GEHA Insurance for Rehab in California

Using Government Employee Insurance for Rehab Coverage in CA

Government Employees Health Association Insurance, otherwise known as GEHA Insurance, is a non-profit health insurance organization that offers comprehensive healthcare insurance coverage primarily to federal employees, retirees, and their families. In business since 1937, GEHA Insurance is currently one of the largest national health plans in the United States, despite catering specifically to government workers.

And rest assured, that, yes, you can use GEHA insurance for rehab in California, including at many facilities that offer specialty programs and forms of treatment for mental health alongside substance abuse.

Even still, many members have questions regarding whether GEHA Insurance coverage provides payment for addiction treatment, mental health, and other types of therapy. Technically, under the CARES Act, all insurance providers must offer some form of insurance coverage for mental and behavioral issues, but this still leaves uncertainties about exactly what type of things are covered during inpatient rehab, and additional addiction treatment care levels.

If you or a loved one are among the estimated 6% of federal employees struggling with alcohol or substance abuse, effective treatment facilities are available to help you find lasting recovery!

In the following article, we relay how to obtain this information and focus on what Finding Addiction Rehabs can do to help you find the treatment you need.

The Basics of the Government Employees Health Association

GEHA Insurance isn’t broken down specifically into what types of therapy are covered during inpatient treatment for federal employees. However, there are instead five different plans that outline different amounts of coverage provided, out-of-pocket costs, and other dynamics.

In the section below, we’ll review these five plans to give you a better idea of what inpatient rehab fees might be covered during substance abuse treatment.

Levels of Care and Rehab Center Services Covered by GEHA

GEHA Insurance operates as a member-owned organization, meaning that policyholders have a voice in what takes place regarding GEHA Insurance and other dealings with the insurance provider. This unique structure allows GEHA Insurance to prioritize the needs of its members and offer competitive benefits and services you might not find with other providers.

The insurance plans provided by GEHA Insurance cover a wide range of healthcare services, including medical, dental, vision, and mental health treatment. They strive to offer cost-effective and high-quality health benefits, ensuring that federal employees and their families have access to essential medical care and services.

PPO Plans and Out of State Rehab Coverage Using GEHA

As a preferred provider organization (PPO), GEHA offers its members the flexibility to choose from a network of healthcare providers, including doctors, hospitals, and specialists. Policyholders have the option to receive medical care from in-network providers, which usually results in lower out-of-pocket costs, or from out-of-network providers at a potentially higher cost.

GEHA Plans that Cover Substance Abuse Treatment

• Elevate
• HDHP
• Standard
• Elevate Plus
• High

The Elevate plan costs roughly $50 every two weeks, HDHP and Standard are roughly $70, Elevate Plus is $85, and High is $105. While this won’t give you the total cost of addiction treatment, it gives you an idea of where to start when you’re estimating the cost of your drug or alcohol addiction recovery treatment.

Each plan above has different amounts for copays, deductibles, and other specifications. To find out more about each plan in particular, contact Rehabs Of Armerica and we can tell you that your specific plan outlines regarding cost and length of treatment.

Considering GEHA or Already a Member? Get Familiar With These Terms

The following terms are important when it comes to addiction treatment. Get familiar with them as they can help you navigate the insurance process for addiction treatment.

Let’s dive into the specifics to understand the scope of support available to those seeking addiction treatment.

Addiction Treatment Coverage in California

The extent of alcohol and drug rehab covered by GEHA depends on the specific policy you carry. Regardless, if you purchase a plan, you can expect at least some level of insurance coverage for rehab and related programs. How much or how little depends on the agreement arranged between you and your agent when you selected your plan.

For the most part, GEHA insurance coverage is preferable to many of even the highest-cost plans obtained under the Affordable Care Act, and such coverage cannot be purchased on the Marketplace but is gained as a qualifying Federal Government employee or immediate family member.

It’s essential you contact Rehabs Of Armerica to get the most up-to-date information regarding your policy and coverage changes. We can even help you obtain things like prior authorization forms and other pertinent documents to send to the insurance provider of your choice.

In-Network vs. Out-of-Network Providers Covered by GEHA Insurance Plans

GEHA Insurance typically differentiates between in-network and out-of-network providers. In-network facilities have pre-negotiated rates with the insurance company, providing more cost-effective options for policyholders. It is worth noting that out-of-network and in-network have little to do with whether a facility is out of state, particularly in the case of GEHA insurance holders.

