and providers in your plan directly through their website.
It is important to note that addiction treatment services may require a pre-authorization from Medical Mutual before any benefits can be processed. In many cases, inpatient treatment programs, including partial hospitalization, are among services that require pre-authorization. Your Medical Mutual plan may have this requirement for all services, including outpatient, so it will be necessary to be aware of all requirements before enrolling in an addiction treatment program.
At AllTreatment.com, we understand the confusion of what benefits you may have, and what you are required to do to be able to use your benefits. Where and how benefits can be used, and trying to understand how you can most effectively apply your benefits, can be a labyrinth of terminologies and limitations. At AllTreatment.com, we can verify and check your health plan and discuss your benefits with you in a clear and concise manner, directly related to the treatment you need. The better you understand your benefits, the easier it will be for you to make the best decision for you and your family.
When dealing with substance abuse and addiction, trying to sift through confusing health insurance terms and contracts is a complication no one needs. We can help to simplify the process for you and get you on the path to recovery, with a clear understanding of your benefits and potential out-of-pocket costs.
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