Health Plan of Nevada Coverage for Rehab in Las Vegas

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Health Plan of Nevada (HPN) is one of the oldest health maintenance organizations (HMO) in the state.1 With over 2,200 in-network doctors, specialists, and health professionals, Health Plan of Nevada may be able to help eligible plan members cover some or all of the cost of substance abuse treatment.1

Substance use disorders—addiction to drugs and/or alcohol—are highly prevalent in Nevada. In 2019, 10.2% of Nevadans have alcohol use disorder and 8.3% have illicit drug use disorder.2 This is a crisis and should not be ignored—substance abuse leads to problems for individuals, families, and communities, as addiction can lead to higher rates of chronic illness and premature death.2

If you or your loved one are struggling with substance use disorder, help is available. 69 of the 106 Nevada substance abuse treatment facilities accept some type of private insurance.13 Understanding the benefits of your Health Plan of Nevada insurance, how to use these benefits to cover the cost of treatment, and how to find rehabs in the state that work with Health Plan of Nevada can help you begin your journey to recovery.

Does Health Plan of Nevada Cover Rehab in Las Vegas?

Health Plan of Nevada’s insurance plans may be able to cover some or all of the cost of substance abuse rehab in the state.3 The Affordable Care Act (ACA) mandates that all health insurance plans, including those offered by Health Plan of Nevada, provide some degree of coverage for the treatment of behavioral and mental health disorders.4 Under the ACA, treatments for mental health conditions and substance use disorders are essential benefits and must be covered for members holding private insurance plans, such as HPN plans.4

The amount of coverage for addiction treatments with your HPN plan depends on the specific plan you have. For example, some plans have higher deductibles that must be reached before coverage kicks in, and you may be responsible for paying co-pays when accessing care. It’s important to speak with your Health Plan of Nevada representative to determine your coverage and costs.

Types of Rehab Covered by Health Plan of Nevada

What treatments you receive will depend on what’s covered by your Health Plan of Nevada and what your medical needs are. Some common treatments you may encounter include:5

  • Medication-assisted detoxification. The process of removing substances from the body, detox is usually done as a precursor to more intensive inpatient treatment. Detox may be accompanied by withdrawal symptoms that can range from mild to severe and potentially life-threatening. As a result, many may find medical detox with 24/7 supervision to be the safe option.
  • Inpatient/residential rehab. During inpatient treatment patients will live at the treatment facility 24/7 for a set period of time (e.g., 3 months), where intensive support, structure, and counseling is provided until treatment is completed. Inpatient programs tend to take place in hospitals and can last a few weeks to a month. Residential programs tend to take place in rehab facilities and can last a few months to a year.
  • Outpatient treatment. Often considered a follow-up to a more intensive inpatient treatment, outpatient programs allow you to live at home while receiving care. This means that you’ll be able to participate in daily life activities, like school or work, while still receiving substance abuse treatment.
  • Aftercare/sober living. If you’ve completed inpatient or outpatient rehab, aftercare and/or sober living facilities are an option that allow you to access ongoing support and structure before fully integrating back into your community.
  • Co-occurring disorders/mental health. Many rehab facilities offer treatment for individuals with substance use disorder and co-occurring mental health conditions, commonly known as dual diagnosis treatment.7

How to Check Your Health Plan of Nevada Benefit Coverage

Knowing what your plan covers can help you prepare for any out-of-pocket expenses you may have when accessing addiction treatments. There are a variety of ways to check your Health Plan of Nevada benefit coverage, including:

  • Call the number on the back of your insurance card.
  • Log in to the member portal.
  • Check with the rehab facility.

American Addiction Centers (AAC) accepts Health Plan of Nevada 

Check your insurance coverage or text us your questions to learn more about treatment by American Addiction Centers (AAC).

