Does 1199SEIU Fund insurance cover Alcohol and Drug Rehab or Detox?

If you or a loved one are struggling with alcohol or drug addiction, you may be wondering how to get help. For many, attending a drug or alcohol rehab program is the next logical step toward recovery, but it can come at a cost. Fortunately, many health insurance plans, including the 1199SEIU Fund, may provide coverage in some capacity for substance use disorder treatment, including rehab for alcohol and drug addiction.

Rehab centers can help you check your coverage based on the information that you provide them. You can also call the number on the back of your insurance card to learn more about the plan you have, including various coverage details. Whenever possible, it’s recommended that you verify your benefits and coverage to help keep your healthcare costs as low as possible.

What is 1199SEIU Fund?

While they are not specifically a health insurance company, the 1199SEIU Funds are a labor-management fund that specific working and retired healthcare workers from certain states are eligible to use.¹ These funds provide quality health, training, educational, and childcare benefits, as well as job security and monthly pensions upon retirement, at little to no cost to eligible workers and their dependents.¹

The fund dates back to 1945, when it was known as the Local 1199 Benefit Plan that was set up to provide NYC retail drugstore workers with various health and life benefits.² By 1948, the plan grew into a self-insured and administrated fund. Flash-forward to today and more than 450,000 people are covered by the fund, including people from Florida, the Maryland and DC area, Massachusetts, the New York City and Long Island area, and upstate New York.^{1, “Health Benefits” and “Find Your Benefits”}

Specifically, over 200,000 1119SEIU Fund members receive comprehensive healthcare coverage, which may include alcohol and drug rehab costs.^{1, “Health Benefits”} Coverage may extend to alcohol and drug rehab costs.

What will 1199SEIU Fund insurance cover?

The benefits provided to you under the 1199SEIU Fund may vary. This means that your benefits may include coverage for a variety of healthcare services and potentially include substance use disorder treatments. Your healthcare provider can help you determine whether any of the following 4 common addiction treatments may be beneficial for you on your addiction treatment journey:

• Inpatient or residential rehab. Patients who are in residential or inpatient rehab will live at the facility where they’re receiving care for the duration of their rehab program. Here, they’ll receive round-the-clock medical supervision and care, which could include detox. ^{3, Pg 8, “What types of treatment programs are available?” Para 2}
• Outpatient rehab or therapy. Patients who are in outpatient rehab or therapy will receive treatment 1 or 2 times a week or potentially less frequently. They’ll travel to a facility, receive their care, and return home after the session is over.^{3, Pg 10, Para 2}
• Intensive outpatient programs (IOP). Patients who are in IOPs receive more structured outpatient care than those who are in a standard outpatient rehab program. You’ll typically be required to attend a minimum number of hours of treatment per week but will not stay overnight in an IOP.^{3, Pg 10, Para 3}
• Partial hospitalization programs (PHP). Patients enrolled in a PHP, which is commonly known as a day program, travel to a facility and receive care for 4–8 hours per day, multiple days a week, but return home after the session is completed.^{3, Pg 10, Para 1}

Please remember that even though these treatments are listed here, they may not be recommended for your situation. Similarly, they may not be fully or partially covered under your 1199SEIU Fund health benefits. Be sure to call a plan representative to verify your benefits before seeking care whenever possible.

Does 1199SEIU Fund Insurance Cover Mental Health Treatment Facilities?

In the United States, the Affordable Care Act (ACA) requires almost all health insurance plans to provide some level of coverage for mental and behavioral health services, which may include services rendered at mental health treatment facilities.⁴ However, because the 1199SEIU Fund isn’t a health insurance company per se, but rather a fund that provides health benefits, it may not be federally mandated to provide such coverage. However, your health benefits may still provide coverage for treatment, including stand-alone heroin rehab and co-occurring disorder treatment.

A co-occurring disorder involves someone having both a substance use disorder and mental illness at the same time.⁵ While it’s not believed that having one directly causes the other, it’s believed that having one makes it twice as likely that you’ll develop the other at some point in your lifetime.⁶ Consequently, it’s recommended that those with co-occurring disorder treatment undergo tandem treatment, where each condition is treated simultaneously in rehab.⁶

How Long Does 1199SEIU Fund Insurance Cover Rehab?

