Cornerstone
Understanding Triwest Drug Treatment Coverage
Learn about using your TriWest insurance policy to cover substance abuse treatment
Alcohol and Drug Treatment Coverage with TriWest
If you’re a veteran or an active-duty service member seeking help for alcohol or drug addiction, TriWest Healthcare Alliance is here to support you on your journey to recovery. As a third-party administrator of the VA’s Community Care Network in regions 4 and 5, TriWest works with a vast network of healthcare providers to ensure you receive the quality care you deserve. Here, we will explore how TriWest can help you access drug treatment services, including in-network and out-of-network coverage options, the claims approval process, types of plans accepted, deductibles, and assistance for financial hardships. We aim to empower you with the knowledge and resources to make informed decisions about your treatment and well-being.1
Jump to the following sections
View our addiction treatment locations
Addictions we treat at Cornerstone
TriWest drug treatment coverage
When seeking drug treatment through TriWest, choosing an in-network provider can offer several advantages. In-network treatment centers have established contracts with TriWest, which often means more streamlined access to care and potentially lower out-of-pocket costs. These providers are also well-versed in TriWest’s policies and procedures, making the administrative aspects of your treatment more efficient. However, while TriWest has an extensive network of providers, your options may be more limited compared to out-of-network facilities. It’s crucial to prioritize finding a treatment center that meets your needs and provides the care you require, even if it means considering out-of-network options.
While TriWest encourages using in-network providers, there may be situations where you prefer or require treatment at an out-of-network facility. The primary advantage of choosing an out-of-network treatment center is the expanded range of options available. This can be particularly beneficial if you’re seeking specialized care or have specific preferences for your treatment environment. It’s important to understand that out-of-network care may come with higher out-of-pocket costs, as these providers have yet to negotiate rates with TriWest. You may need to be responsible for submitting claims and coordinating communication between the treatment center and TriWest.
Information about TriWest Programs and Plans
Veterans Affairs Patient-Centered Community Care
This program was designed to provide veterans with a comprehensive, nationwide network of high-quality community healthcare providers. The VAPC3 program focuses on ensuring that veterans receive care that is both timely and geographically accessible.2
Veterans Choice Program (VCP)
Launched as part of the Veterans Access, Choice, and Accountability Act of 2014, this program allows veterans to receive care from non-VA doctors if they have been waiting more than 30 days for VA medical care or live more than 40 miles away from a VA healthcare facility.3
Community Care Network (CCN)
TriWest is a contractor for the VA’s CCN in various regions, which is the VA’s direct link with community providers for delivering healthcare to veterans outside of VA facilities. The CCN is part of the VA’s effort to provide veterans with timely, high-quality care.4
Patient Centered Community Care (PC3)
Similar to the CCN, the PC3 program also focuses on providing veterans access to community care when VA facilities are not readily accessible. This includes a wide range of medical services, from primary care to specialty care and mental health services.
Urgent Care
TriWest facilitates the VA’s program that allows eligible veterans to visit urgent care providers within TriWest’s network without prior authorization. This benefit is intended to offer veterans convenient care for non-emergency situations.
Understanding Policy Definitions
Deductible
Co-Insurance
Out-of-Pocket Max
A deductible is the amount you’ll need to pay out-of-pocket for covered services before your insurance starts to pay its portion. TriWest usually has no deductibles because their goal is to make veteran care fully accessible.
Co-insurance refers to the percentage of covered healthcare costs you’ll pay after you’ve met your deductible. TriWest usually has no co-insurance applied to their plans because their goal is to make veteran care fully accessible.
Out-of-Pocket Max refers to the maximum amount you’ll have to pay for covered services in a given plan year, including your deductibles, copayments, and co-insurance. TriWest usually has no out-of-pocket maxes applied to their plans because they aim to make veteran care fully accessible.
TriWest Approval Process for Treatment
Verification
Submission
Adjudication
Payment
Appeal
The first step in using your TriWest insurance for drug treatment is verification. During this process, your chosen treatment center will contact TriWest to confirm your active coverage and determine your plan’s specifics. The treatment center will learn essential details such as your deductible, co-insurance, and out-of-pocket maximum. They will also find out if there are any specific requirements or limitations related to drug treatment coverage. Once verification is complete, the treatment center will clearly explain your financial responsibility, if any, for your treatment.
After you’ve started treatment, the next step is claim submission. Your chosen treatment center will manage this process on your behalf. They will gather all the necessary information about the services you’ve received, such as dates of treatment, specific therapies, and associated costs. They will then create a formal claim using standardized codes and formats TriWest requires and submit it directly to the insurance provider. By entrusting this task to an experienced treatment center, you can be confident that the process will be efficient and accurate, minimizing the risk of delays or denials. Stay in communication with your treatment center throughout the submission process, as they can keep you informed about the status of your claims and address any questions or concerns you may have.
After submitting your claim to TriWest, the next step is adjudication. During this process, TriWest will review the submitted claim to determine if the services provided are covered under your specific plan and meet the necessary medical criteria. The adjudication process involves verifying the patient’s eligibility, the treatment’s appropriateness, and the claim’s accuracy. TriWest will also check for any potential errors or missing information that must be addressed. If everything is in order and the services are deemed covered, the claim will be approved, and payment will be issued to the treatment center. If there are any issues or discrepancies, TriWest may request additional information or deny the claim, leading to the appeal process if necessary.