 How to Use Health Plan of Nevada to Pay For Rehab in Las Vegas

There are a few key steps you may need to take to begin using your Health Plan of Nevada to pay for rehab treatment. While Health Plan of Nevada generally doesn’t need patients to have a referral to access treatment, you may need pre-authorization.5 In particular, you may need prior authorization from your healthcare provider for intensive services, such as day treatment, intensive outpatient programs, residential (inpatient) programs, or partial hospitalization programs.5 It’s important to reach out to your HPN representative and to any prospective rehab facility to coordinate pre-authorization before committing to treatment.

Do I Have to Choose an In-Network Rehab Center To Use Health Plan of Nevada?

To get the most out of your Health Plan of Nevada benefits, you may need to attend an in-network rehab facility. When you choose an in-network rehab facility, this generally means you will have fewer out-of-pocket costs for treatment. However, you will be responsible for paying your plan’s deductible and any co-pays.

Health Plan of Nevada does not cover out-of-network services unless it is specifically stated in your Schedule of Benefits.8 If you access addiction treatment out-of-network, you may be responsible for the full cost of any services and treatments you receive.8

Health Plan of Nevada Insurance Plans

As a Health Plan of Nevada member, you have the choice between two types of plans:9

Health Maintenance Organization (HMO). With an HMO plan, you must choose a primary care provider and stay within the HPN network when accessing care (including doctors, urgent care centers, hospitals). You must get a referral from your primary care provider in order to see any specialists with an HMO plan.

Within HMO plans, you can choose between different levels of coverage, including:10

  • Gold. Gold plans are ideal for those who want to reduce out-of-pocket expenses. Higher premiums, but these plans cover 80% of all healthcare costs once the deductible is met.
  • Silver. For those who want to balance the monthly premium and out-of-pocket health costs. With moderately priced premiums, these plans cover 70% of all healthcare costs once the deductible is met.
  • Bronze. With the lowest monthly premiums and higher out-of-pocket costs, bronze plans cover 60% of all healthcare costs once the deductible is met.

Point-of-Service (POS). Designed to offer flexibility, POS plans are based on three tiers that members can choose from:9

  • Tier 1 (HMO). Visit your primary care provider and get referrals for specialists. This option has the lowest out-of-pocket costs.
  • Tier 2 (PPO). You can see specialists or doctors in any network without a referral from your primary care provider. These plans require members to share more of the costs, including co-insurance, co-payments, and deductibles.
  • Tier 3 (Out-of-network). You can visit any licensed healthcare provider, hospital or treatment facility. However, you must pay for all costs at the time of service and file claims for reimbursement through HPN. You must also meet a deductible and will have higher co-insurance costs.

For most HPN plans, you will pay more money if you see a provider out-of-network. In some cases, you may have to pay all of the costs if you do not stay in-network.

Does Health Plan of Nevada Offer Medicare and Medicaid?

Health Plan of Nevada offers Medicaid plans.11 The company also offers dual health plans for people with Medicare and Medicaid.11 HPN has been serving Medicaid members since 1997.11 Health Plan of Nevada Medicaid provides unlimited doctor visits and unlimited prescription drugs and over-the-counter medications to members.11

While Health Plan of Nevada doesn’t offer Medicare plans, its parent company, United Healthcare, does offer Medicare plans for eligible individuals.12

Finding Rehab Centers That Accept Health Plan of Nevada

Once you’ve decided to attend rehab, the next important part of the process is finding a facility in Nevada that can meet your needs. One of the best ways to find a facility that takes your insurance would be to reach out to your doctor. They can work with you to determine your treatment needs and may be able to refer you to in-network facilities. It’s also a good idea to reach out to your Health Plan of Nevada representative to check your coverage and see what facilities are in-network. You may also consider visiting SAMHSA’s treatment locator.

You may also be able to reach out to an addiction helpline. Many helplines, like the one operated by American Addiction Centers, have staff available 24/7 to discuss the rehab process. They may also be able to help you find treatment centers in Nevada. American Addiction Centers operates one such treatment center: Desert Hope is a rehab located in Las Vegas, Nevada, that offers a full continuum of care and evidence-based treatment for substance abuse and co-occurring mental health disorders.

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