Does TriWest Cover Drug Rehab?

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Does TriWest cover drug rehab? The short answer is yes. TriWest does cover drug, alcohol, and substance abuse rehab. The ACA (Affordable Care Act) ensures that insurance companies like TriWest cover these treatments. However, the extent of the coverage may vary according to your individual insurance coverage plan. The staff at our rehab center in Orange County, Recovery Beach, is experienced in dealing with TriWest coverage, so you can focus on getting better. Let’s go over some important information about this insurance option.

Overview of Substance Abuse and Mental Health Services

Under the Affordable Care Act (ACA), drug, alcohol, and substance abuse rehab is an essential health benefit. This means that all healthcare insurance options on the market must cover this service. There may be variations in whether your healthcare plan covers outpatient, inpatient, MAT, and various other degrees of coverage. However, drug, alcohol, and substance abuse rehab must be covered by your insurance, at least partially in some way. You may still be responsible for out-of-pocket expenses like deductibles, coinsurance, and copayments.

A stethoscope with a plastic heart.
TriWest covers drug rehab at least partially.

We have plenty of experience working with TriWest. Talk to our team about TriWest rehab coverage to find out more about what it covers specifically.

Coverage Eligibility Criteria

The Department of Veterans Affairs (VA) Community Care program administers the TriWest Healthcare Alliance. They provide eligible veterans and their dependents care from community providers when VA services are not available or accessible. To be eligible for TriWest, the VA will evaluate your military service history, discharge status, and income level. If you meet the eligibility status, you can receive TriWest healthcare benefits, including drug rehab coverage.

Eligibility for drug rehab specifically hinges on clinical need. You may need to show a documented need for substance abuse treatment. You may also need to show a referral from a VA healthcare provider and authorization from TriWest.

At Recovery Beach, we understand that being a veteran presents some unique challenges when it comes to mental health. At our drug rehab for veterans, there are experienced professionals working with the patients.

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Does TriWest cover drug rehab? The extent of coverage will vary according to clinical needs and your policy.

Does TriWest Cover Drug Rehab? Types of Covered Drug Rehab Service

The specific services covered will depend on the veteran’s clinical needs and the recommendation of the VA healthcare provider. TriWest may cover any combination of these:

The extent of coverage will depend on various factors. These include the type of coverage you have, the substance you are addicted to (not all require MAT, for example), and the recommendation from your doctor in the letter assessing your clinical need for drug rehab.

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You can recover from addiction with the right support

Process for Accessing Services

Call or make an in-person appointment with a TriWest representative to get information about the extent of your coverage. The process after this step will vary, but it will generally go something like this:

  1. Professional assessment
  2. Referral or authorization
  3. Coverage verification
  4. Finding a provider
  5. Admission
  6. Treatment
  7. Follow-up and aftercare

1) Get a Professional Assessment

This generally involves a healthcare provider, case manager, and/or counselor talking to you about your specific drug rehab needs. Some things they will ask include:

  • Describe your substance use history in detail
  • What are your treatment goals?
  • What does your support network look like right now?
  • Do you have any dependents?
  • Do you have any co-occurring mental or physical illnesses?
  • Any other relevant information to the case?

It is important to be as honest as you can during this interview. This is so because, based on what you say during the interview, TriWest will approve coverage for certain services.

For example, if you have a strong support network, you may get approved for a partial hospitalization program and still get to sleep and have breakfast with your family at your own house. Ideally, you should not feel judged during the interview. These professionals are experienced when it comes to talking to people with substance use disorder and know how to frame the conversation as a simple discussion of the facts and not a judgment of your character.

2) Referral or Authorization

After this conversation, you will get an official recommendation to receive drug rehab or any other relevant treatment. Depending on the extent of care they recommend, you may have to talk to a TriWest representative once more to find out if your insurance covers the totality of the recommended care.

3) Verification of Coverage

Does TriWest cover drug rehab? This step involves you finding out the exact extent of your coverage. You may discover what drug rehab centers in California TriWest covers and what services are covered. You may have to make separate payments for copayments, coinsurance, and other out-of-pocket expenses. In some cases, TriWest only partially covers drug rehab. However, TriWest is bound by ACA to provide at least a portion of your mental health costs. As the law says, drug rehab is part of essential healthcare that all insurance services on the market must cover.

4) Finding a Provider

Once you have all the relevant information at hand, you will choose a healthcare provider that is close to where you and your support network are located and whose reputation you trust. Recovery Beach in Orange County, California, has worked with TriWest for years and has years of experience in Substance Use Disorder treatment. This includes, but is not limited to MAT, dual diagnosis treatment, family therapy, and scientifically-backed psychotherapy such as CBT or DBT.

5) Initial Appointment Scheduling and Admission

Once you have selected a provider, you will schedule an initial appointment with them. They will interview you again, this time to evaluate the strength of your motivation. Not unlike diabetes, Substance Use Disorder is a chronic, treatable illness. This means that you cannot handle it on your own.

However, just like in the case of diabetes, the motivation of the patient to make lifestyle changes, get good sleep, get good nutrition, and get an appropriate amount of exercise, the motivation of a person with Substance Use Disorder does count for something. This is especially the case for therapies like MAT, which can be very taxing on the body and thus require a higher level of commitment than others.

A doctor with white scrubs and a stethoscope around her neck forms a heart with her hands representing does triwest cover drug rehab
The path to recovery is more straightforward with TriWest

6) Receive Treatment

Then, you will receive the best treatment according to your and your team’s assessment. During MAT, full hospitalization is generally required, at least at the start of your treatment. During said treatment, you will only receive medical treatment. This is so because professionals recommend the patient be stabilized before they begin talk therapy and other forms of therapy.

Doctors and nurses will administer FDA-approved drugs that will lessen the impact of withdrawal syndrome. In some cases, you will receive gradually smaller doses of the substance you are addicted to. This is so because quitting some substances like heroin and other opioids and cold turkey can be life-threatening.

After MAT, if you require it, individual and group therapy will begin. You will also receive holistic treatment, such as yoga classes and art therapy. You will be given strategies to go out into the world from day 1. If you prefer to have a transitional period, you may opt for a sober living home once the most intensive part of therapy is over.

7) Follow-up and Aftercare

Addiction is rarely treated in a few weeks or months. Recovery is generally a long-term process that requires ongoing therapy and other appointments, like keeping up with NA or AA meetings. You will additionally have to maintain certain habits and routines and possibly avoid certain stressors and triggers.

Other Insurance Options at Recovery Beach

Does TriWest cover drug rehab? Is it the only coverage we accept? TriWest is not the only coverage available at Recovery Beach. Aetna rehab coverage is also an option. Recovery Beach is an in-network provider, which is great news as there are not many such options.

Some of the patients in our centers benefit from Cigna Regan Coverage.

Another option for coverage is Blue Cross. There is more information available about Blue Cross Blue Shield Coverage.

And, as of recently, we have been an in-network provider with Blue Shield of California. No matter which insurance policy you have, we will help you understand your coverage and find the best possible solution for you, both in terms of treatment and financial consideration.

Our main goal is to make sure you focus on recovery without worrying about any other external factors. 

Start Healing with Recovery Beach

Ready to get started with your path toward recovery? Here at Recovery Beach, we have plenty of experience working with TriWest. Reach out to our Orange County rehab center today.

Get Help for Yourself or Your Loved One

Call Now: (855) 588-1422

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