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Rehabs That Accept Optima Health Insurance

Rehabs That Accept Optima Health Insurance

Virginia is in the midst of a fierce and pervasive substance abuse epidemic. The state is currently ground zero for opioid addiction, and the Centers for Disease Control and Prevention (CDC) reports that there were 1,507 overdose deaths in the state in 2017. That same year, the Virginia Department of Motor Vehicles Highway Safety Office reported 7,285 alcohol-related crashes, 248 fatalities, and 4,430 injuries. The substance use issues plaguing Virginia residents require affordable and accessible treatment resources to help vulnerable residents reclaim their lives.

One of the ways Virginia is endeavoring to make care more accessible is by partnering with insurance entities to serve more and more patients, including Optima Health. Optima Health provides health plan coverage to more than 444,000 Virginians, across a network of fifteen thousand primary care, specialty, and hospital providers. There are more Virginia rehabs than ever that accept Optima Health as a means of streamlining and facilitating access to treatment and recovery from substance abuse.

What Kinds of Insurance Plans Does Optima Health Offer?

Optima Health offers a variety of insurance options for individuals, families, and employers.

While there are numerous offerings and services from which current and prospective members can choose, plans generally fall under three categories:

  1. HMO – Health maintenance organization plans provide affordable medical care as long as a patient goes to a doctor or provider within the network, and referrals are not needed.
  2. PPO – Preferred provider organization plans give patients the freedom to visit out-of-network providers, for an added cost.
  3. POS – Point-of-sale plans merge the benefits of an HMO and a PPO into a plan that offers out-of-network benefits.

Within these plans models, coverage is broken down into three tiers:

  1. Gold – A higher monthly premium brings lower out-of-pocket costs for those who visit the doctor frequently.
  2. Silver – This middle-of-the-road plan has a moderate premium cost and moderate out-of-pocket costs.
  3. Bronze – Designed for those who rarely seek medical care, bronze plans have low monthly premiums and high out-of-pocket costs.

Each one of these plan types will offer some level of substance use disorder (SUD) treatment. The amount a patient pays out of pocket for their treatment will vary upon their plan tier and scope of coverage. Deductibles for plans generally range from around $1,000 to $16,000. Patients may also need to pay a copay for their substance abuse treatment needs and are encouraged to consult their representatives or the plan documents.

What Kind of Addiction Treatment Services Does Optima Health Cover?

Optima Health covers a full array of addiction treatment services to help Virginia residents offset the cost of their care, including but not limited to:

  • Inpatient and outpatient detox. When deemed medically necessary by patients’ doctors, Optima Health will cover part or all of a patient’s medically managed detox and withdrawal management. Inpatient detox programs are generally reserved for patients with a more severe history of SUD. These programs generally last for three to seven days. Coverage takes effect after patients meet their deductible and may require a copay.
  • Inpatient drug and alcohol rehab. Optima pays for a majority of eligible patients’ residential drug and alcohol rehab. After meeting their deductible, members with individual plans may be required to cover up to a third of their inpatient rehab costs. For patients with employer-sponsored Optima Health programs, inpatient treatments require a daily copay or a coinsurance charge, which will vary based on the specific plan. Inpatient rehab programs typically last between twenty-eight and thirty days and include group therapy, individualized counseling, and supplemental therapies to help patients address the root causes of their SUD and develop long-term behavioral coping mechanisms for sustained recovery.
  • Outpatient rehab. Optima Health also provides ample coverage for outpatient and intensive outpatient (IOP) behavioral rehab. These programs involve multiple weekly treatment sessions comprised of group therapy, individualized counseling, and supplemental therapies. Patients attend treatment sessions and return home each day. Regular outpatient programs are typically four to six weeks with three to five days of treatment per week. IOP programs are more protracted and will include more frequent treatment sessions each week. Optima members with individual plans may be up to a $40 copay for their outpatient rehab after they pay their deductible. Employer-sponsored plans can require patients to pay a copay up to $350 per visitor a coinsurance fee not exceeding 40 percent of the cost.

Optima Health plans may also cover medication-assisted treatment (MAT) such as buprenorphine (Suboxone®), naltrexone (Vivitrol®), and methadone. These needs are generally met under Optima’s prescription benefits plans and costs will depend on the tier of coverage and specific plans. At this time, Optima Health does not offer coverage for sober living facilities and restricts this sort of service to inpatient or residential behavioral rehab. Further, Optima Health only covers addiction treatment facilities that are in-network with the company.

How Do I Find Addiction Rehabs That Accept Optima Health?

Optima members looking for SUD treatment can start by identifying what type of plan they have. Once they have this information, they can browse the organization’s database to find a substance use treatment facility in their specific area. Optima Health and other insurance providers have made it easier for patients and their loved ones to access and afford life-saving addiction treatment, so, f you or a loved one live in Virginia and need help with drug or alcohol abuse, consider exploring your options to have insurance cover your treatment.


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