Everyone should be able to receive addiction treatment if they need it. Unfortunately, addiction treatment costs money. Luckily though, the Affordable Care Act (ACA) requires that individuals receive just as much coverage for addiction treatment as they do for any other medical issue. One insurance company that caters to individuals that suffer from behavioral health disorders is Exclusive Care Insurance.
What is Exclusive Care Insurance?
Exclusive Care insurance is a health insurance company that’s made just for Riverside County, CA employees, retirees, and their families along with other qualified contracted employer groups. There are also various Exclusive Care insurance out-of-area dependent plans and retiree plans.
All Riverside County employees, dependents, and contracted employer groups can enroll and start taking advantage of Exclusive Care insurance as long as they’ve met their employer’s eligibility criteria. The Exclusive Care insurance company’s benefits, coverage, and plan limits differ based on if it’s an in-area or out-of-area plan.
Exclusive Care insurance offers quality services for the lowest out-of-pocket prices. Most Exclusive Care insurance services also require little co-payment.
Exclusive Care insurance plans typically include extensive coverage for healthcare needs. Examples of healthcare needs that Exclusive Care insurance plans will likely cover the cost of include specialty services, hospitalizations, preventative care, and prescription drugs.
Exclusive Care insurance contains an Exclusive Provider Organization (EPO) network that consists of Riverside County hospitals, medical groups, and physicians.
How Exclusive Care Insurance Works
Exclusive Care insurance operates by requiring all of its members to select a primary care provider (PCP). Exclusive Care insurance members that don’t select their own primary care providers will be assigned one.
Having a primary care provider is important as an Exclusive Care insurance member. This is because primary care providers can make multiple serious decisions on a person’s behalf. For example, an Exclusive Care insurance member’s primary care provider will coordinate and provide members with medical services that meet their needs.
PCPs will also make specialty care requests to Exclusive Care insurance on their members’ behalf. Some Exclusive Care PCPs will even determine whether or not a person needs lab or radiology work.
All new Exclusive Care insurance members will receive a benefit election/open enrollment form along with a new enrollment packet that must be filled out. Once new Exclusive Care insurance members fill those out and pick their PCPs, they will receive identification cards. After that, there is no additional paperwork to fill out.
Things to Know When Selecting a Primary Care Provider
Primary care providers have a large amount of influence on Exclusive Care members. As a result, it’s important to select the right primary care provider.
The right PCP is within a 30-mile radius of a person’s primary residence or workplace. Note that individual Exclusive Care insurance members within a family are allowed to choose different primary care physicians if they want to.
Individuals with PCPs that leave the Exclusive Care insurance network must choose a new PCP, though. Individuals with PCPs that are no longer accepting new patients must also select new PCPs.
In-Network Healthcare Providers vs. Out-of-Network Healthcare Providers
All healthcare providers are either in an insurance company’s network or out of an insurance company’s network. Healthcare providers that are in-network with an insurance company have a contract with that insurance company. The contract requires healthcare providers to accept more coverage from the insurance company’s members when they are seeking care at their healthcare facilities. In exchange, the insurance company gives out referrals to the healthcare provider’s facilities.
Out-of-network healthcare providers don’t have a contract with that particular insurance company. Therefore, they don’t accept higher amounts of coverage from the insurance company’s members. This also means that out-of-network healthcare providers don’t receive referrals from that particular insurance company.
To reap all the benefits of Exclusive Care health insurance, members should receive healthcare at facilities that are within the insurance company’s network. Luckily, Florida Center for Recovery is within Exclusive Care insurance’s network.
Types of Health Insurance Plans
Not all health insurance plans are created equal. This is because there are different types of health insurance plans. The primary types of health insurance plans are health maintenance organizations plans, preferred provider organizations plans, and point-of-service plans.
Health Maintenance Organizations (HMOs)
Health maintenance organizations, or HMO, plans are health insurance plans that require members to receive care at healthcare providers that are within the insurance company’s network. Otherwise, insurance company members with HMO plans won’t receive insurance coverage to pay for their healthcare.
Preferred Provider Organizations (PPOs)
Preferred provider organizations (PPO) plans are health insurance plans that will cover some of the cost of care that’s received at an out-of-network healthcare. On top of this, PPOs also provide coverage for in-network healthcare providers. Because PPO plans cover some of the cost of healthcare at out-of-network healthcare facilities, they’re considered more flexible than HMOs.
Point-of-service (POS) health insurance plans have some HMO plan traits and some PPO plan traits. POS plans are similar to PPO plans in that they are also flexible. In fact, POS plans are more flexible than both HMO and PPO plans when it comes to covering the cost of care at out-of-network healthcare facilities.
