Yes, Magellan Insurance offers substance abuse treatment coverage for adolescents in California.Â
Magellan Healthcare, part of Centene Corporation, specializes in behavioral health services. Magellan Healthcare operates in California as Human Affairs International of California, Inc. and Magellan Health Services of California, Inc. While Magellan is not a direct insurance provider, it administers insurance coverage for teen substance abuse treatment costs under various health plans in California.Â
In California, Magellan currently administers benefits for members enrolled in the following plans:
- Blue Shield of California
- Health Plan of San Mateo
- Positive Healthcare California
Federal laws, such as the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), mandate teen substance abuse treatment coverage, ensuring that Magellan Insurance covers inpatient, outpatient, and residential services for adolescents in California.
At Key Healthcare, we understand that navigating the complexities of insurance, especially for teen substance abuse treatment, can be overwhelming. Our goal is to ensure that families and adolescents in California get the care they need while making the insurance process as smooth as possible. Magellan Insurance provides extensive coverage for our teen substance abuse treatment using our teen treatment programs in California. We’re here to help you understand how to make the most of your insurance benefits.
This page will guide you through everything you need to know about Magellan Insurance coverage at Key Healthcare, from verification of benefits to understanding out-of-pocket costs, pre-authorization requirements, and how we help with claims and appeals.
What is Covered by California Magellan Insurance for Teen Substance Abuse Treatment?
Magellan Insurance offers comprehensive behavioral health coverage for your dependent’s substance abuse treatment in California. This includes a variety of teen treatment programs tailored to meet your teen’s unique needs. The following services are generally covered under Magellan Insurance:
1. Teen Inpatient (Residential) Treatment in California
Magellan covers California inpatient rehab programs for teens struggling with severe substance abuse conditions. These programs include:
- 24/7 medical supervision.
- Individual and group therapy sessions.
- Medical detox (if necessary).
- Comprehensive behavioral health interventions.
Inpatient treatment typically requires pre-authorization, which Key Healthcare assists in securing.
2. Adolescent Outpatient Treatment in CA
Teen Outpatient programs offer flexibility for teens who need structured care but can continue to live at home and attend school. Magellan covers:
- Teen Intensive Outpatient Programs (IOP): Structured therapy sessions multiple times a week.
- Adolescent Partial Hospitalization Programs (PHP): Day programs with intensive therapy.
- Standard Outpatient Programs: Weekly or bi-weekly therapy sessions.
3. Teen Detoxification Services
Detox is the first critical step in many Teen substance abuse treatment plans. Magellan covers medically supervised detox, ensuring your teen safely withdraws from drugs or detox from alcohol in a supportive environment.
4. Teen Medication-Assisted Treatment (MAT)
For teens battling opioid or alcohol addiction, Magellan covers Medication-Assisted Treatment (MAT), which combines counseling with FDA-approved medications like Suboxone or Vivitrol.
Magellan’s inforMED Pharmacy Program optimizes costs for Medication-Assisted Treatment (MAT), reducing out-of-pocket expenses for behavioral health prescriptions and making treatment more accessible.
5. Teen Therapies and Counseling in California
Therapy is an essential component of teen substance abuse treatment. Magellan covers a variety of therapy types, including:
6. Teen Aftercare Services, CA
Magellan also provides coverage for Teen aftercare programs that support teens as they transition back into everyday life after completing treatment. These services can include:
- Ongoing therapy sessions.
- Participation in support groups to maintain sobriety.
- Peer support services.
7. Employee Assistance Programs (EAP):
These services often include no cost to the member for initial sessions, such as therapy or counseling.
How Key Healthcare Assists with California Magellan Insurance for Teen Substance Abuse Treatment Coverage?
At Key Healthcare, we strive to take the guesswork out of the insurance process. Here’s how we support you through every step:
1. Insurance Verification
At Key Healthcare, we simplify the insurance verification process to ensure you know exactly what your coverage includes before starting your teen’s substance abuse treatment. Here’s how to complete our Insurance Verification Form and what information is needed:
Step 1: Access the Form
Our Insurance Verification Form is on the Key Healthcare website. It allows us to verify your insurance benefits and provide you with detailed information regarding your coverage.
Step 2: Fill in Your Teen’s Information
- Teen’s First and Last Name: Enter your teen’s legal first and last name.
- Teen’s Date of Birth: Use the format MM/DD/YYYY to ensure the correct details.
- Parent/Guardian’s Name: Include your full name as the primary point of contact.
Step 3: Enter Your Contact Information
- Email Address: Provide an active email address so we can send you a verification summary.
