TRICARE SUBSTANCE ABUSE TREATMENT

TriCare offers a broad spectrum of coverage to assist individuals confronting substance use disorders, emphasizing both immediate medical intervention and holistic, long-term recovery.

Below is an overview of services TriCare supports:

• Inpatient Services (Including Emergency): TriCare provides coverage for both emergency interventions and planned inpatient care, ensuring timely access to necessary treatments without delay.³
• Intensive Outpatient Programs (IOPs): TriCare supports intensive outpatient programs for individuals requiring regular oversight without the need for constant inpatient care. These programs typically feature group therapy, individual counseling, and structured recovery activities.⁴
• Detoxification: Recognizing the difficulty of managing withdrawal symptoms, TriCare covers detoxification services, which are crucial for the safe mitigation of withdrawal under professional supervision.
• Mental Health Services: Acknowledging the frequent overlap between addiction and mental health issues, TriCare extends coverage to a variety of mental health services, including cognitive-behavioral therapy (CBT), psychotherapy, and counseling, to tackle underlying mental health challenges.
• Opioid Treatment Programs: For severe opioid dependency, TriCare includes comprehensive treatment programs that combine medication-assisted treatment, counseling, and ongoing recovery planning.
• Partial Hospitalization Programs (PHPs): PHPs balance intensive inpatient care and outpatient services, covered by TriCare, facilitating substantial care without overnight stays.
• Residential Treatment for Substance Use Disorders: TriCare also covers residential treatment programs for individuals needing immersive, 24/7 care. These programs offer medical oversight, therapy, and peer support in a residential setting.

TriCare’s wide-ranging coverage ensures that military members and their families have access to varied treatment pathways, catering to diverse needs for achieving sustainable recovery from substance abuse.

TriCare is committed to providing comprehensive healthcare assistance, including coverage for medically necessary substance use treatment.

If a healthcare professional determines that your rehabilitation stay is essential for your health and recovery, TriCare typically covers the associated treatment expenses, depending on the specifics of your policy.

However, to fully understand your benefits, you should review your TriCare policy or speak with a Cornerstone admissions representative for detailed coverage information.

We can verify your insurance coverage, check your benefits, and ensure you receive the necessary treatment.

To determine what your TriCare insurance plan covers, follow these steps:

• Review Your Policy Documentation: Read your TriCare insurance policy documents thoroughly. Look for sections on coverage limits, exclusions, deductibles, and co-pays.⁵
• Visit the TriCare Website: The official TriCare website provides detailed information about various plans and coverage. Use the site to find specifics related to your policy type.
• Contact TriCare Directly: Contact TriCare customer service for direct inquiries. Have your policy number ready for reference so you can ask specific questions about your coverage.
• Use the TriCare Coverage Tool: Utilize online tools provided by TriCare to check coverage for specific treatments or services. This can give you a clearer understanding of what is included in your plan.
• Consult With Your Healthcare Provider: Healthcare providers often have experience with TriCare billing and can offer insights into what services are typically covered under your plan.
• Check for Pre-Authorization Requirements: Determine if TriCare requires pre-authorization to ensure the services you need are covered.
• Understand In-Network vs. Out-of-Network Services: Know the difference in coverage levels for in-network versus out-of-network providers to avoid unexpected expenses.
• Seek Assistance from a Military Health System Counselor: Military health system counselors or patient advocates can provide guidance and help navigate your TriCare coverage.
• Review Annual Updates: Insurance policies can change, so it’s important to review any updates to your TriCare plan annually or as notifications are received.

Taking these steps can help clarify what your TriCare insurance plan policy covers, ensuring you make the most out of your benefits.

Tricare covers addiction treatments, subject to specific policy terms, limitations, exclusions, and medical necessity, including outcomes of past treatments.

To understand your coverage better, here are some important aspects that you should keep in mind:

• Annual and Lifetime Limits: Policies might restrict the number of substance abuse treatment sessions within a year or across the policy’s duration. It’s crucial to check your plan for any specified limits on treatment frequency or covered days.
• Medical Necessity: TriCare generally requires a healthcare professional to confirm the medical necessity for each treatment phase, underscoring the treatment’s importance for recovery.
• Prior Treatment Outcomes: Coverage decisions for additional treatment sessions often consider the success and progress of previous treatments, evaluating the need and potential benefits of ongoing treatment.
• Type of Treatment: The coverage may vary depending on the treatment type; for instance, TriCare might consistently cover outpatient therapy sessions annually more than multiple inpatient rehabilitation stays.
• Policy Specifics: It is essential to familiarize yourself with the details of your specific TriCare policy, as policies manage coverage for repeated treatments in considerable variation.
• Pre-Authorization: Similar to initial treatments, follow-up treatments typically require pre-authorization from TriCare to confirm coverage eligibility and medical necessity.

To better understand your coverage for addiction treatments, review your TriCare policy, get in touch with Cornerstone for insurance verification, or speak directly with a TriCare representative to discuss coverage for ongoing treatment.

Like other insurance providers, TriCare sets certain restrictions or limitations on the addiction treatments it covers, considering factors like medical necessity, evidence-based effectiveness, cost efficiency, and the details of your specific insurance plan.⁶

Common restrictions may include:

• Type of Treatment: Coverage may be restricted to certain types of treatment, such as inpatient, outpatient, or Medication-Assisted Therapy (MAT). In contrast, more luxurious or experimental treatments might not be covered.
• Provider Network: TriCare has a network of approved addiction treatment providers. Getting care outside this network could lead to higher out-of-pocket costs or lack of coverage.
• Pre-Authorization Requirement: Many TriCare plans require pre-authorization for addiction treatment services, meaning approval is needed in advance to ensure coverage.
• Duration and Frequency of Treatment: Limits may be placed on how long and how often treatments can be received, for example, a maximum number of days for inpatient care or a limited number of therapy sessions.
• Substance-Specific Coverage: The coverage might differ based on the substance being treated, with certain substances or behaviors possibly facing exclusions or limitations.
• Evidence-Based Treatments: TriCare generally covers treatments proven effective through scientific research.
• Appropriate Level of Care: Coverage is provided only for the level of care deemed necessary for the patient’s specific condition, which could restrict access to more intensive treatment options unless there is a medical justification.

There are many factors to consider when determining your coverage.

Contact our admissions team for personalized guidance based on your unique situation.

We have made the admission process as simple and convenient as possible.

Once we verify your TriCare insurance, we can proceed with treatment planning and admission without delays.

So you can start your journey toward recovery as soon as possible!