Does HealthPartners Insurance Cover Rehab?

Published on August 1st, 2013
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Does HealthPartners Cover Rehab?

Healthpartners Insurance works to provide affordable health insurance, enhance the patients experience and to improve the health of the overall population in the Minnesota and Wisconsin area. Members are put first at Health Partners insurance, they provide the tools, information and health care professionals to ensure that each member is able to stay healthy, this includes drug and alcohol addiction treatment services. By offering individuals, group and medicare coverage, Health Partners Insurance is able to reach out to a large group of people from all walks of life and help them to live happy and healthy lives.

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Do all Policies Cover Behavioral Health Services?

Under Healthpartners insurance policy “Behavioral Health” covers chemical health residential services. However, not all Healthpartners plans cover addictions treatment, it is important for members to review their policy documents for their specific coverage information. Healthpartners stresses that there is a difference between general information offered and what is on your personal health insurance plan.

Admissions Requirements

Before entering into a Chemical Dependency program you will require a referral from your primary care Doctor that these services are necessary. All chemical health residential services require a prior authorization, this can be done by the rehab center you choose to enter into or you can do this yourself.

In Minnesota, HealthPartners Care members must have a Rule 25 assessment completed and submitted. Assessments must be submitted on the Minnesota Department of Human Services Rule 25 Universal Assessment form or HealthPartners Chemical Health Authorization Request assessment form. The chemical health assessment will be reviewed by a HealthPartners Quality and Utilization Coordinator and a Board Certified Psychiatrist as needed.

Coverage Requirements

For a member to meet the coverage requirements by Healthpartners, A chemical health assessment must be completed in the last 30 days by a licensed alcohol and drug chemical health professional or comparably licensed professional has been submitted and identifies a need for this particular level of care.

The American Society of Addiction Medicine’s (ASAM) Second Edition -Revised of Patient Placement Criteria (ASAM PPC-2R) is used for coverage determination regarding treatment for this level of care. This provides two sets of guidelines, one for adults and one for adolescents, and five broad levels of care for each group. The levels of care are: Level 0.5, Early Intervention; Level I, Outpatient Treatment; Level II, Intensive Outpatient/Partial Hospitalization; Level III, Residential/Inpatient Treatment; and Level IV, Medically-Managed Intensive Inpatient Treatment. Within these broad levels of service is a range of specific levels of care.

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