More than 20 million are living with a substance use disorder (SUD) at this time in the U.S. Unfortunately, only about 10% of them will receive treatment. Furthermore, 40% of Americans have co-occurring SUD and anxiety, depression, or other mental illness.
This can cause physical health problems and undermines a person’s ability to:
- go to school
- maintain relationships with family and friends
No matter what the substance is, Magellan Healthcare can offer a solution. If you have health insurance through Magellan, you are already covered for substance use disorder (SUD) treatment.
What is Magellan Health Insurance?
Magellan is a healthcare company that has been operating since 1969. They started as a chain of psychiatric facilities and later expanded into managed care and specialty health insurance. Magellan Health Inc. is a managed care company that focuses on:
- special populations
- complete pharmacy benefits
- other specialty areas of healthcare
Magellan customers include:
- managed care organizations
- labor unions
- military and governmental agencies
Magellan was named to Newsweek’s 2023 List of the “Most Trustworthy Companies in America.”
Magellan’s Approach to Behavioral Health
The need for unified behavioral healthcare in the United States has never been greater. Combined with 24/7 news, the fast pace of life today, anxiety, and the historical increase in negative feelings, many people are at the breaking point. Magellan Healthcare recognizes the challenges of the 21st century.
In response, Magellan has set out an integrated approach to behavioral health services such as:
- Address all facets of wellness
- Emphasize prevention and identify mental health issues early
- Enable primary care physicians to give mental health treatment
- Apply behavioral health clinical expertise with centers of excellence for serious mental illness, substance use disorder, eating disorder, and Autism
- Offer a behavioral health network with over 118,000 credentialed providers
- Deliver results that impact treatment and outcomes positively and reduce cost
- Provide care management support for substance abuse and addiction through discharge
What Addiction Services are Covered?
Coverage for SUD treatment is provided and the type of addiction doesn’t matter. If you have been diagnosed with SUD, Magellan will cover your treatments. This includes treatment received in inpatient and outpatient settings. Partial hospitalization programs (PHPs) are also qualified for coverage.
Magellan Insurance Rehab covers inpatient programs for addiction treatment. These programs are also known as residential programs. In this type of program, you live at the drug rehab center while receiving treatment. Services typically provided and covered by Magellan include:
- Detox (drug and alcohol)
- Addiction treatment therapy in Los Angeles, CA
- Medications (for example, methadone maintenance for opioid addiction)
- Relapse prevention
- 12-step program facilitation
Magellan rehab insurance provides coverage for dual-diagnosis treatment. A dual diagnosis program in Los Angeles, CA treats SUDs that co-occur with a mental health disorder. It’s common for people with alcohol SUDs to suffer from anxiety or depression. Regrettably, many people use drugs or alcohol to self-medicate a diagnosed or undiagnosed mental disorder.
Magellan also covers outpatient services including:
Intensive Outpatient Programs (IOPs)
The treatment provided in an intensive outpatient program in Los Angeles, CA is the same as a residential program but you don’t live at the treatment facility and typically spend a few days at the center for 3 or 4 hours. People with mild SUDs might only need outpatient treatment.
Partial Hospitalization Programs (PHPs)
Partial hospitalization programs in Los Angeles, CA are often called “day programs.” A PHP is somewhere between residential and outpatient treatment. In a PHP, you attend inpatient treatment at the facility during the day and return home at night for 5 to 7 days per week. This is usually an appropriate program if you have a more serious addiction but have stable, supportive housing. Magellan covers the same services for PHPs as inpatient and outpatient programs. This means you can be covered for detox, therapy, and more.
What Mental Health Services are Covered?
Magellan also provides coverage for outpatient and inpatient mental health services. However, you may need a diagnosis and a referral in some cases. Coverage may then be provided for these mental health conditions:
- Mood disorders (depression, bipolar disorder, etc.)
- Anxiety disorders (social phobias, generalized anxiety disorder, etc.)
- Attention-deficit hyperactivity disorder (ADHD)
- Post-traumatic stress disorder (PTSD)
The policy is the same for substance use and mental health disorders. The amount for addiction services is the same fee as for mental health services. Sometimes, you might have to see an in-network provider or receive a diagnosis and a referral to get coverage.
Inpatient Mental Health Services
Inpatient mental health services are similar to those for SUDs. You can enroll in one of these whether you have SUD or not. This includes group therapy, behavioral therapy, and medications.
Outpatient Mental Health Services
Outpatient mental health services covered include IOPs and PHPs. The treatments are identical to residential programs. In addition, Magellan also covers virtual IOP in Los Angeles, CA. This is helpful because people in outpatient treatment often use teletherapy. The exact amount you pay for medication depends on your policy coverage.
Why is it Important to Have Coverage for Mental Health and SUDs?
This is important coverage because if you are struggling with SUD, there is a strong possibility that you have a co-occurring mental condition. A lot of people who become dependent on drugs or alcohol start out as a way to mask the effects of their mental issues.
According to the Journal of the American Medical Association (JAMA), 37% of alcohol abusers and 53% of drug abusers also have at least one serious mental illness. Despite which condition appeared first, both disorders need to be treated simultaneously, preferably in a dual diagnosis treatment program.
The laws that make that possible are:
This federal law was passed in 2008 to keep group health plans and insurance companies from limiting coverage for SUDs or mental health disorders. Since then, medical insurance companies are required to provide coverage equal to surgical/medical coverage.
Reported that nearly 90% of people had never heard of the MHPAEA even though it applies to most employer-provided plans and individual plans bought through the healthcare marketplace.
The ACA helps people find and buy health insurance in their area. Insurance companies that are part of the ACA marketplace are required to cover SUDs and mental health conditions.
Do Treatment Centers Need to be In-Network?
Magellan will cover in-network or out-of-network treatment providers. But using an out-of-network provider will cost more. You pay a higher insurance premium for a plan that covers out-of-network care. Or you may have to pay a 40% or higher coinsurance fee.
How Does That Work?
Healthcare providers that are in-network have contracted with your insurance company to accept certain negotiated, discounted rates. Out-of-network providers have not agreed to the discounted rates. For example, you go to a doctor that’s in-network and the charge is $250. A negotiated discount is applied to that amount. It may be $75.
Magellan pays $140 and you pay the rest, which is $35. If you go to a provider that’s out-of-network there is no discount applied to the charge of $250. Magellan still pays $140, but you pay the rest which is $110.
Westwind Recovery® is In-Network with Magellan Health Insurance
As an in-network provider with Magellan Health Insurance, Westwind Recovery® can provide the full range of SUD services covered by Magellan. Our facility in Los Angeles is able to offer a wide range of therapy treatments in our PHP and IOP programs.
Our counselors are licensed and experienced addiction specialists whose only job is to help you or someone you care about recover from addiction and rebuild their life. Contact us today. We will be glad to answer your questions and help in any way we can.
Dr. Deena is the Chief Clinical Officer of Westwind Recovery®, an award-winning outpatient treatment center in Los Angeles where she oversees the clinical and administrative program and treatment methods. Dr. Deena is a doctor of psychology and licensed clinical social worker since 1993. LCSW #20628. Originally from the East Coast, Dr. Deena has worked running treatment centers, worked as a therapist in psychiatric hospitals as well as school settings and currently has a thriving private practice in the LA area. Dr. Deena has appeared regularly on the Dr. Phil Show as an expert since 2003. She has also been featured on many other TV shows, podcasts and has contributed to written publications as well as podcasts.