Rehabs That Accept Preferred Medicine Claims Solutions (PMCS)
Preferred Medical Claims Solutions (PMCS) is an intermediary organization helping to settle and process claims and negotiate pricing between payers and consumers. They work with a diverse group of local, regional, and national health insurance network affiliates.
The reality of addiction treatment is that, while a necessary and lifesaving component of the recovery process, it can be punitively expensive, and prospective patients often find themselves priced out of the process. Even though the Affordable Care Act (ACA) has rendered addiction and mental health treatment an Essential Health Benefit, which means that any insurance company participating in the ACA Marketplace has to offer some scope of coverage, services continue to be out of reach for those with limited means.
Organizations like PMCS work with payers and customers alike to negotiate claim pricing for substance use treatment and other vital medical and behavioral care services.
Extensive Group Health Provider Network Partnerships
PMCS is a member of the American Association of Payers, Administrators and Networks (AAPAN) and works with a broad range of health insurance provider networks.
This includes but are not limited to:
- Beech Street
- Cofinity
- Devon Health Services, Inc.
- FedMed
- Federal Prover Network, Inc.
- HealthSmart Preferred
- Galaxy Health Network
- HPO
- Integrated Health Plan, Inc.
- InterGroup Services Corporation
- MultiPlan Insurance
- Prime Health Services, Inc.
- Three Rivers Provider Network
- USA Managed Care Organization
If you or a loved one are struggling with alcohol or drug use disorder, and you are affiliated with any of the above health insurance provider networks, start exploring your options for treatment today.
The Process: Customized Cost-Saving Healthcare Solutions for Payers and Patients
PMCS helps payers (insurance companies or any other entity financing the cost of patient care) negotiate services to save both them and the customer money.
Their two primary plans include:
- PMCS Advance – A single-source solution that advances funds from out-of-network claim settlements to providers, Advance ensures payers receive the best possible discounts.
- PMCS Select – Fully automated out-of-network claim settlement solution that allows select payers to remit payment and an Explanation of Benefits (EOB) directly to PMCS providers.
Each insurance provider network affiliated with PMCS has its own set of guidelines that determine the scope of coverage and pricing for each patient.
Common Behavioral Health and Rehab Services Covered by PMCS Partners
Most networks affiliated with PMCS offer, within their plan selections, a baseline level of substance abuse treatment services. The exact tier and scope of coverage vary upon each patient’s individual plan.
Coverage will invariably include some combination of:
- Medical Detox and Withdrawal Management – Most private insurance plans that deal with PMCS will offer some level of coverage for detox and withdrawal management when deemed medically necessary. Detox generally lasts three to seven days and may be fully or partially covered under your insurance plan, depending upon the tier of coverage. The process is a complex and delicate medical procedure that should be administered by experienced and qualified physicians to monitor withdrawal symptoms.
- Behavioral Rehab – The type of rehab covered and negotiated by PMCS will vary based upon patients’ individual care needs, as well as their insurance resources. Affiliated networks are often more apt to cover outpatient treatment because of the cost differential involved. The process can also be affected by the need for post-treatment services like transitional housing and more. Participants may have all or part of their treatment covered by a PMCS-affiliated network.
- Medication-Assisted Treatment (MAT) – More and more insurance providers are offering coverage for MAT for opioid disorder through the use of drugs like buprenorphine (Suboxone), naltrexone (Vivitrol), and methadone. The exact coverage will vary based upon patient eligibility and insurance resources. Regulatory guidelines governing the dispensation of these drugs can also affect eligibility. Talk to your physician or care provider to learn more about your coverage options.
How Do I Know I’m Covered?
If you’re looking for drug and alcohol rehabs that accept PMCS insurance affiliates, the first step is to contact your insurance provider directly. They will be able to tell you exactly what is covered and what is not. You can also contact your prospective facility for a full insurance verification to find out whether or not they deal with third-party entities like PMCS. The admissions representative from your prospective facility will be able to fully break down pricing and how to make treatment as affordable and accessible as possible, based upon your insurance resources and other assets.
Get the Help You Need Today.
Organizations like PMCS can relieve you or your loved one of some of the financial impact associated with addiction through an expert claims process, negotiation, and intervention. Don’t let fear over money or logistics get in the way of your recovery. Start exploring your options today to begin the healing process.
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