| HMO | Substance Abuse Inpatient |
| Aetna US Healthcare | Covers: Inpatient services for detoxification and treatment.
Cost Sharing: Copayment applies. Excludes: Chronic alcoholism or drug addiction treatment. |
| Blue Cross Blue Shield | Covers: Inpatient substance abuse services provided by Magellan, a specialized managed care organization the provides mental health and substance abuse services.
Magellan contracts with providers and hospitals in your area. No referral needed from PCP before calling Magellan for mental health services. Limits: Coverage limited to 30 days per calendar year for the purpose of diagnosis and medical treatment for alcoholism and drug abuse. Inpatient and outpatient services, except detoxification, are subject to a combined $8,000 calendar year maximum and a $16,000 lifetime maximum. Cost Sharing: Copayment required for each day. Detoxification: Provided on an inpatient or outpatient basis as medically necessary for an unlimited number of days. |
| CIGNA / Healthsource | Excluded: Unless purchased in a supplemental policy.
With the purchase of a supplemental policy-- Covers: Inpatient services provided by Cigna Behavioral Health, Inc., a specialized managed care organization that provides mental health and substance abuse services. Also covers some day treatment services. Emergency services are available 24 hours a day. Limits: Inpatient care is approved only when the physician determines that outpatient treatment is not inappropriate. Coverage is limited to short-term therapy that is medically necessary to provide diagnosis, crisis intervention, and treatment of substance |
| Doctors Health Plan | Excluded: Unless purchased under a supplemental policy. Emergency services are available 24 hours a day. Referral from PCP is not necessary.
Limits: If covered, care must be authorized and referred by Magellan Behavioral Health of North Carolina (1-800-359-2422). Substance abuse services are limited to an annual maximum of $8,000 per member and a lifetime maximum of $16,000. Cost sharing: Copayments may apply. |
| Generations | Covers: Inpatient detoxification for drug or alcohol abuse or addiction when deemed medically necessary and approved in advance by Generations’ Mental Health network provider, Magellan.
Limits: Benefits, combined inpatient and outpatient, maximum of $8,000 per contract year and $16,000 lifetime. All care must be authorized by Magellan. |
| Optimum Choice | Covers:
Limits: To be covered, treatment must be arranged through appropriate referral by the member’s PCP and must be medically necessary. The condition must also be treatable. Cost Sharing: Care and treatment are subject to a maximum dollar amount per benefit year ($8,000) and lifetime ($16,000). A deductible and coinsurance may apply. |
| PARTNERS | Excluded: Unless covered by a supplemental rider.
With purchase of a supplemental rider covers: Inpatient and Partial Hospital Services for short-term evaluation or crisis treatment of alcohol or substance abuse. Limits: All services except for emergencies must be approved in advance by plan’s designated chemical dependency providers. Maximum benefit per member per contract year of $8,000; maximum lifetime benefit per member of $16,000. Cost Sharing: Copayment applies. Excludes: Treatment of chronic, non-acute conditions, long-term rehabilitation, vocational rehabilitation, and employment, religious, pastoral and psychic counseling. |
| Coventry/Principal Health Care of the Carolinas | Excluded: Unless purchased in a supplemental policy.
Supplemental policy: Covers: Inpatient and partial inpatient hospital stays related to the treatment of substance abuse Limits: 30 days per calendar year and 2 admissions per lifetime for detoxification and rehabilitation Cost Sharing: 50% coinsurance applies for all substance abuse services |
| QualChoice | Covers: Short-term crisis intervention and inpatient care that is medically or psychologically necessary care and is provided by a network provider. Covers detoxification treatment if medically necessary. QualChoice has a special network of substance abuse providers. Under the HMO gatekeeper option (Option 1), you must first call QualChoice for a referral in order to get services.
Notification: You must call QualChoice prior to a admission to a hospital or inpatient facility, or for partial hospitalization treatment. You will be charged a non-notification penalty if you fail to call QualChoice, except in cases where your condition renders you unable to comply. Limits: Care and treatment are subject to a maximum dollar amount per benefit year and lifetime. Cost Sharing: A deductible and coinsurance may apply. Excludes: Detoxification treatment that requires medical involvement or is medically complicated. |
| The Wellness Plan of North Carolina, Inc. | Covers: Diagnosis and medical treatment.
Limits: Inpatient and outpatient services are subject to a combined $8,000 calendar year maximum and a $16,000 lifetime maximum. A behavioral health case manager picked by TWP-NC will manage the care. Services must be provided by participating providers. The member may obtain a referral for mental health services by his or her PCP or directly by calling the behavioral health case manager. |
| United HealthCare | Covers: Semi-private room and physician services.
Limits: Covered only when provided by a participating provider. Treatment must be approved in advance by United Behavioral Health. Chemical dependency services are limited to an $8,000 annual maximum and a $16,000 lifetime maximum. Cost Sharing: Copayment may apply. Excludes: Nutrition-based therapy for alcoholism or other chemical dependency. |
| WellPath | Excluded: Unless covered by a supplemental policy. Most groups purchase the chemical dependency rider.
Covers, with the purchase of a supplemental policy: Inpatient hospital facilities, residential facilities for the treatment of chemical dependency. Limits: The participating provider of chemical dependency services must provide and arrange for the services. The covered services must be provided in the most cost-efficient setting that is appropriate for the member’s condition. Chemical dependency services are limited to an $8,000 annual maximum and a $16,000 lifetime maximum. Cost Sharing: Copayments apply. |