Does HealthPartners Cover Drug Rehab for Women?

Will HealthPartners Pay for Outpatient Rehab Programs?

Yes, HealthPartners does cover outpatient substance abuse treatment programs. For outpatient services specifically, HealthPartners typically covers these with a copay structure, though the exact copay amount may vary depending on the specific plan.

Important things to know

• Preauthorization: While outpatient services may have different requirements than inpatient care, it’s always best to check if preauthorization is needed for your specific treatment plan
• Network providers: Using in-network providers will generally result in lower out-of-pocket costs
• Plan variations: Your specific copays, deductibles, and coverage limits will depend on which HealthPartners plan you have

Next steps

1. Call the number on the back of your HealthPartners insurance card to verify your specific outpatient rehab benefits.
2. Ask about any preauthorization requirements
3. Confirm whether the outpatient program you’re considering is in-network
4. Get details on your copays, deductibles, and any visit limits

How Can Women Verify Their HealthPartners Rehab Benefits?

Verifying benefits is a crucial step to ensure that insurance will cover all aspects of treatment at an outpatient or inpatient Medicaid rehab facility. Here are the most effective ways to verify your HealthPartners rehab benefits:

Call HealthPartners Member Services

• Use the phone number on the back of your insurance card
• Ask specifically about substance abuse treatment coverage, including inpatient and outpatient services
• Request information about copays, deductibles, and any annual or lifetime limits
• Confirm preauthorization requirements

Check Your Online Account

• Log in to your HealthPartners member portal online
• Review your plan documents and benefits summary
• Look for behavioral health or substance abuse coverage details

Contact the Treatment Facility Directly

• Most rehab centers have insurance verification specialists on staff
• They can call HealthPartners on your behalf and get detailed benefit information
• They’ll help you understand your out-of-pocket costs before you start treatment

Review Your Plan Documents

• Look at your Summary of Benefits and Coverage (SBC)
• Check the Evidence of Coverage booklet you received when you enrolled
• Look for sections on “Behavioral Health,” “Mental Health and Substance Abuse,” or “Chemical Dependency.”

Key Questions to Ask

• Is preauthorization required?
• What are my copays for inpatient vs. outpatient treatment?
• Is there a deductible, and has it been met?
• Are there limits on the number of days or visits covered?
• Is my chosen facility in-network?
• What documentation is needed for coverage approval?

Getting this information upfront will help you avoid unexpected costs and ensure a smoother admission process.

What If My Rehab Facility Is Out of Network?

If your rehab facility is out of network with HealthPartners, it does not mean you cannot attend treatment at the facility or that financial assistance is not available. Here’s what you need to know:

What It Means for Coverage

• Higher out-of-pocket costs: Out-of-network facilities typically have higher copays, coinsurance, and deductibles
• Different coverage levels: You may be responsible for a larger percentage of the costs (e.g., 50% instead of 20%)
• Balance billing: The facility may bill you for the difference between what they charge and what HealthPartners pays
• Separate deductible: Some plans have an individual, higher deductible for out-of-network care

Your Options

Request a Single Case Agreement

• Contact HealthPartners and explain why you need this specific facility
• If there are no comparable in-network options in your area, they may agree to cover it at in-network rates
• This requires documentation and approval before starting treatment

Appeal for Medical Necessity

• If the facility offers specialized treatment you need, like women-specific trauma programs, document why it’s medically necessary.
• Have your doctor provide supporting documentation.
• Submit a formal request to HealthPartners.

Negotiate With the Facility

• Ask the rehab center about self-pay rates or payment plans
• Some facilities offer discounts for out-of-network patients
• Inquire about sliding scale fees based on income

Look for In-Network Alternatives

• Ask HealthPartners for a list of in-network rehab facilities
• Many offer women-specific programs and quality care at lower costs

Check State Parity Laws

• Mental health and substance abuse coverage must be comparable to medical coverage
• If HealthPartners covers out-of-network medical care, they may need to provide similar coverage for rehab

Before Making a Decision

• Obtain a detailed written cost estimate from both HealthPartners and the facility.
• Calculate your total expected out-of-pocket costs.
• Weigh the benefits of the specific program against the additional financial burden.

The treatment facility’s admissions team can often help you navigate these options and may have experience working with patients from HealthPartners.