- Phone Number: This allows us to follow up quickly if any additional information is needed.
Step 4: Insurance Details
Are You the Primary Policyholder?: Indicate if you are the main policyholder or if another family member holds the policy.
Insurance Provider:Â Select or enter Magellan Insurance (or other insurance providers).
Type of Insurance Plan:Â Indicate whether it’s a PPO, HMO, or self-insured plan.
Step 5: Upload Insurance Card Information
Insurance Card (Front and Back): Upload clear images of both sides of your insurance card to ensure accuracy when verifying your coverage.
Step 6: Type of Treatment Needed
Select the type of treatment you are seeking for your teen, such as inpatient rehab, outpatient therapy, or detox services.
Step 7: Additional Information
How Did You Hear About Us?:Â Let us know how you found out about Key Healthcare.
Message:Â Provide any additional information or questions regarding your insurance, coverage, or treatment needs.
Step 8: Submit the Form
Once all fields are completed, click Submit. Our admissions team will receive your form, verify your insurance, and contact you with a full breakdown of your coverage.
You can start this process by filling out our Insurance Verification Form on our website. We’ll follow up with a comprehensive coverage report so you know exactly what to expect.
2. Pre-Authorization Process
Magellan requires pre-authorization for certain services, such as inpatient rehab or residential treatment. Don’t worry—Key Healthcare will handle this for you. Our team:
- Gathers the necessary medical documentation.
- Submitted the pre-authorization request to Magellan.
- Follows up to ensure the treatment is approved in a timely manner.
3. Claims Submission
At Key Healthcare, we handle the claims process for teen substance abuse treatment under Magellan Insurance with care and efficiency. Below is an overview of how we ensure that all claims are submitted correctly and on time to avoid any interruptions in coverage:
1. Timely Submission
All claims, whether submitted electronically or via paper, must be filed within 90 days of the service date under Magellan’s guidelines. Our team ensures that claims are processed within this timeframe to avoid any potential denials. In rare cases where extraordinary circumstances prevent timely submission, we work closely with Magellan to address the situation.
2. Accurate Insurance Claim Information
To guarantee smooth claims processing, each submission must include precise information, such as:
- Subscriber and patient details.
- National Provider Identifier (NPI).
- CPT codes for the services provided.
- ICD-10 diagnosis codes.
- Dates of service and provider credentials.
Any missing or incorrect information can lead to delays or denials, so our administrative team meticulously verifies all details before submission.
3. Claims for Self-Insured Plans
For members with self-insured plans managed by Magellan, claims are submitted according to the specific contact details provided on the member’s benefit card. We ensure all claims are directed to the correct place for processing, ensuring coverage remains seamless for your teen’s treatment.
4. Appeals for California Magellan Insurance Denied Claims
At Key Healthcare, we know how frustrating it can be to have a claim denied for your teen’s substance abuse treatment. We are committed to helping you navigate through Magellan Insurance claim denials and ensuring your teen receives the care they need. Our experienced team will manage the entire appeal process on your behalf, simplifying the complex paperwork and administrative steps.
1. Identifying the Reason for Denial
When Magellan Insurance denies a claim, the first step is understanding the reason. At Key Healthcare, we will:
- Review the denial notice from Magellan.
- Identify if the denial was due to missing documentation, lack of medical necessity, or administrative errors.
- Discuss the next steps with you.
2. Filing an Appeal
If we believe the claim was incorrectly denied, Key Healthcare will prepare and submit an appeal, which includes:
- Gathering required medical documentation from your providers.
- Preparing a detailed explanation of why the treatment is medically necessary.
- Submitting the appeal to Magellan, ensuring all forms and documents are properly completed.
3. Submitting a Provider Dispute
We may file a provider dispute with Magellan’s Provider Dispute Resolution Mechanism for more complex cases. This includes:
- Filing a written dispute outlining the issue with the original claim.
- Providing essential details such as the original claim number, date of service, and reasons for reconsideration.
- Supporting the dispute with medical records and any additional documentation to reinforce your case.
4. Communication and Follow-Up
Key Healthcare will:
- Actively follow up with Magellan to track the status of your dispute.
- Keep you informed at every stage, so you know the progress of your appeal.
- Handle all communication with Magellan to ensure a timely resolution.
5. Final Resolution
- Acknowledgment: Magellan will acknowledge receipt of our dispute within 15 business days.
- Final Decision: Typically, a final determination is made within 45 business days of receiving the dispute. We will inform you as soon as the decision is made.
