Drug And Alcohol Rehabs That Accept Neighborhood Health Plan

Medically reviewed by

Dr. Gerardo Sison

April 1, 2019

Neighborhood Health Plan offers comprehensive coverage plans to individuals, families, and employers, covering nearly half a million individuals in Massachusetts. Their coverage includes behavioral health services such as drug and alcohol addiction treatment, making the diverse treatment goals of people in need more attainable.

Learn More About Neighborhood Health Plan

Neighborhood Health Plan is an NCQA-accredited member of Partners HealthCare and is a not-for-profit health plan. As of 2016, NHP had 448,000 members who “have access to a robust network of top doctors, community health centers, and academic and regional hospitals.” This includes over 4,900 primary care physicians (PCP) and over 13,000 specialists.

According to their website, all individual, family, and small business plans include the ten essential health benefits required by the Affordable Care Act. One of these makes certain that members can obtain mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy.

How Did The Laws Change To Benefit Addiction Treatment?

With the advent of the Affordable Care Act, came changes to the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. These changes expanded the previous measures (which only applied to group health plans) to also include individual health coverage.

When made into law, the legislation behind MHPAEA ensured that individuals can gain access to behavioral healthcare, including addiction treatment, which is consistent with the level of care for medical and surgical matters.

What Coverage Does Neighborhood Health Plan Offer?

Individuals and families can buy commercial or private plans one of two ways, either through a public or private exchange:

Massachusetts Health Connector: In order to receive any applicable subsidies or tax credits a person much purchase their plan through a public exchange called the Massachusetts Health Connector. Here you can buy NHP Prime HMO plans or:

• NHP ConnectorCare plans — are for those individuals and families who qualify for subsidized insurance.
• Zero cost sharing plans for American Indians and Alaska Natives — with incomes up to 300% FPL.

Previously, NHP offered Catastrophic Plans for Individuals and Families; however, they are not currently offered on their site as an option.

Through a preferred partner: If you wish to purchase a Prime HMO Plan on the private exchange, NHP works with two preferred partners, HSA Insurance and Mosaic Insurance.

Both exchanges offers plans with deductibles which begin at zero and then range from low to high. In the zero to low range an individual would have higher monthly premiums due to their lower out-of-pocket expenses. Inversely, those plans with higher deductibles have lower monthly premiums because of the higher out-of-pocket expenses associated with treatment. These are factors you should consider as you review the costs associated with your substance abuse treatment.

In addition to these, NHP covers members through two other types of plans:

NHP Prime for Group Insurance Commission (GIC) Members: As explained by Mass.gov, “The mission of the Group Insurance Commission (GIC) is to provide high-value health insurance and other benefits to state employees, retirees, and their survivors and dependents.”

NHP MassHealth Plans: According to their website, NHP is not currently enrolling new members for MassHealth plans; however, they do note that current MassHealth members will not be affected by this change. According to Mass.gov there are six different type of MassHealth plans.

Does Neighborhood Health Plan Pay For Drug Or Alcohol Addiction Treatment?

In order to better address their member’s behavioral health needs, Neighborhood Health Plan is partnered with Beacon Health Options. Unlike other aspects of HMO coverage, according to NHP’s website, members “do not need a referral from your PCP to seek mental health services.” But—because it is an HMO, out-of-network providers are not covered. Neighborhood Health Plan offers its members outpatient and inpatient (detox or rehab) treatment coverage. The specifics of your coverage are determined by your plan.

In an example, here’s a comparison of two plans at each end of the spectrum in terms of deductible and premium cost:

NHP Prime HMO 25/40 FlexRx 4-Tier (Standard Platinum): This plan has no deductible, but again, the monthly premium will be higher; however, certain out-of-pocket expenses will be less.

• Treatment: Outpatient services are $25 per visit and inpatient treatment (detox or rehab) is $500 copay per admission for the facility fee, with no member cost-sharing for the professional fee. Inpatient treatment may require prior authorization.
• Prescriptions: There is no prescription drug deductible. As an example, all listed Suboxone films (a drug commonly used within opioid addiction treatment and maintenance) are Tier 3, or a preferred brand drug. It may require prior authorization. There is a $30 copay for a 30-day supply and a $60 copay for a 90-day supply.

NHP Prime HMO 3000/6000 25/40 FlexRx 4-Tier (Standard Bronze): While this plan’s premium payment is less, there is a deductible of $2,750, with higher out-of-pocket expenses. You will see this reflected in the cost for treatment.

• Treatment: After the deductible is met, outpatient services are $25 per visit and inpatient treatment (detox or rehab) is $1000 copay per admission for the facility fee, with the professional fee being subject to the deductible. Inpatient treatment may require prior authorization.
• Prescriptions: An individual has to meet an additional $250 deductible for prescription drugs before their copay applies. All listed Suboxone films are $75 after the deductible for a 30-day supply or $150 for a 90-day supply. As a Tier 3 drug, it may require prior authorization.

In certain other plans, outpatient treatment is covered before the deductible is met.

Keep in mind, these are just examples. Your exact member benefits should be explained by a NHP representative, as each plan varies and may have certain limitations on coverage or the services provided.

Supportive And Integrative Supplemental Care

Committed to comprehensive care, Neighborhood Health Plan’s services extend far beyond their coverage. With membership, individuals have access to a variety of programs and resources designed to improve quality of life, including those which focus on disease management, social care, and wellness.

To better support their member’s health needs, including those related to both behavioral health and substance abuse, all new members of NHP receive what they term a “welcome call” or a Health Needs Assessment. If need is determined, members will be directed to NHP’s Care Management Programs, which include various “internal case management programs and/or external community-based programs and resources for assistance.”

Factors To Consider When Looking At Insurance Plans

If you’re considering using Neighborhood Health Plan coverage for your treatment, it is to your benefit to have certain questions prepared prior to speaking to a representative.

The following are questions and concerns which are pertinent to addiction treatment:

• To what extent is substance abuse treatment covered under this plan?
• Can you provide me with a list of treatment centers that accept this insurance for addiction treatment?
• If I need to enroll in inpatient drug rehab, is there a maximum coverage amount per day?
• Is there a cut off for the amount of days inpatient treatment is covered for?
• What are the specific services you do and do not cover during rehabilitation?
• Are medications utilized within treatment covered?
• Does your insurance provide coverage for any aftercare services?

Asking these questions help to ensure that you receive the coverage that best serves your unique needs. Going forward, these also aid you in taking full advantage of the care you are entitled to.

Are There Other Financial Options To Consider?

While you’re looking over your insurance options, take into consideration other financial options or assistance which may be available to supplement your insurance coverage. These may include a variety of scholarships or grants, available either directly from the rehab facility or from a third party; financing; sliding fee scales; assistance from family or friends; or even an Employee Assistance Program (EAP), which is offered through certain employers.

Contact RehabCenter.net Today For Help

If you or a loved one is struggling with an addiction to drugs and/or alcohol and has Neighborhood Health Plan contact us today. We will be able to find the best treatment program that fits your individual needs while minimizing any out-of-pocket expenses.