Yes, Humana Insurance provides substance abuse treatment coverage for adolescents in California.
At Key Healthcare, we understand the concerns parents face when seeking substance abuse treatment for their teens in California.
If you hold a Humana Insurance plan, you may have questions about whether your plan will cover the cost of teen substance abuse treatment in California. Our admission director, Sarah Carillo, designed this blog to provide a comprehensive overview of how Humana Insurance supports the treatment of substance abuse issues for adolescents, including detailed information about plan coverage, out-of-pocket costs, and the services that are covered. Our aim is to make this process as seamless and clear as possible so that you can focus on getting your child the care they need.
What You Need to Know About California Humana Insurance?
As the third-largest healthcare company in the U.S., Humana serves over 13 million customers nationwide. It offers HMO, PPO, POS, and EPO plans, giving individuals flexibility in choosing their healthcare providers and coverage levels. These include Medicare Advantage Plan, Medicaid, individual and family health plans, and supplemental insurance options. Each plan may provide different levels of coverage for teen substance abuse treatment, so it’s essential to understand how your specific plan works.
Once coverage is confirmed and authorization is obtained, we coordinate with you to schedule your teen’s treatment, ensuring timely and effective care.
Here’s a breakdown of Humana’s key plan types:
- Medicaid Plans: Comprehensive coverage for low-income families and individuals.
- Individual and Family Plans: Health coverage for those under 65 who do not qualify for Medicare.
- Medigap (Medicare Supplement): Complements Original Medicare, covering out-of-pocket expenses for approved services.
- Supplemental Insurance: Adds coverage for dental, vision, and other specialized needs.
Does My Humana Insurance Cover Teen Substance Abuse Treatment in California?
Yes, Humana does cover a wide range of treatments for teen substance abuse issues. However, the specifics of the coverage depend on your plan type. To Verify your Humana Insurance plan with us, simply fill out our insurance verification form on our website, and we will handle the rest. We work directly with Humana to ensure that all services are covered and that you are aware of any out-of-pocket costs before starting treatment.
How to Fill Out Insurance Verification Form for Teen Substance Abuse Treatment at Key Healthcare?
- Step 1: Provide your teen’s full name.
- Step 2: Enter your email address for communication updates.
- Step 3: Provide your phone number for quick follow-ups.
- Step 4: Enter your teen’s date of birth.
- Step 5: Provide your full name as the parent or guardian.
- Step 6: Specify whether you are the primary policyholder.
- Step 7: Indicate your insurance provider (Humana One).
- Step 8: Select your plan type (HMO, PPO, etc.).
- Step 9: Upload the front and back of your insurance card.
- Step 10: Specify the type of treatment your teen needs (e.g., inpatient, outpatient).
- Step 11: Submit the form.
After parents submit the insurance verification form our admissions team immediately reviews your Humana plan, checking the coverage for teen substance abuse services, including inpatient, outpatient, and therapy options. We ensure that your teen’s treatment is covered and assess any out-of-pocket costs such as co-pays or deductibles.
If pre-authorization is required, we submit all necessary documentation to Humana, including the treatment plan and medical necessity details, ensuring a smooth and prompt approval process.
We provide regular updates on the status of your insurance approval. If there are any issues, such as a denial, we guide you through the appeals process and resubmit the required information to secure coverage.
What Services Does Humana Insurance Cover for Teen Substance Treatment in Arizona?
Teen Inpatient and Outpatient Teen Substance Abuse Treatment
Humana Insurance provides comprehensive coverage for both inpatient and outpatient substance abuse treatment for teens. These services may include:
- Detoxification Services: Medical supervision and support during the withdrawal process.
- Teen Residential Rehab: Intensive, structured care at an inpatient facility, which may last anywhere from 30 to 90 days or more.
- Teen Outpatient Programs: Flexible treatment options for teens who do not require 24/7 medical care. Humana covers Teen Intensive Outpatient Programs (IOP) and Adolescent Partial Hospitalization Programs (PHP), providing teens with the necessary structure and support while allowing them to return home in the evening.