- Request for Additional Information: If Magellan requests further information, we will promptly provide the necessary documents and continue working toward resolution.
6. Office Addresses for Provider Dispute Submissions
For your convenience, below are the office addresses for submitting disputes based on the plan associated with the service:
Blue Shield of California
Mailing Address
Blue Shield of California
Mental Health Service Administrator
P.O. Box 719002
San Diego, CA 92171-9002
Customer Service Contacts
- DMHC and DOI Plans: 1-877-263-9952
- ASO BSC Buy-Up Product Plans: 1-800-378-1109
- CalPERS Plan: 1-866-505-3409
- City and County of San Francisco Plan: 1-866-830-0328
- Medicare Advantage Plan: 1-800-985-2398
Positive Healthcare
Medicare Provider Claims Disputes
Magellan Health
P.O. Box 1718
Maryland Heights, MO 63043
Medicaid Provider Claims Disputes
PHC California
P.O. Box 46160
Los Angeles, CA 90046
Customer Service: 1-800-480-4464
Kaiser Permanente (Northern Region)
Mailing Address
Magellan Health
P.O. Box 710430
San Diego, CA 92171
Customer Service: 1-800-327-5479
Fax: 1-888-656-4099
Health Plan of San Mateo
Mailing Address
Health Plan of San Mateo Provider Dispute Resolution Unit
P.O. Box 710520
San Diego, CA 92171
Customer Service: 1-800-327-5479
Fax: 1-888-656-4099
6. Assistance with Future Claims
To prevent future denials, Key Healthcare ensures:
- Pre-authorization is obtained for all necessary treatments.
- Accurate claims submission with complete and correct information to minimize the risk of denials.
Out-of-pocket costs and Deductibles
Magellan Insurance covers most services related to teen substance abuse treatment, but it’s essential to be aware of potential out-of-pocket costs, which may include:
- Co-pays for outpatient services, typically between $30 and $50 per session.
- Deductibles, which must be met before insurance begins paying for services. The amount varies depending on your plan.
- Coinsurance: A percentage of the service cost (often 10%–30%) for in-network care.
Key Healthcare provides a detailed breakdown of these costs before treatment begins so you can plan accordingly.
Does Magellan Insurance Cover Telehealth for Teen Substance Abuse Treatment in California?
Magellan covers telehealth services for teen substance abuse treatment. This is particularly useful for outpatient therapy and counseling sessions when in-person visits aren’t possible. Key Healthcare offers telehealth options, allowing your teen to receive high-quality care from the comfort of home.
What are the Exclusions in California's Magellan Insurance Coverage for Teen Substance Abuse Treatment?
While Magellan Insurance provides extensive coverage for most teen substance abuse treatment services in California, it’s important to understand certain exclusions. These may include:
Services that are not authorized or lack medical necessity may be excluded from coverage. Providers must inform members of their financial responsibility in advance, through a signed waiver.
The document contains important information regarding financial responsibility for patients receiving substance abuse treatment under Magellan Insurance in California. Here are the key takeaways related to substance abuse treatment from the document:
1. Financial Responsibility for Non-Covered Services
- Patients cannot be billed for services beyond applicable copayments, deductibles, or coinsurance unless Magellan denies authorization for a service.
- If a service is denied, the provider must obtain written consent from the patient and acknowledge financial responsibility before delivering non-covered services.
2. Patient Acknowledgment and Consent
- For non-covered services, a patient must sign a Financial Waiver form that acknowledges:
- They understand the denial.
- They are aware of their rights to appeal the decision.
- They have been informed of the cost of non-covered services and agree to be financially responsible.
3. Appeal Rights
- Patients have the right to file an appeal if services are denied. This includes:
- Filing a grievance through Magellan’s appeal process.
- Submitting an Independent Medical Review (IMR) with the California Department of Managed Health Care (DMHC).
4. Prohibited Practices
- Providers are prohibited from billing patients for services beyond what Magellan authorizes, except where a written waiver has been provided.
- The document emphasizes that billing beyond what is authorized is considered balance billing and is prohibited under California law.
This document outlines the process for managing patient financial responsibility in cases where Magellan denies coverage for certain services. It ensures that patients are fully informed of their rights and responsibilities, and providers must follow specific procedures to obtain consent for non-covered services.
Get Started Today
At Key Healthcare, we’re dedicated to helping your teen recover and thrive. With our support, you can confidently navigate your Magellan Insurance coverage and ensure your teen receives the highest standard of care. Contact us today to start the insurance verification process or to learn more about our treatment programs.
