Does Optima Insurance Offer Drug Rehab Coverage?

People who are covered by Optima health insurance can access an array of inpatient and outpatient treatment services for addiction recovery. 

The level of coverage through Optima will be determined by the specifics of the Optima plan, the location of the policyholder and the rehab facility, and other variables. 

Using health insurance for addiction treatment is essential for people looking to reduce the financial burden of a drug rehab program. 

How To Use Optima Insurance Plans For Substance Abuse Treatment

Optima Health is a Virginia-based insurance company that currently provides insurance coverage to nearly 600,000 members.

Plans through Optima may include employer-sponsored plans, family plans, employee assistance plans, and plans specifically designed for people enrolled in Medicaid and Medicare.  

People with substance use disorders can use their Optima health plan to cover all or part of their addiction recovery program in Virginia, but they may need to seek prior authorization from a doctor first. 

Types of health insurance plans available through Optima:

• health maintenance organization (HMO): HMO plans offer healthcare services, including addiction treatment, at a fixed price as long as the provider is in-network. 
• point of service (POS) plan: This type of HMO plan allows members to pay lower copays or coinsurance within the network, and higher out-of-pocket payments for services received out-of-network. 
• preferred provider organization (PPO): A PPO plan will provide 90% to 100% of treatment coverage for members using an in-network provider. 

Addiction Treatment Services Covered By Optima Insurance

Optima insurance plans will cover a wide range of evidence-based and holistic therapies for substance abuse. 

Addiction treatment options may include:

• medication-assisted treatment (MAT)
• medical detox 
• 12-step programs for alcohol addiction
• inpatient treatment
• intensive outpatient programs (IOP)
• mental health treatment
• partial hospitalization programs (PHP)
• behavioral therapy
• dual diagnosis treatment for co-occurring disorders
• support groups for people with opioid drug addiction
• aftercare services
• sober living homes
• relapse prevention
• wellness services

The costs associated with using Optima will vary based on what kind of insurance plan a person has and the level of care they need.

Typically, Optima will require clients to obtain a referral from a healthcare provider first before they will agree to pay for a residential or outpatient rehab program. 

Questions To Consider Before Choosing A Rehab Center Using Optima Insurance

Before selecting an addiction treatment center, you want to ask the following questions to an Optima insurance representative. 

Common questions to ask before enrolling in a drug and alcohol rehab program:

• How much will my deductibles and copays be if I enroll in an out-of-network provider?
• Is detoxification covered in my health plan?
• What are my options if I can’t afford any out-of-pocket costs?
• Can I use scholarships or grants for a rehab program?
• Will my health insurance plan cover long-term residential treatment and outpatient services?
• Does my health coverage include prescription drugs?
• Are there certain addiction treatment services that Optima will not cover?
• Will the insurance plan only cover costs for in-network treatment providers?
• Do I need to get prior authorization from my primary care provider before Optima will cover the cost of a drug and alcohol treatment facility?
• What are the specific health benefits offered by the insurance provider?
• Can I only receive behavioral health services that are deemed medically necessary? 
• Do covered services change depending on which state I’m in?

Find Substance Use Disorder Treatment Using An Optima Health Plan Today

Call our helpline today for more information on using Optima health insurance for addiction recovery services. Our team can assist you or your loved ones in achieving lasting sobriety.

Published on November 29, 2022

Written by the Free Rehab Centers Editorial Staff