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Are Drug and Alcohol Rehab Costs Covered by MHNet Insurance?
MHNet covers a broad range of acute and sub-acute facilities and programs for substance abuse treatment, including rehab. According to MHNet’s Member Services’ and Provider Services’ departments, rehab coverage is based upon medical necessity criteria specific to each contract.
Medical need is determined by on-staff case managers in conjunction with the member’s primary care provider (PCP) and other pertinent professionals involved in the member’s care. Case reviewers include addictionologists, who are medical doctors board-eligible or certified by the American Society of Addiction Medicine. Addictionologists specialize in addiction disorders.
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According to Appendix B of MHNet’s online utilization manual, utilization and care management staff and physicians consider the following when determining medical necessity:
- Member’s age
- Presence of co-morbid (i.e., concurring) conditions
- Complications
- Treatment progress
- Psychosocial factors
- Pertinent factors related to home environment
- Characteristics of the local delivery system available to the member (e.g., availability of alternative care levels, MHNet’s or the health plan’s coverage of benefits for such alternatives, and ability of local providers to deliver all recommended services within the estimated length of stay.)
MHNet states that it does not intend for its medical necessity criteria “to replace sound clinical judgment or internal clinical guidance.” Involved professionals are encouraged to base their ultimate decision upon pertinent clinical data specific to the member whose case is under consideration.
Founded by clinicians in 1985, MHNet is a national behavioral health company based in Austin, Texas. It is available through an insured’s healthcare plan and/or Employee Assistance Plan (EAP) and its function is to coordinate benefits. MHNet endeavors to create customized behavioral health insurance plans. Policyholders are encouraged to read their benefits information to learn more about their specific substance abuse coverage. Members can also talk to a customer service representative by calling their assigned Member Services’ call centers or one of the following National Service Centers (NSCs):
- NSC – Austin: (800) 336-2030
- NSC – Orlando: (800) 835-2094
- NSC – St. Louis: (800) 377-9096
- NSC – Kentucky: (800) 336-2030
- TTY number: (800) 200-3269
More information can also be found at the MHNet website: http://www.mhnet.com/
Have Any Questions?
If there are any question regarding MHNet Behavioral Health coverage and drug/alcohol rehabilitation, contact the insurance company to get accurate and timely information. Their team of customer care representative will be glad to discuss the policy to help make the decisions easier.
Keep in mind that entering a facility within the MHNet Behavioral Health network will be far less costly than one that is out-of-network.
In order for someone addicted to alcohol or drugs to overcome, there must be the proper support system in place. Rehabilitation centers along with MHNet Behavioral Health gives each person a fighting chance at survival.
Learn about Oxford rehab insurance coverage.