Prominence Health Plan, established in 1993 in Reno, Nevada, started as a Health Maintenance Organization (HMO) and has since expanded to include a Preferred Provider Organization (PPO) and Point of Service (POS). Additionally, Medicare Advantage plans are available through Prominence Health Plan, serving residents in Nevada and Texas.
Prominence is contracted with several addiction treatment and substance abuse providers throughout Nevada and Texas, offering care at various levels. The company also provides an Online Wellness Assessment for members, a survey with questions about lifestyle habits and medical history. Behavioral health and chemical dependency services are available for PPO, POS, and HMO ppolicyholders Prominence does adhere to the common practice of requiring pre-authorizations for inpatient treatment and detox; however, outpatient services do not require a pre-authorization.
Depending on the type of policy you have with Prominence Health Plan, your options for addiction treatment may vary. For example, the Nevada POS/HMO plan members have two treatment providers in Nevada for addiction rehab services, and there are four participating providers in Nevada for members with Prominence PPO plans. These are not the only options for members, as Prominence offers out-of-state benefits through its partnership with First Health, available from national PPO providers. Members with PPO plans can check the First Health national networks search tool.
Addiction treatment can be very expensive, ranging from approximately $7500 to over $100,000 for a thirty-day stay. Out-of-pocket expenses can also become overwhelming, even with health insurance benefits. The burden of extra expenses is less likely in treatment facilities paid for through government-funded programs like Medicaid and Medicare. However, addiction treatment paid through private plans such as a PPO or POS are more likely to have different billing practices, which may result in charges for certain therapies or activities that are not covered by insurers like Prominence. The way in which out-of-pocket costs can add up with addiction treatment programs is through services and ancillary therapies that may not be covered by the insurance plan benefits.
Some examples include:
Some health insurance companies will cover any services or therapies offered in an addiction treatment program, even if those services and treatments would not be covered independent of the program. However, it is not uncommon for insurance companies to specify which treatments and services are medically necessary, nor is it uncommon for addiction treatment providers to bill for certain services separately. The combination of a separate bill for something like massage therapy plus an insurer denying payment due to lack of medical necessity equals an added cost for you. These types of costs can become substantial; therefore, it is necessary to understand how your Prominence Health Plan covers various approaches and therapies in addiction treatment. It is further recommended to check with your preferred treatment program about how services are charged to insurance.
It should be noted that services that have been established as evidence-based, such as cognitive behavioral therapy and individual and group counseling, are recognized by all health insurance companies as medically relevant and necessary, and are not typically billed apart from the treatment program itself.
At the time when addiction treatment must be considered, health insurance benefits can become deciding factors in what type of treatment programs and providers are available to you.
At AllTreatment.com, we understand how important it is to get the most effective treatment for your situation—fast. We also understand how impactful your health insurance benefits are to mitigating the costs of treatment. Unfortunately, neither addiction treatment options nor health insurance are particularly simple to navigate, but we can help to simplify the process.
Instead of endless searches, making dozens of calls, waiting for transfers, and holding for the information you may not even understand, we can verify your health care plan and explain your benefits in a way that makes sense and addresses your addiction treatment needs. A simple understanding of your complete treatment benefits will allow you to more easily choose the best addiction care available, at the most efficient use of your insurance and smallest out-of-pocket cost to you.
If you or someone you love is struggling with substance abuse or addiction, and you have a health insurance policy with Prominence Health Plan, call us for a confidential and clear review of how your plan can most effectively used on your path to health recovery. The vast majority of outpatient and inpatient addiction treatment programs accept health insurance plans like Prominence, and we can help you to narrow your options and make an educated decision in the best interest of your recovery and your wallet.
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