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Humana Insurance Rehab Coverage | Best Rehab Centers

Editor Dan Schimmel, LCSW, CAP
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Humana is one of the largest health insurance providers in the United States. With over 13 Million members, Humana offers a wide array of policy options to meet their specific needs. Most of these policies have addiction treatment coverage, however the amount of coverage will vary between plans.

Addiction Resources with Humana

Humana Behavioral Health, a subsidiary of Humana, offers addiction resources to its members through a 24/7 helpline and easy access to participating providers. Humana takes pride in being an advocate for their members, providing assistance to members with any questions or concerns they may have, and providing case management in cases of multiple hospitalizations and behavioral health needs that require frequent or ongoing assistance.

Addiction Treatment Coverage with Humana

Addiction Treatment Coverage will vary with each Humana policy, the state in which the member lives and is choosing to seek treatment within, if there are legal requirements and the level of care the member is going to begin treatment within. Unfortunately not all Humana plans have substance abuse coverage, however it is available to be purchased as an add on to the individual policy. Regardless of the plan, for a member to be covered for substance abuse treatment, there must be medical necessity and the provider must obtain authorization for the treatment services.

Most Humana plans cover the following addiction treatment services;

  • Outpatient Detox
  • Inpatient Detox
  • Inpatient Rehab
  • Residential Treatment
  • Partial Hospitalization (PHP)
  • Intensive Outpatient (IOP)
  • Group Therapy
  • Individual Therapy
  • Psychiatric Evaluation and Management
  • Medical Evaluation and Management
  • Assessments and Screenings

Does Humana Cover Out-of-Network Treatment?

Depending on the plan, Humana may cover out-of-network treatment. Those with Humana HMO plans will be required to seek treatment within the health maintenance organization, an in-network provider. However those members with Humana PPO policies are able to seek treatment both in and out of network, widening their treatment options and allowing them to find a treatment facility that meets their individual treatment needs.

When seeking treatment with an out-of-network substance use disorder treatment provider you will face higher costs than if you were to seek treatment with an in-network provider. Treatment is subject to a higher out-of-network deductible, coinsurance and maximum out of pockets, as well as any additional costs that may be due to the provider.

Inpatient Treatment Coverage with Humana

Inpatient Treatment Coverage with Humana is dependent on the plan. Some plans may not offer coverage, others may offer coverage only within the network or with a high out of pocket cost for out-of-network providers. All inpatient treatment services will require prior authorization to ensure coverage of treatment.

To determine your inpatient treatment coverage, contact Human Behavioral Health member services.

Outpatient treatment Coverage with Humana

Humana Behavioral Health policies cover a wide array of outpatient treatment services. Depending on the policy these services may be received with an in or out of network provider. Unfortunately, most Humana policies exclude court ordered outpatient treatment. Depending on the level of outpatient care there may be prior authorization requirements for treatment services.

Commonly covered outpatient treatment services include;

  • Partial Hospitalization (PHP)
  • Intensive Outpatient (IOP)
  • Group Therapy
  • Individual Therapy
  • Psychiatric Evaluation and Management
  • Assessments and Screenings

Addiction Treatment Costs with Humana

The cost of addiction treatment with Humana will be determined by the specific plan. Typically in-network treatment will have a copay, members may be required to pay a deductible depending on the level of care. Out-of-network treatment requires the member to pay an out-of-network deductible, once that is met the member will be responsible to pay a coinsurance amount until they meet their maximum out of pocket, at which time Humana will begin to cover the member at 100%. With out-of-network treatment providers the member may also incur additional treatment costs.

To determine your out of pocket costs for addiction treatment, contact Humana Behavioral Health member services department.

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