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Meritain Health operates as a third-party administrator, commonly abbreviated to TPA, administering health insurance benefits for organizations and employers throughout the United States. Founded in 1983, Meritain specializes in managing the healthcare benefits of hospitals, companies, academic institutions, and healthcare systems, operating as a subsidiary of Aetna.
Read on to discover how Meritain Health can help with the administration of benefits for the treatment of substance use and mental health disorders, and what to expect from benefits administered by this TPA.
Does Meritain Health Cover Addiction Treatment?
Meritain Aetna rehab coverage includes all types of addiction treatment deemed medically necessary for recovery, from detox and outpatient programming to residential rehab and ongoing aftercare. The scope of coverage depends on the specifics of your health insurance plan.
The type of health plan determines the baseline benefits delivered. Your out-of-pocket costs will vary depending on whether your chosen treatment provider is part of the Meritain provider network. The location of the treatment center may also influence your choice of treatment providers, coverage levels, and overall out-of-pocket costs. The services you require also have varying coverage parameters.
Meritain Health plans offer coverage for substance abuse and mental health conditions as essential health benefits in line with federal parity legislation. Laws like the Affordable Care Act and the Mental Health Parity and Addiction Equity Act mandate health insurers to provide the same level of coverage for these Meritain Aetna rehab as for other chronic medical conditions or surgical procedures.
What Types of Drug and Alcohol Rehab Does Meritain Health Cover?
Meritain Health is a third-party administrator, so it does not directly offer health insurance. Instead, the organization administers healthcare benefits for organizations, including access to inpatient and outpatient treatment programs at drug and alcohol rehabs. Meritain Health also helps individuals with co-occurring mental health disorders access integrated dual diagnosis treatment.
Covered treatment modalities depend on the determination of medical necessity and plan limitations. These may include:
- Residential rehab, also known as inpatient rehab, is intended for those with severe addictions or co-occurring mental health disorders. These programs deliver continuous clinical and emotional care in a residential setting over 30, 60, or 90 days. Meritain Aetna rehab coverage for inpatient services includes all types of therapy (individual, family, and group), psychiatric services, behavioral therapies, motivational therapy, medication management, and aftercare. Meritain inpatient rehab typically requires pre-authorization before treatment begins.
- PHPs (partial hospitalization programs) are the most immersive form of outpatient care, involving 30 hours or more of therapy sessions weekly. This enables individuals to get highly structured addiction treatment without compromising their everyday obligations.
- IOPs (intensive outpatient programs) may serve as a step-down from more intensive levels of care. Participants attend 12 to 15 hours of individual counseling, group therapy, and family therapy sessions each week around their existing commitments.
- Traditional outpatient programs offer weekly or twice-weekly therapy sessions to help people transition from rehab to independent living.
- Medication-assisted treatment at Meritain Aetna rehab centers combines FDA-approved medications like disulfiram, acamprosate, naltrexone, methadone, and buprenorphine with talk therapies to manage alcohol and opioid use disorders. This evidence-based intervention improves treatment retention, streamlines withdrawal, and encourages ongoing abstinence.
- Treatment for co-occurring disorders is covered by Meritain Health Aetna-administered health plans, targeting substance use disorders and mental health disorders simultaneously. This is proven to deliver superior treatment outcomes compared to managing each condition separately.
Check Your Meritain Insurance Coverage
You must verify your benefits before beginning treatment. Use the online member portal or call Meritain Health customer service to clarify your deductible, co-insurance, and co-payments amounts, out-of-pocket annual maximums, pre-authorization requirements, and any limitations on Meritain Aetna rehab coverage.
Alternatively, contact the admissions team at your chosen treatment center. They can help verify your benefits and provide summaries of covered services.
Get Insurance-Covered Addiction Treatment
Do Treatment Centers Need to Be In-Network to Accept Meritain Health Insurance?
The network status of the treatment center affects the amount you pay out of pocket when using your Meritain Health benefits. Still, it is nevertheless possible to receive treatment from an out-of-network facility.
An in-network treatment provider has a contract with Meritain Health to deliver behavioral health services at pre-negotiated rates. Getting treatment in-network results in paying only your co-insurance or co-payment amount after meeting the deductible, with Meritain covering the remainder of the costs.
Treatment providers outside the Meritain network may accept your health insurance, but you’ll need to pay more out of pocket (up to 70% of costs, set against 10 to 30% of the expenses at in-network facilities). Not all plans cover all services at out-of-network facilities.
What Are the Coverage Levels and Plans for Meritain Health?
Meritain Health plans include HMOs (Health Maintenance Organization) plans, PPOs (Preferred Provider Organization) plans, and HDHPs (High Deductible Health Plans).
An HMO requires you to choose a primary care physician. They will coordinate care and make referrals to addiction treatment facilities. HMOs offer reduced out-of-pocket expenses but less flexibility in choosing treatment providers – you’ll need to get treatment in-network.
A PPO offers much more flexibility, enabling you to select a treatment provider without needing to obtain a referral. You can choose from in-network or out-of-network providers. Expect costs to vary considerably in line with network status.
An HDHP has a low monthly premium but a high deductible. You must pay all costs for treatment until the deductible is met; after that, insurance coverage kicks in. Many people use an HDHP combined with an HSA (Health Savings Account) to access tax-advantaged healthcare.
Do My Dependents Have Access to Healthcare?
Meritain Aetna rehab coverage may extend to eligible dependents, such as children and young adults under the age of 26 and spouses. Coverage for dependents is available at the same level as that provided for primary members. Services may include family therapy sessions, educational programs, and addiction treatment focused on adolescents and young adults.
FAQs
Is Meritain part of Aetna?
Yes, Meritain is a third-party administrator that operates as an Aetna/CVS Health subsidiary.
What type of insurance is Meritain Health?
Meritain is a third-party administrator that manages healthcare benefits for employer groups through an extensive provider network. The company does not offer insurance products directly.
Does Meritain Health Cover Therapy?
Yes, Meritain Health plans generally cover therapy as part of their behavioral health benefits. Coverage often includes individual counseling, family therapy, and group therapy when deemed clinically necessary. The specifics depend on your plan type, deductible, and whether your provider is in-network.
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Get Addiction Treatment with Health Insurance at a Premier Rehab Center in California
If you need help getting back on track from addiction to alcohol, prescription medications, or illicit drugs, we can help you at Renaissance Recovery in Southern California.
We work with health insurers and TPAs like Meritain to offer addiction treatment at reduced cost for eligible members. Our intensive outpatient programs enable you to live at home and continue meeting your everyday obligations while receiving structured, evidence-based treatment for any addiction.
Personalized treatment plans include therapies such as:
- Counseling
- Family therapy
- Group therapy
- Motivational therapies
- Behavioral therapies
- Medication management
- Holistic therapies
- Aftercare support
To verify your health insurance benefits, call our friendly admissions team today at 866-330-9449.
Sources
- https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
- https://www.fda.gov/drugs/information-drug-class/information-about-medications-opioid-use-disorder-moud
- https://www.ncbi.nlm.nih.gov/books/NBK554454/
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At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.