While GEHA Insurance generally covers a portion of the costs for both in-network and out-of-network services, the coverage levels can differ significantly.

In many cases, using an out-of-network provider requires a prior authorization form. This form is essentially a letter written by the provider informing your provider why you need a specific type of therapy or visit their practice.

What Are the Types of Drug Rehab Services Covered by GEHA?

GEHA Insurance usually covers a range of substance abuse treatment services, which include:

Inpatient Treatment: This involves residential rehabilitation programs where individuals stay at a facility for intensive treatment and 24/7 support. During a stay at inpatient rehab, clients receive multiple forms of behavioral health services, along with optional holistic treatment options. Clients participate in treatment daily and have optional group therapy sessions available throughout the day.

Outpatient Treatment: Outpatient programs allow individuals to live at home while attending therapy sessions and support groups at a treatment center. These types of programs can often save money when compared to inpatient facilities. However, it’s important to be mindful of whether you have the willpower and support structure to successfully complete outpatient treatment, as you won’t have the support pillars that come with residential treatment.

Medically-Assisted Detox: Medically-assisted detox is usually combined with inpatient therapy, taking place beforehand and allowing clients to overcome the physical challenges of withdrawal before entering residential recovery. Normally you spend anywhere from 5 to 14 days in medical detox and receive around-the-clock care.

During this detox period, you’ll receive medication to make you more comfortable during the withdrawal period. The medication ranges from things like benzodiazepines, sleep aids, stomach medication, and blood pressure medicine. These medications are all short-term, and typically the prescriptions are not extended past detox until you meet with your permanent counselor.

Partial Hospitalization: Partial hospitalization, or PHP, is a type of treatment that doesn’t require clients to live at the facility. However, they participate for most of the day, usually arriving at 9 AM and staying until 4 or 5 PM. The days are often crafted much like the typical day in inpatient rehab, with the only difference is clients return home in the evenings to sleep at home.

PHP is also used as a segue between inpatient and outpatient therapy, allowing clients more time to get comfortable before making the permanent transition.

Verification of Those Seeking Treatment for Drug or Alcohol Addiction

If you’re looking for GEHA therapy coverage and the amount, they’ll cover for each of the above-listed levels of care, it’s important that you contact Rehabs Of Armerica. We can help you calculate what percentage your insurance company will pay, along with any out-of-pocket costs left over.

In some cases, GEHA coverage might provide much of the payment for your treatment program. However, in most situations, it depends on the total cost of the treatment. For example, GEHA may offer 100% of any given form of therapy up to $2,000. After the price eclipses $2,000, they might provide 75%, and so on.

Other elements of treatment like medically assisted detox might be fully covered, but require a prior authorization form. These forms aren’t uncommon when it comes to GEHA coverage.

Is Pre-Approval Required for Detox and Rehab with GEHA?

Sometimes you’ll be required to receive pre-approval before your insurance company covers certain services. To avoid out-of-pocket expenses or a delay in treatment, Rehabs Of Armerica can help you plot your course before entering rehab, giving you an idea of whether your treatment plan may include items that require pre-approval.

What About Out of Pocket Expenses for Addiction Treatment?

Normally, out-of-pocket expenses are covered in one of several ways. Clients usually pay for their deductibles or copayments by check or credit card. In the event the amount is too large for a client’s budget, grand programs might be available in specific regions.

Certain rehab facilities offer sliding scale programs and even work out payment plans with clients to ensure they don’t miss the treatment they desperately need.

Get Options for Treatment Using GEHA Insurance in California!

If you’re located in the California area, specifically Orange County, the chances are high that you will receive GEHA Insurance through a variety of government jobs. Rehabs Of Armerica can help you obtain all the information you need to get the process started smoothly and efficiently, leaving you with a brighter outlook on recovery.

Reach out for a confidential consultation and get options for yourself or a loved one that includes exact costs and provides facility options across the state of California!

Edward P.

Edward lives and works in South Florida and has been a part of its recovery community for many years. With a B.A. in English Literature from the University of Massachusetts, he works to help Find Addiction Rehabs as both a writer and marketer. Edward loves to share his passion for the field through writing about addiction topics, effective treatment for addiction, and behavioral health as a whole. Alongside personal experience, Edward has deep connections to the mental health treatment industry, having worked as a medical office manager for a psychiatric consortium for many years.