The length of time that your 1199SEIU Fund health benefits may cover rehab will depend on the type of plan you have and where you seek care. Every health benefit plan is different, which is why it’s so important for you to check your benefits before seeking care. You can do this by looking up your plan’s information on your insurance card or by calling the number on the back of the card to speak with a plan representative.

Regardless of your plan’s coverage details, it’s important to listen to the treatment plan and advice your doctor has provided you. Every person is unique, and some patients may need to be in rehab for longer or shorter periods of time, but, generally speaking, longer treatment times are considered to be most effective. Experts agree that treatment times should be at least 90 days to improve overall outcomes. ^{7, bullet 5} Because every person’s situation is unique and every plan is different, please work with your insurance company and doctor to determine what’s right for you.

What if my 1199SEIU Fund policy does not cover rehab?

If your 1199SEIU Fund doesn’t cover the costs associated with rehab, you may be responsible for paying for these costs on your own. That said, depending on the rehab center you choose to attend, there may be financing or scholarship options available to you. Be sure to ask the rehab center whether any of these options are available to you. Remember, getting the treatment you need right now is critical rather than pushing it down the road.

1199SEIU Fund In Network vs. Out of Network Rehab Centers

When you’re seeking out care at a rehab center, it’s important to make sure you find an in-network provider, or a provider that participates in your 1199SEIU Fund health benefits.⁸ If you see an out-of-network provider, you may be fully responsible for the costs of your care, which can result in high out-of-pocket costs.⁸ To find an in-network provider, 1199SEIU recommends you contact Member Services at 646-473-9200.⁸

1199SEIU Fund Plans

There are a total of 6 different health benefits that may be available to you through your Fund.⁹ Please note, each plan may offer different levels of mental and behavioral health coverage. Be sure to check your plan card to find out what plan you have.

• 1199SEIU National Benefit Fund. Under this benefit type, you may receive alcohol, substance use, and mental health coverage. Therapy via in-person, phone or online talk services may also be covered under this plan type as long as it’s done through Teladoc or with an in-network provider.¹⁰ Finally, PHPs and inpatient rehab and detox may also be covered services. ¹⁰
• 1199SEIU National Benefit Fund for Rochester Members. Under this benefit type, there may also be a variety of mental and behavioral health services covered. It’s recommended that eligible enrollees review their SPD to double-check which addiction treatment services are covered.¹¹
• 119SEIU Greater New York Benefit Fund. Under this benefit type, members may be able to receive coverage for various inpatient and outpatient mental health services at no additional cost.^{12, pg. 4} However, this is applicable only if you see an in-network provider. Seeing an out-of-network provider may result in you having to pay whatever the provider charges.^{12, pg. 4}
• 119SEIU Greater New York for New Jersey Fund. Under this benefit plan, members may have to pay a $10 copay per visit for outpatient services and a 15% coinsurance for inpatient services but may receive full coverage after these costs.^{13, pg. 4} However, prior authorization is required for non-emergency rehab admissions, as well as PHP and IOP services, so be sure to check with the plan representative before seeking care whenever possible.^{13, pg. 4}
• 1199SEIU National Benefit Fund for Home Care Employees. Under this Fund type, there are 2 types of plans:
  • 1199SEIU National Benefit Fund for Home Care Employees – Plan A. With this plan type, members may be able to receive their needed mental health services, including substance use treatment, from in-network providers at no charge, but prior authorization is required for non-emergency rehab admissions, as well as PHP and IOP.^{14, pg. 4}
  • 1199SEIU National Benefit Fund for Home Care Employees – Plan B. With this plan type, members may receive mental health services, including substance use treatment, from in-network providers at no charge for outpatient services and a $25 copay for inpatient services, subject to prior authorization is required for non-emergency rehab admissions, as well as PHP and IOP.^{15, pg. 4}
• 1199SEIU Licensed Practical Nurses Welfare Fund. Under this plan type, no mental health coverage is provided to members.^{16, pg. 4}

Check 1199SEIU Insurance Coverage for Rehab

Checking your plan for rehab coverage doesn’t need to be complex. The team at American Addiction Centers, an industry leader in addiction care, is here to help. Call our confidential helpline today to speak with a real person who can check your benefits for you right while you’re on the phone. If you’d prefer to quickly check your benefits on your own online, enter your insurance information into the form below and see whether your 1199SEIU Fund provides coverage for addiction treatment.

Don’t delay getting treatment any longer, call us today to find out how you can get started.