Does Kaiser Pay For Rehab?

Does Tricare Insurance Cover Rehab?

Kaiser Permanente insures many individuals in California, and if you’re one of them who’s seeking rehab services, you might be wondering, “Does Kaiser pay for rehab?” The answer is yes. Substance abuse and mental health services are usually covered  under Kaiser’s behavioral health coverage, though how much is covered depends on the specific plan. 

Here’s everything you need to know about Kaiser Permanente health insurance and how coverage works for rehab. 

What Kaiser Drug and Alcohol Rehab Treatment Includes

Experts agree that effective addiction treatment must address the whole person, not just their substance abuse. This is because addiction can affect anything from your physical health to your relationships and professional life. 

Kaiser Permanente takes this into account as they cover a wide range of services to accommodate people who need different levels of care at various stages in their recovery journey. With a Kaiser plan, you may get coverage for: 

  • A thorough assessment and diagnosis
  • Medical detox and withdrawal management
  • Inpatient rehabilitation stays
  • Outpatient treatment, including IOP and partial hospitalization
  • Individual and group therapy sessions
  • Evidence-based therapies like CBT, DBT, and exposure therapy
  • Family counseling services
  • Relapse prevention and aftercare planning

Keep in mind that specific coverage details vary depending on your location and the type of plan you have. Be sure to contact Kaiser Permanente or your provider to get clarification on your coverage before moving forward with treatment.  

Types of Addiction Treatments Through Kaiser

Finding the right level of care is necessary for successful recovery from substance use disorders (SUD). Kaiser insurance typically covers different treatment options that are based on the criteria outlined by the American Society of Addiction Medicine (ASAM). These guidelines help to ensure that you receive the appropriate care for your needs. Treatments that Kaiser may cover include: partial hospitalization, intensive outpatient, and outpatient services for adolescents.  

Partial Hospitalization Program

In a partial hospitalization program (PHP), patients receive care for up to six hours per day, five days per week. This is often used as a step-down option for those transitioning from inpatient treatment or as an intervention to prevent the need for hospitalization altogether. These programs include: 

  • Return home in the evenings rather than staying overnight
  • Services similar to inpatient care but with more freedom
  • Individual therapy, group counseling, and psychiatric services
  • Medication management when appropriate

Intensive Outpatient Program

An intensive outpatient program (IOP) is designed to still provide the structure of rehab, but it is also designed to accommodate those who have work, school, or family obligations. These programs offer:

  • Flexible scheduling
  • Group therapy and individual counseling
  • Education about addiction and recovery
  • Peer support and community building

Outpatient Adolescent Program

With teen overdose rates rising despite overall declining substance use, specialized adolescent treatment is more critical than ever. Designed specifically for 12 to 17-year-olds, these programs address not only substance use but also co-occuring mental health issues like anxiety, depression, school refusal, and social anxiety. Coverage may include: 

  • Therapeutic and behavioral interventions
  • Whole-family therapy
  • Multi-family group sessions
  • Psychiatric services
  • Other age-appropriate treatments

Coverage Levels and Plans for Kaiser Permanente

Kaiser Permanente offers a variety of insurance plans that can cover addiction treatment services. Individual and family plans available include: 

  • Copay Plans: Higher monthly premiums but lower costs when accessing treatment. You’ll pay a copay for services without meeting a deductible first. 
  • Deductible Plans: Lower monthly premiums, but you’ll pay full costs for most services until reaching your deductible. Addiction treatment costs may be entirely out-of-pocket until this threshold is met. 
  • Virtual Plans: Offer reduced costs for telehealth services, which can include virtual addiction counseling and therapy sessions. 
  • HSA-Qualified Plans: Allow you to use tax-free health savings account funds to pay for addiction treatment costs, including services sometimes not covered by your plan. 
  • Catastrophic Plans: Primarily for emergencies with very high deductibles.

If you have Kaiser through an employer, your coverage for addiction treatment may fall under: 

  • Deductible plans
  • PPO plans
  • HMO plans
  • Point of Service plans
  • Consumer-directed health plans

For adults over 65, Kaiser Medicare plans provide federally regulated coverage that may include addiction treatment services.

What Services Does Kaiser Permanente Cover? 

For California residents with Kaiser Permanente insurance, several services may be covered under your plan: 

  • Preventative care
  • Prescription drug coverage
  • Primary care doctor visits
  • Specialty doctor visits
  • Stays in the hospital
  • Outpatient treatment, including IOP and partial hospitalization
  • Inpatient treatment for severe addiction cases

For treatments like inpatient addiction services or IOPs, Kaiser often has limitations on the length of treatment they’ll cover. It can range anywhere from a few days to several weeks depending on your specific plan and medical necessity. 

How to Verify Coverage of Your Kaiser Plan

Before beginning addiction treatment, you need to understand exactly what your Kaiser plan covers. The most reliable way to do this is by contacting Kaiser Member Services directly using the phone number on your insurance card. During this call, be sure to: 

  • Ask specifically about coverage for SUD treatment
  • Request information about preauthorization requirements and the process for getting approval
  • Ask about copayments, coinsurance, and how your deductible will apply to your treatment
  • Verify which providers in your are in-network for addiction treatment 

If you need treatment outside of your home coverage area, Kaiser offers support through their “Away from Home Travel Line.” This service can help connect you with appropriate care options that will be covered by your plan, even when you are away from home. 

Kaiser also partners with external providers, like Mission Behavioral Health, to expand their network of addiction treatment options. These partnerships mean you may have more choices for quality care than you originally thought. When verifying coverage, be sure to ask specifically about Mission Behavioral Health as we may be covered as in-network providers depending on your insurance plan. 

What to do if Kaiser Won’t Cover the Total Cost of Rehab

If Kaiser won’t cover your full treatment costs, you have some options to make rehab more affordable: 

  • Appeal Kaiser’s decision through their appeals process
  • Ask your treatment provider about payment plans that fit within your budget
  • Look into healthcare financing options for medical expenses
  • Apply for treatment scholarships that are offered by non-profit organizations

At Mission Harbor, we understand the financial barriers to substance abuse treatment and will work with you to find a solution. Don’t hesitate to start treatment–addressing addiction now can prevent more costly health problems down the road. 

Start Your Recovery Journey Today

Here at Mission Harbor, we work closely with Kaiser Permanente to maximize your benefits and make treatment accessible, regardless of your financial situation. Our team can verify coverage, explain your options, and help guide you through any insurance hurdles you may run into. 

If you have Kaiser Permanente and have questions about your plan’s benefits for rehab, give us a call today.

The facilities at Mission Harbor are staffed with trained experts to best assist patients with their mental health issues. We are capable of dealing with any and all cases with a licensed staff, equipment, and approved techniques. Our mission is to help those who want to help themselves, and we support your decision in seeking help.

Get Help Now

Alcohol addiction is extremely difficult to overcome on your own.. Seek specialized help and let professionals guide you in your recovery.

(805) 874-5922