One of the main reasons people do not seek treatment for behavioral health is the expected cost. The American healthcare system can be a bureaucratic nightmare with confusing rules for insurance and financing options for treatment. The Affordable Care Act changed the landscape of insurance and behavioral health services in the United States by ensuring greater access to more people. Insurance providers were required to offer coverage for addiction and mental health services.
For Californians, choosing the right insurance may seem daunting. However, one of the largest not-for-profit insurance providers is Kaiser Permanente, and although it is a national provider, it is headquartered in Oakland, California. More than 8 million Californians enjoy Kaiser insurance benefits, and they offer plans to serve individuals, families, or employers.
At La Fuente Hollywood Treatment Center, we want to lessen the confusion of finding affordable care; please call us today at 844.956.3514 to get started.
Why Choose Kaiser Insurance?
Most Kaiser plans will cover residential and outpatient addiction treatment services. Naturally, there are a number of plan options based on the coverage desired:
Kaiser insurance benefits offer the best rates for coverage when individuals use a provider that is considered in-network.
Depending on the plan, an out-of-network provider may be covered at a less favorable rate or not at all.
Other variables include things like preauthorization for specialist services or whether name-brand prescriptions are covered or only generic.
An in-network provider contracts directly with Kaiser, whereas an out-of-network provider does not, so understanding the difference in terms of services covered and costs is essential.
What Do Kaiser Insurance Benefits Cover?
Addiction treatment services covered through Kaiser Permanente may include some or all of the following types of treatment:
- Diagnostic evaluations
- Inpatient / residential treatment programs
- Detoxification services
- Medication evaluation and management
- Crisis intervention and stabilization
- Outpatient treatment
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Individual and group therapy sessions
Inpatient services may require prior approval from a plan mental health or substance abuse physician, which means that a person will need to see an eligible physician approved by their specific plan before enrollment in a drug rehab program. Generally, inpatient services have a coinsurance rate. For example, your share of the cost is 20%, while Kaiser pays 80%. Additionally, outpatient services often require a copay at the time of service.
Insurance plans generally have an out-of-pocket maximum amount each year. Once an individual reaches this amount, the insurance provider pays the rest of the approved treatment service costs in full.
5 Benefits of Kaiser Insurance: Example Plans that Fit Your Needs
Californians have a range of options to choose from when selecting a health insurance plan with Kaiser insurance. This is the benefit of choosing the right insurance from a large, trusted provider like Kaiser. Kaiser offers a range of plans for individuals, families, or employers, including HMO plans.
An HMO is a health maintenance organization. This is a group of doctors, hospitals, and other providers contracted with Kaiser. This allows for lower costs but limits the choices in selecting a doctor or other provider.
In 2022, there are at least ten plans offered by Kaiser1 and even more are available when you consider the subsidiary companies of Kaiser Permanente that also offer plans. Five of these beneficial plans are listed below:
1. Minimum Coverage HMO
Available to individuals or families, this plan covers mental health, behavioral health, and substance abuse services, but only if an in-network provider delivers them. It also requires an extremely high deductible ($8700 for an individual) before the plan pays anything other than essential preventative health services.
2. Bronze 60 HDHP HMO
This plan also covers mental health, behavioral health, and substance abuse services if delivered by in-network providers (since it is an HMO) and is available to individuals and families. The HDHP stands for “high deductible health plan,” and these types of plans usually have a health savings account (HSA) attached so that you can save money for when you have to eventually meet the high deductible ($7000 for an individual in this case).
3. Silver 70 HMO Off Exchange
This plan has a lower deductible available to individuals and families but expects you to shoulder some of the costs for mental health, behavioral health, or substance abuse services. For example, there is a copay for outpatient treatment services, and inpatient treatment would require you to pay 20% of the cost (after you meet the deductible of $3700 for an individual). Additionally, out-of-network providers are not covered.
4. Gold 80 HMO Coinsurance
Like the other HMO plans, out-of-network providers are not covered. However, this plan has no deductible. Just an out-of-pocket maximum, after which point the plan begins to cover expenses. For an individual, this number is $8200, but there are still copays for mental health, behavioral health, and substance abuse services. For example, $35 for an individual visit and $35 per day for other outpatient services.
5. Platinum 90 HMO
Similar to the other plans, this plan is for individuals and families and covers mental health, behavioral health, and substance abuse services if they are in-network providers. There is no deductible, just a maximum out-of-pocket expense, but the copays are lower.
Besides these five listed, there are many other plans that offer a range of Kaiser insurance benefits.
Contact La Fuente Hollywood Treatment Center Today
If you are a Californian, especially in the Los Angeles area, La Fuente Hollywood is ready to help you break the cycle of addiction. Contact us today at 844.956.3514, and we will verify your insurance and go over all the covered services so that you can make a confident decision and get the help you need.
1 Kaiser Permanente – “Individual and Family Summary of Benefits and Coverage”