When it comes to finding the best treatment for a substance use or mental health disorder, issues around one’s insurance coverage can be stressful. Fortunately, the admissions team at The Retreat of Atlanta can go over insurance options to find our patients the most appropriate and affordable services. Read on to learn more about options for PHCS detox in Georgia.
What is PHCS?
PHCS—which stands for Private Health Care Systems—is a network provider and manager. PHCS allows healthcare providers—including addiction treatment and mental health providers—to offer discounted rates to members of health insurance plans that count PHCS in their network.
It should be noted that PHCS is not an insurance company. Over the years the PHCS logo, or the logo of its parent company, has appeared on health insurance cards. This gave cardholders the mistaken impression that PHCS and Multiplan are insurance companies and thus responsible for determining the scope of members’ healthcare coverage.
This is not the case. PHCS merely provides networks of doctors, hospitals, and medical professionals. Many of the largest insurance companies in the U.S. contract with PHCS, which negotiates costs with healthcare providers in the network. Therefore, no PHCS representative can answer questions about benefits.
Multiplan, the parent company of PHCS, maintains the largest independent preferred provider organization (PPO) in the U.S. Its network offers access in all 50 states and includes more than 700,000 healthcare providers, 4,500 hospitals, and 70,000 other healthcare treatment facilities. PPOs differ from Health Maintenance Organizations (HMOs) like those provided by Cigna, Humana, and Aetna in the size of their networks, the freedom to see a healthcare specialist, and out-of-network coverage.
Advantages of PHCS
- Choice of providers. PHCS and Multiplan PPO plans offer great flexibility when it comes to seeking medical assistance, both inside and outside their networks. Members have a choice of seeing providers outside their network without losing coverage. That said, the benefits are superior for those who stay in-network. Plus, members can consult a specialist without a referral from their primary care doctor.
- Negotiated savings. PHCS’s network providers are contractually obligated to provide care at in-network rates. In this way, members save money on their healthcare bills.
- Quality of healthcare providers. PHCS maintains strict criteria when it comes to evaluating providers. Plus, PHCS boasts one of the highest network retention rates in the industry. Members who tap a primary care physician for their healthcare can move forward with confidence that they’re receiving superior care for a low cost.
- Range of services. PPO plans with PHCS and Multiplan often include a broader spectrum of services than typical HMO plans. Most PHCS and Multiplan PPO plans cover preventive care and screenings, prescriptions, routine checkups, specialty treatment, emergency care, and hospitalization. Some plans even include coverage for alternative therapies like acupuncture and therapeutic massage.
- Analytics-based services. MultiPlan and PHCS offer a range of data analytics-driven healthcare cost management services that can be combined to help organizations strike a nice balance of healthcare coverage. The organizations’ comprehensive and transparent analytics-based services include reference-based pricing, negotiated agreements, and value-driven health plan services.
Does PHCS Cover Addiction Treatment?
Insurance plans operating within PHCS’s network cover a wide range of addiction services. This is consistent with the requirements of the Affordable Care Act (ACA) passed in 2010. The ACA calls for all insurance providers to provide full or partial coverage for substance use disorder treatment.
Still, the amount of coverage one may have depends on one’s state of residence, whether the facility is in-network or out-of-network, and the level of one’s insurance plan. Also counting for variations in coverage include the type of rehab center, the type of treatment program, and specific related services.
Any limits applied to substance use or mental health treatment services cannot be more restrictive than limits placed on medical services. These include prior authorizations, length of treatment, deductibles, copays, and out-of-pocket expenses. PHCS is a nationwide PPO network used by many health insurers.
Consequently, members have more choices of treatment providers who can provide discounts for addiction treatment services. With PHCS, people have several excellent treatment options for alcohol or drug detox facilities. Moreover, there are several addiction treatment providers working within the network.
Most health insurance plans allow out-of-network treatment, but such treatments usually cost more and have less coverage. For those looking for PHCS detox, they can ask their employer’s Human Resources officer. They can also ask their health insurance provider about the specifics of their coverage.
PHCS cannot cover the cost of inpatient treatment for substance abuse, dual diagnosis, or mental health disorders. However, the network may be able to refer those in need to treatment facilities that offer these programs. Also called residential treatment, rehab is often the most viable treatment option for those with severe drug or alcohol abuse disorders.
Does PHCS Cover Mental Health Treatment?
Substance use disorders tend to come with co-occurring mental health disorders, such as anxiety, depression, bipolar, and post-traumatic stress disorder (PTSD). Again, under the ACA, traditional insurance plans are required to offer limited mental health treatment options. Members are advised to check the specifics of their plan to find out which mental health treatment services are covered. Once this is done, PHCS can locate network providers in their area.
In response to a dual diagnosis—wherein a physician diagnoses someone with both a substance use disorder and a co-occurring mental health disorder—treatments addressing both disorders are common. The Retreat of Atlanta offers individualized treatment plans that your health insurance plan may cover.
Out mental health treatment services include:
- Cognitive-behavioral therapy (CBT)
- Dialectical behavioral therapy (DBT)
- Individual therapy
- Group therapy
- Family Counseling
If someone covered under the PHCS network is struggling with alcohol or drug abuse, they can turn to their insurance plan for coverage. This extends to a portion of their treatment. Many specialize in services like mental health treatment. It helps to keep in mind PHCS is in contract with over 1.2 million healthcare providers across the country.
PHCS for Detox in Georgia
We offer a range of detox services for those interested in treatment. The Retreat of Atlanta believes group therapy is essential to the treatment process. After all, our primary goal is successful recovery and relapse prevention.
Contact us to discuss our group therapy options.