In exchange, POS plans require its members to fill out more paperwork than both HMOs and PPOs. A primary care physician must also refer members of POS plans to other healthcare providers to receive care.
Important Health Insurance Terms
Whether a person has Exclusive Care health insurance or some other form of health insurance, that person needs to understand basic health insurance terminology. Some important health insurance terms include the following:
A health insurance premium is the amount of money that a person pays each month for health insurance.
Deductibles refer to the amount of money that individuals must pay out-of-pocket before insurance kicks in. If a health insurance plan has a high deductible, it likely has a low premium and vice versa.
Copays and Coinsurance
Copay is the set amount of money that people must pay for healthcare and medications. Coinsurance is the percentage of the cost of care that’s left to pay after the deductible is met.
Exclusive Care Insurance Coverage for Addiction Treatment
Exclusive Care insurance covers the cost of most addiction treatment programs. This is especially true if a person is receiving addiction treatment at a rehab facility that’s within Exclusive Care’s network, like Florida Center for Recovery. Below are some of the key forms of addiction treatment that Exclusive Care insurance will likely provide coverage for.
Medical detox is the process of ridding the body of toxins in a professional detox facility with the supervision of physicians and a medical team. Detox usually requires the supervision of physicians and a medical team because detoxing from substances can cause severe withdrawal symptoms.
If not treated properly, the withdrawal symptoms that detoxing from substances often causes can lead to death. Through medical detox though, doctors can safely prescribe individuals withdrawal medications that will help them manage symptoms.
Because medical detox is a professional healthcare service, it costs money. This is especially true if a person receives medication-assisted treatment during medical detox. Therefore, having healthcare insurance that helps cover the cost of medical detox such as Exclusive Care insurance is highly beneficial.
Once individuals complete detox, they must attend rehab to overcome their addictions. The most intensive form of addiction treatment is inpatient treatment. This is because inpatient treatment requires patients to live in rehab facilities while receiving care. Inpatient treatment also provides patients with 24/7 care and monitoring.
There are two types of inpatient treatment that individuals can attend while in rehab. The first is standard inpatient treatment and the second is residential inpatient treatment.
Both standard inpatient treatment and residential treatment require patients to live in rehab facilities while receiving care. They also both provide patients with 24/7 care and monitoring.
The main difference between the two types of inpatient treatment is that standard inpatient treatment is much more structured than residential treatment. Therefore, residential treatment patients get much more free time to themselves and time to partake in holistic forms of treatment.
Exclusive Care insurance will also likely cover the cost of all types of inpatient treatment at rehab. This is especially true if a person is attending inpatient treatment at a rehab facility that’s within Exclusive Care’s network.
Individuals whose addictions aren’t severe or who can’t take away from life to live in a rehab facility while receiving care can attend outpatient treatment. Outpatient treatment allows patients to live in the comfort of their own homes when not receiving care.
There are three types of outpatient treatment that individuals can attend. The most intensive form of outpatient treatment is partial hospitalization program (PHP) treatment. PHP treatment patients attend rehab for five to eight hours a day, five to seven days a week.
The second most intense form of outpatient treatment is intensive outpatient program (IOP) treatment. IOP treatment patients attend rehab for a few hours a day, a few days a week.
The least intense form of outpatient treatment is standard outpatient program (OP) treatment. OP treatment patients attend rehab for a couple of hours a day, once or twice a week.
Benefits of Outpatient Treatment
One major benefit of receiving outpatient treatment for addiction is that it’s much less expensive than inpatient treatment. Therefore, the amount of money that a person will need from his or her health insurance to pay for outpatient treatment is much less than what that person would need to pay for inpatient treatment.
Contact Exclusive Care to see how much coverage the insurance company will provide for outpatient treatment. The amount of coverage that Exclusive Care will provide will depend on the type of outpatient treatment program and the type of insurance plan that an individual has.
Use Exclusive Care Insurance to Receive Addiction Treatment At Florida Center for Recovery Today
Florida Center for Recovery is a renowned addiction treatment center that’s within Exclusive Care insurance’s network. Therefore, Exclusive Care insurance members can receive more coverage for addiction treatment while receiving care at Florida Center for Recovery.
Here at Florida Center for Recovery, we’ve worked hard to provide the most effective addiction treatment to our patients. As a result, our drug and alcohol programs are the most comprehensive models in the U.S. Our addiction treatment programs here at Florida Center for Recovery are all science-based. Florida Center for Recovery addiction treatment programs also offer both traditional and alternative forms of therapy.
To learn more about Florida Center for Recovery and the various addiction treatment programs, therapies, and services that we offer, contact us today! Also, feel free to contact us to verify your insurance or ask any questions pertaining to the amount of coverage that you’ll receive through your health insurance.