In the majority of cases, Molina provides coverage for substance use disorder treatment. The exact coverage varies. It may include outpatient services, partial hospitalization programs, and residential treatment in an inpatient rehab facility. Because every state has slightly different regulations regarding healthcare coverage, the options available will vary depending on your location. Different areas have diverse requirements and benefits offerings.
Rehab Coverage Through Molina
Regardless of whether or not you purchased your Molina plan through the state exchange marketplace, rehab options are available. Rehab coverage plans are all built around federal and state requirements since the company functions as a coverage coordinator for Medicare.
Mental health services are a covered benefit in all Molina plans. They’re subject to the same requirements as physical health services. If you have a Molina health insurance plan, you can contact a Molina company representative to discuss the specifications of your insurance policy. You can also ask your primary care doctor to give you a list of in-network mental health providers that might match your needs.
Outpatient Mental Health Services
Many different services fall under this umbrella. They include:
- Individual mental health evaluations and psychiatric assessments
- Any psychological testing clinically required for the diagnosis and evaluation of a mental health issue
- Outpatient laboratory tests
- Outpatient supplements, supplies, and laboratory drugs
- Outpatient services monitoring drug therapy
- Psychiatric consultations
Unfortunately, Molina does not cover mental services that relate to relationship issues. This includes family counseling, marriage counseling, and couples counseling. With that said, family therapy is often an integral part of the recovery and healing process. If you’re able to pay for it out-of-pocket, it’s a worthwhile endeavor to integrate into your treatment plan.
Behavioral Health Coverage Through Molina
Most of the coverage and benefits offered through Molina’s plans are built around state and federal guidelines. The Affordable Care Act created exchange guidelines regarding what health policies must cover before they could be sold on the Marketplace.
Also, Molina adheres to state and federal requirements regarding Medicare and Medicaid. Under these guidelines, covered behavioral health services include therapist and doctor appointments, treatment programs, medication management, and care coordination between multiple mental health providers.
Molina is staffed by teams of care coordinators; These individuals can work with members to help them understand their policies, options, and treatment plans. Their job is to connect members with the ideal provider for whatever behavioral health needs they have. Besides, Molina can help to coordinate long-term and medical treatments with behavioral treatments, allowing better communication between all of your healthcare providers.
On top of all of this, Molina is responsible for operating a behavioral health crisis line that’s available to call 24 hours a day. If a member has a problem related to their behavioral or mental health, they can contact a qualified nurse at any time to get a recommendation for how to proceed.
To get specific information regarding your benefits, you can contact the Member Services division of Molina. There’s also a Summary of Benefits that you can read to get the highlights of your medical coverage, including coverage for behavioral health treatment.
Rehab Coverage Through Molina
But this isn’t true across all states. Illinois, for example, provides full coverage of substance abuse treatment. That includes day treatment, psychiatric evaluations, medically supervised detoxification, and outpatient treatment.
Different states have significantly different rehab coverage options based on state regulations.
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Molina Healthcare Plans
Bronze Plan
The bronze plan covers outpatient services with a $35 copay. After the inpatient services have been pre-authorized, Molina covers up to 60 percent of the costs. The bronze plan also covers inpatient rehabilitation as long as the treatment center is in-network, and the treatment is authorized before beginning.
Silver Plan
Outpatient services have a copay of $20, while inpatient services receive up to 60 percent coverage. If you meet the pre-authorization requirements for an in-network treatment center, Molina will cover up to 60 percent of residential rehab treatment.
Gold Plan
The gold plan has the lowest out-of-pocket cost for drug treatment. Outpatient treatment comes with a 10 dollar copay, and inpatient treatment has 80 percent insurance coverage. With the pre-authorization of an in-network treatment center, Molina covers 80 percent of the costs of residential rehab.