In California, teen outpatient substance abuse services are covered under Humana plans. As long as the services are within the network, there is a $10 copayment for specialist office visits and a $0 copayment for partial hospitalization.
Medication-Assisted Treatment (MAT)
For teens dealing with opioid use disorder (OUD) or teen alcohol addiction, Humana’s coverage includes FDA-approved medications such as methadone, buprenorphine, and naltrexone. These medications, in combination with counseling and behavioral therapy, are highly effective in treating substance use disorders. Under Humana’s plan, members may face a $10 copayment for services at a specialist’s office, but partial hospitalization services often have no additional cost.
Counseling and Therapy
Humana Insurance plans cover teen individual therapy, teen group therapy, and teen family therapy sessions, which are crucial for addressing the psychological and emotional factors contributing to substance abuse disorders. Therapy can take place in both inpatient and outpatient settings and is essential for long-term recovery and support.
Beyond Humana, our partnerships extend to other insurers, including Blue Cross Blue Shield of Arizona, Cigna , Aetna, Kaiser, GEHA, UMR, and Magellan.
Will My Humana Gold Plus H5619-021 (HMO) Member Plan Cover Substance Abuse Issues?
Yes, most Humana plans including Gold plus cover co-occurring disorders. This means if your teen has both mental health issues (such as anxiety or depression) and substance abuse problems, they can receive treatment for both under one plan.
Do I Need Pre-Authorization for Teen Inpatient and Teen Outpatient Substance Abuse Treatment?
For many types of teen substance abuse treatments—especially for inpatient or residential care—Humana may require pre-authorization. Pre-authorization ensures that the treatment is medically necessary and aligns with the plan’s coverage guidelines.
At Key Healthcare, we understand that navigating the insurance pre-authorization process can seem overwhelming, but it is an essential step in ensuring your teen receives timely and comprehensive care. Humana requires pre-authorization for inpatient and outpatient for many behavioral health services, including teen substance abuse treatments. Here’s what you need to know about how the process works and how we assist you every step of the way.
Step 1: Initiating Pre-Authorization
Pre-authorization is needed to confirm that the requested treatment is medically necessary and covered by your Humana plan. At Key Healthcare, we handle this process for you. Once we develop a treatment plan for your teen, we submit the pre-authorization request to Humana on your behalf.
You can also start this process by logging into Humana’s member portal, where there is an option to request pre-authorization directly.
Step 2: Information Required for Pre-Authorization
Humana requires detailed information to approve a pre-authorization request. This includes:
- Member Details: Full name, date of birth, and Humana insurance ID number.
- Provider Details: Provider’s name, National Provider Identifier (NPI), and contact information.
- Service Details: Diagnostic codes (ICD-10) and service codes (CPT/HCPCS) that outline the type of care being requested (e.g., inpatient or outpatient rehab, detox, therapy).
- Medical Necessity: A statement from the healthcare provider explaining why the treatment is medically necessary for the patient.
At Key Healthcare, we ensure all the necessary documentation( e.g., medical records, progress notes, assessments, lab reports, etc.) and information are submitted, reducing the likelihood of delays or denials.
Step 3: Expected Response Time
Once a pre-authorization request is submitted, Humana typically responds within 72 hours for standard requests. If the situation is urgent, such as when delaying treatment could jeopardize your teen’s health, a fast-tracked review will be completed within 24 hours. Our team at Key Healthcare ensures that any urgent requests are flagged and expedited.
Step 4: How We Submit Pre-Authorization
Pre-authorization requests is the submitted to Humana’s Behavioral Health UM team at 469-913-6941 by fax. In urgent cases, we recommend contacting Humana’s customer service line to ensure the request is processed immediately. At Key Healthcare, we manage this entire process and maintain communication with Humana to keep you informed about the approval status.
