Medica Insurance Coverage for Drug & Alcohol Rehab
NOTICE: Step One Rehab works hard to make sure our information is accurate. Due to constant changes in insurance company policies, we suggest you contact your insurance company with your member ID for any policy questions. This FAQ is only intended as a guide to point you in the right direction.
Medica Drug and Alcohol Rehab Coverage – FAQ
Where does Medica Operate?
Medica operates mainly in Iowa, Kansas, Minnesota, Nebraska, North Dakota and western Wisconsin.
Does Medica Cover Rehab?
Medica usually will cover drug rehab as part of their Behavioral Health Program. They base coverage on a number of factors which vary based on your plan. Medica offers a host of individual medical plans for health insurance.
What Medica Plans can I get?
Common Medica Plans for individuals and families are as follows:
- Medica Altru Prime
- Medica Inspiration Health
- Medica Applause
- Medica Connect
- Medica Individual Choice
- Medica Insure
- Medica with Mayo Clinic
- North Memorial Acclaim by Medica
Each plan is available in only specific areas, and has their own policies. Click a link above to learn more.
Medica also has Medicare based plans (they are not the same entity).
Verify Benefits / 100% Confidential
What does Medica Insurance Cover?
Medica coverage varies based on your plan. You are responsible for whatever they do not cover. If your plan has a deductible, you have to pay the deductible amount before your insurance coverage takes over.
Most Medica plans have coverage for the following:
Intensive outpatient programs (IOP)
Various mental health and behavioral health programs
To manage your Medica plan, or learn more about it, you can visit MyMedica’s Website. They also have a mobile app.
Medica Customer Service Hours are:
Monday – Friday:
7AM – 8PM.
(closed Thursdays 8 – 9AM)
9AM. – 3PM
How Long will Medica Cover Addiction Treatment?
Medica coverage length varies. We are happy to verify length of coverage for you.
Are out of network providers allowed with Medica?
It depends on your plan. For an example, you can view a list of in-network behavioral health providers for the Altru Prime Plan here.
Contact Medica to confirm your level of coverage, if any, for out-of-network providers.
Does Medica Allow for Treatment at Luxury Rehab Facilities?
They may allow you to go to a luxury or private rehab. It depends upon your plan. Luxury (private) drug rehabs are often where wealthy people and celebrities will go for addiction help. They are often as nice as any hotel or resort you may use for a vacation spot. They usually have massages, acupuncture, hot-tubs, pools, and quality dining, in addition to other exclusive privileges.
Inpatient Addiction Treatment vs. Outpatient Treatment
This is one of the biggest and most important choices that a patient or their family will make when looking for addiction help. Where you go, and what you do from here on matters and can determine your level of success.
Both options are better than not seeking treatment and could save your life. They each have their own strengths and weaknesses.
An outpatient facility is usually a local option. They give you the chance to meet with medical professionals like doctors, alcohol and drug counselors, or therapists, attend group sessions, and go to recovery meetings while being able to head home afterwards. Co-pays may be required for each visit.
Inpatient facilities, also called residential programs, are most often 28 day programs. They provide structure and are typically remote destinations where you stay in the facility for the duration of the program.
Do I need Insurance to go to Rehab?
You are not required to have insurance to get addiction treatment. However, without insurance, the cost of drug rehab facilities is usually very expensive and impractical for most people. You would need to pay out of pocket. You can certainly pay with a credit or debit card, work out a payment plan, or use other methods that each facility accepts.
Typical inpatient rehabs may cost anywhere from $6,000-$20,000 for a 28 day program.
Outpatient Rehab can range from $4,000-$10,000 for 90 days. The cost of outpatient rehab will vary and is mostly based on how many visits are made.
How does Medica Decide my Claim?
Medica makes decisions about their coverage based on your health plan. Each claim decision is reviewed on a case by case basis and varies by state. In general, Medica will look at services you use. They then follow national guidelines and other policies to determine if you’re covered. Services that may be covered can include drug addiction rehab, blood-tests, surgeries, or hospital stays.
For drug treatment, you will need a doctor’s evaluation and recommendation, and you may need prior approval from Medica.
If your claim is denied, Medica will notify you. You DO have the right to appeal. To start an appeal with Medica, call their Member Services number on your Medica ID card. They typically allow 180 days from the date of the initial payment or denial notice to file. If Member Services doesn’t resolve your issue, ask for an appeal.
All Medica appeals are responded to compliance with state, federal and NCQA guidelines. It is possible to get appeals expedited.
Follow this link to see more about Medica’s Appeal Process and member responsibilities.
What Else does Medica Provide?
Medica has a host of health, wellness options, and discounts
A variety of plans and the ability to manage and adjust your plan.
Per HIPAA laws, anything that you say is kept confidential. You don’t have to worry about anyone knowing you may have trouble with alcohol or drugs.
Get an Approved Medica Drug and Alcohol Rehab
Verifying what insurance will cover can be a time-consuming process. This hassle usually involves lots of waiting and multi phone calls back and forth. Our knowledgeable staff can verify your coverage for you and take the stress and annoyance out of this already difficult time. You have enough to worry about already. Verifying insurance coverage for rehab shouldn’t be an additional burden.
Instead, give us a call now and let us handle this step, at no cost to you! We are totally confidential. Our number is 877-348-7494