QualCare Detox & Rehab Benefits Guide

QualCare Detox & Rehab Benefits Guide

Acquired by Cigna in 2015, QualCare Insurance is a private insurance company that offers the same set of products and services as it did before the acquisition.1 QualCare offers individual and group health plans, workers’ compensation insurance, and third-party administration. The company is headquartered in Piscataway, New Jersey, and serves over 900,000 members. The insurance company’s network includes over 100 specialty, acute, and rehab hospitals and over 40,000 other providers throughout New Jersey, Pennsylvania, and New York.2

Does health insurance cover detox? Yes. The plans offered by QualCare provide insurance coverage for rehab, detox, and addiction treatment. This article will help you understand how drug rehab insurance coverage works, QualCare detox coverage, and how you can use your QualCare insurance to start on your path to sobriety.

Does QualCare Cover Detox?

You may be wondering, is detox covered by insurance? Does QualCare cover therapy? Today, under the Affordable Care Act (ACA), all long-term insurance plans are required to include some level of coverage for mental health and substance abuse. The law considers this coverage an essential benefit.4 In addition, the ACA includes mandatory coverage for behavioral health treatment such as counseling and psychotherapy. That means your QualCare rehab insurance coverage includes therapy. What’s more, insurance companies cannot charge you more or deny you coverage if your addiction is a pre-existing condition. They also cannot set spending limits—annual or lifetime—on your substance abuse treatment.

The ACA requires that all addiction treatment coverage be treated the same as medical coverage. That means that the deductibles and copayments you’ll be charged cannot be more than you would have for a medical procedure. The same percentage of costs should be covered for both types of care.

If you’re concerned about the cost of copayments and deductibles, your rehab facility may have payment plans or aid available. If you’re curious about how to get into detox without insurance, you’ll want to contact the facility directly. They may be able to set up a payment plan or make other arrangements for you.

Before you commit to a treatment facility using your QualCare insurance, be sure you note whether the center is within the treatment network. You might struggle to find QualCare out-of-state coverage if you have one of the less expensive, network-only policies.

In the end, your insurance provider has the final say in what coverage you receive, what treatment facilities are in-network, and how much coverage is available. Be sure to contact QualCare directly to verify coverage before you commit to a program.

Check Your QualCare Benefits

There are several ways to find out more about your QualCare benefits. If you receive insurance coverage through your employer, you can contact your human resources department for information about specific coverage. They may be able to give you a phone number to contact the company directly.

You can also review your insurance coverage online. The My QualCare website5 allows members to log in and view their insurance information. You’ll see your recent insurance claims, plan information, premium, and more.

My QualCare also gives you access to provider information, allowing you to find a doctor or a hospital within the network.

Finally, you can also contact the company directly. Simply call 1-888-935-1318 anytime between 8 am and 6 pm EST Monday through Friday. The customer service representatives will be happy to discuss your insurance plan and give you information about your substance abuse treatment options.

 

Types of QualCare Insurance Plans

If you’re curious about QualCare drug rehab coverage, you’ll need to understand what kind of insurance plan you have.

What does QualCare cover? They offer several types of health insurance.3

  1. Open Access Plan: You coordinate your own care and do not need a primary care physician (PCP) or referrals. If you stay within the provider network, you’ll have most of your costs covered. However, you can also use out-of-network providers—you’ll just pay a higher deductible or copayment. You may need pre-authorization for some services.
  2. Point-of-Service (POS) plan: members use a PCP to coordinate their medical care. They can use both in-network and out-of-network providers, but out-of-network care is much more expensive.
  3. Health Maintenance Organization (HMO): plan requires a PCP as well. You need referrals to see specialists and you’ll have to stick with in-network providers. While this plan is a bit more restrictive, the monthly premiums are much less expensive.
  4. Preferred Provider Organization (PPO) plan. This type of coverage has the most options and tends to cost more in monthly premiums. You pay less for in-network providers, but you can see out-of-network doctors if you’re willing to pay higher deductibles and copayments. You do not have to have a PCP, but you might need preauthorization for specific types of care.

QualCare does not offer Medicare or Medicaid plans directly, but you might be able to get that type of coverage from other Cigna subsidiaries.

QualCare at American Addiction Centers

Everyone who makes the courageous decision to pursue sobriety needs help to succeed. We’re here to provide that assistance. At American Addiction Centers, we’re proud to offer a large nationwide network of treatment options. Our providers offer the highest quality of care and use the latest effective treatment programs.

We are proud of our strong relationships with insurers, including QualCare. If you have QualCare insurance and are ready to start on the path to a new life of freedom from addiction, reach out to us today. You can contact us at 1-888-935-1318.

  1. QualCare Inc. (2015). Cigna to acquire New Jersey-based QualCare Alliance Networks, Inc.
  2. QualCare Inc. (2016). About.
  3. QualCare Inc. (2016). Health plans.
  4. Healthcare.gov. Mental health & substance abuse coverage.
  5. QualCare Inc. (2016). My QualCare member login.