Step 5: What Happens If Pre-Authorization is Denied
In the event that Humana denies a pre-authorization request, you have the right to appeal the decision. Our team will work with Humana to address any issues, including submitting additional medical documentation or requesting a peer-to-peer review with Humana’s medical reviewers. If needed, we will guide you through the appeals process to ensure that your teen gets the care they need.
At Key Healthcare, we handle the entire pre-authorization process on your behalf. Our admissions team submits the necessary documentation, including your teen’s diagnosis and proposed treatment plan, to Humana for approval. This reduces delays and ensures that your teen’s treatment begins as soon as possible.
If you need assistance with a claim or face a denial, our experienced staff will work directly with Humana to appeal the decision. This includes gathering any additional medical documentation required and, if necessary, requesting a peer-to-peer review with Humana’s medical team.
What are Out-of-Pocket Costs Should I Expect from California Humana Insurance?
Out-of-pocket costs depend on your plan and may include:
- Co-payments: Fixed amounts for services like therapy.
- Deductibles: You must pay a certain amount before your insurance begins covering services.
- Co-insurance: A percentage of costs you share with the insurer after meeting your deductible.
Here are the details about Medicare Part A and Part B costs for 2024, which can give insights into potential out-of-pocket expenses for Humana plans as they often follow similar structures. Here’s a breakdown of what it states:
Medicare Part A
- Premium: Most people don’t have to pay a Part A premium if they worked for at least 10 years and paid Social Security taxes.
- Deductible and Coinsurance:
- $1,632 deductible per benefit period.
- Days 1–60: No coinsurance.
- Days 61–90: $408 coinsurance per day.
- Days 91 and beyond: $816 coinsurance per “lifetime reserve day” for up to 60 days.
After the lifetime reserve days are used, all costs are out-of-pocket.
Medicare Part B
- Premium: The standard premium is $174.70 per month in 2024, or more depending on income.
- Deductible and Coinsurance:
- In 2024, the deductible is $240, after which you’ll typically pay 20% coinsurance for most doctor services, outpatient therapy, and durable medical equipment (DME).
Annual Maximum Out-of-Pocket Costs
- There is no maximum out-of-pocket limit with Original Medicare.
For Humana insurance, which might offer Medicare Advantage plans or similar structures, the deductible, coinsurance would influence out-of-pocket expenses, and whether there is an annual out-of-pocket maximum, which can vary by plan type.
What Teen Substance Abuse Treatment Services are Not Covered by Humana Insurance?
Certain teen substance abuse services, whether outpatient or inpatient, are not covered by Medicare, including:
- Transportation to or from Key Healthcare Residential Treatment Center
- Private room (unless deemed medically necessary)
- Private duty nursing services
- Amenities like a phone or television in your room
- Personal items such as toothpaste, socks, or razors
If you have further questions or need assistance verifying your Humana coverage, please contact us. We are here to support you every step of the way to ensure your teen receives the care they need.
Conclusion
At Key Healthcare, we prioritize your teen’s health and well-being while ensuring that the financial aspect of treatment is as seamless as possible. With Humana’s comprehensive coverage and our dedicated support team, you can focus on your teen’s recovery journey. Contact us today to get started on verifying your coverage and enrolling your teen in the best treatment plan available.
Frequently Asked Questions
What If My Teen Relapses?
Relapse is part of the recovery process, and Humana often covers additional treatment if your teen requires further care after a relapse.
Does Humana Cover In-Network and Out-of-Network Providers?
Humana PPO and POS plans typically cover out-of-network providers, though at a lower rate. HMO plans generally require you to stay in-network for coverage.
Can My Teen’s Substance Abuse Treatment Be Covered if They Are Out-of-State?
Humana may cover out-of-state treatment, depending on your specific plan and whether the facility is in-network.
Can I Expect Follow-Up Care to Be Covered?
Yes, many Humana plans cover aftercare services such as follow-up therapy, outpatient counseling, and support groups to maintain sobriety after completing inpatient or outpatient treatment.