Once your claim has been submitted and processed by TriWest, the next step is payment. If your claim is approved, TriWest will pay the covered portion of your treatment costs directly to the center. Depending on your specific plan and coverage details, you may be responsible for paying some expenses, such as your deductible or co-insurance. The treatment center will typically bill you for any remaining balance after receiving payment from TriWest. It’s essential to stay in communication with TriWest and your treatment center throughout this process to ensure you understand your financial responsibilities and address any questions or concerns that may arise.
In some cases, TriWest may deny a drug treatment claim. This can happen for various reasons, such as a lack of medical necessity or a service not covered under your specific plan. If your claim is denied, don’t lose hope—your treatment center will likely file an appeal on your behalf. Treatment centers have experienced billing departments that are well-versed in handling denials and appeals. They will work diligently to gather additional information, provide supporting documentation, and make a strong case for why the denied service should be covered. It’s important to remember that treatment centers aim to provide only services that are likely to be approved. Still, in the event of a denial, they will be your advocate and work hard to get the decision overturned.
Get Help Paying Your Deductible
File a Hardship With TriWest
Assistance Programs & Payment Plans
Community Resources & Charitable Organizations
FAQs About Using TriWest Benefits to Pay for Alcohol and Drug Treatment
Does TriWest cover both inpatient and outpatient drug treatment?
Yes, TriWest typically covers a comprehensive range of drug treatment options designed to support individuals in their recovery journey.
These options include:
- Inpatient Programs: TriWest covers inpatient or residential treatment programs where individuals stay at a treatment facility for a specified period. These programs offer a highly structured environment with 24-hour care, providing medical supervision, therapeutic activities, counseling sessions, and peer support. Inpatient programs are particularly beneficial for individuals with severe addiction issues or co-occurring mental health disorders, as they offer an immersive, focused approach to recovery.
- Outpatient Programs: TriWest also covers various outpatient treatment programs that allow individuals to live at home while receiving treatment.
Outpatient services can vary in intensity:
- Partial Hospitalization Programs (PHP): These programs offer intensive treatment similar to inpatient care but allow patients to return home each day. PHPs typically involve multiple therapy sessions, medical monitoring, and structured support activities.
- Intensive Outpatient Programs (IOP): IOPs provide a flexible treatment option with several hours of therapy and support services per week. Patients can continue working or attending school while participating in treatment.
- Standard Outpatient Programs: These programs involve regular, scheduled therapy sessions and support groups that patients attend while maintaining their daily responsibilities. They are suitable for individuals with milder addiction issues or those transitioning from more intensive treatment.
- Detoxification Services: TriWest covers medical detox programs that help manage withdrawal symptoms as individuals stop using substances. These programs provide medical supervision to ensure the patient’s safety and comfort during the detox process, which is often the first step in addiction treatment.
- Medication-Assisted Treatment (MAT): TriWest includes coverage for MAT, which combines behavioral therapy with medications to treat substance use disorders. Medications such as methadone, buprenorphine, and naltrexone can help reduce cravings and withdrawal symptoms, making it easier for individuals to maintain sobriety. MAT is commonly used for opioid and alcohol addiction.
- Counseling and Therapy: Coverage typically includes individual and group therapy sessions, which are crucial components of addiction treatment. These sessions provide psychological support, help individuals develop coping strategies, and address underlying issues contributing to substance use.
- Aftercare and Relapse Prevention: TriWest supports ongoing recovery through aftercare services, which may include follow-up therapy sessions, support groups, and other resources to help prevent relapse and maintain long-term sobriety.
However, the specific coverage details, including the extent of coverage and any out-of-pocket costs, may vary depending on your particular TriWest plan. It is essential to verify your benefits by reviewing your plan documents and consulting with a TriWest representative before starting treatment. This ensures that you have a clear understanding of what services are covered and any potential financial responsibilities.
How do I know if a specific treatment center is in-network with TriWest?
What happens if I need to go to an out-of-network treatment center?
If you go to an out-of-network treatment center, you may face higher out-of-pocket costs than staying in-network. However, depending on your plan, you may still have some coverage for out-of-network services. Review your plan details and talk to TriWest about your options before deciding.
Will TriWest cover medications used in drug treatment, such as methadone or buprenorphine?
How can I make sure I'm getting the most out of my TriWest coverage for drug treatment?
To maximize your TriWest coverage for drug treatment, start by carefully reviewing your plan documents and understanding your benefits. Choose an in-network treatment center whenever possible to minimize your out-of-pocket costs. Stay in communication with TriWest and your treatment provider throughout the process, and don’t hesitate to ask questions or seek clarification when needed. Finally, take advantage of any available resources, such as hardship programs or community organizations, that can help make treatment more affordable.
Sources
CLINICALLY REVIEWED
Lionel Estrada, LISAC
CLINICAL DIRECTOR
Lionel, our Clinical Director is a Licensed Independent Substance Abuse Counselor (LISAC) with over 4 years at Cornerstone, specializes in addiction and mental health. Trained in EMDR therapy, he employs a trauma-informed, empathetic approach to address the underlying causes of these issues.
- Read our Editorial Policy
Still have questions about treatment?
Our admissions specialists are here to explain the process, answer any questions you may have, and ensure you’re getting the help you need to live a healthy life free from addiction.