Medical Mutual Insurance Coverage for Drug and Alcohol Rehab

Does Medical Mutual Cover Drug & Alcohol Addiction Treatment?

Medical Mutual policies usually cover behavioral health and substance abuse treatment. 

Mental health and substance abuse care must be treated at parity under federal law, such as the Mental Health Parity and Addiction Equity Act (MHPAEA). 

Coverage levels are determined by your individual Medical Mutual policy, the setting, and the level of care you receive, as well as possible referrals or prior authorizations depending on your plan. 

Medical Mutual Plan Types

Coverage of addiction treatment varies with your plan type:

PPO (Preferred Provider Organization) 

Generally has maximum flexibility. Covers in-network care and some out-of-network benefits at a greater cost.

HMO (Health Maintenance Organization) 

Covers primarily in-network care. Generally requires referrals from your PCP to see a specialist.

POS (Point of Service) 

Requires referrals from your PCP and may have some out-of-network coverage at a greater cost.

 EPO (Exclusive Provider Organization) 

Generally covers in-network care only. Usually does not require referrals from a PCP.

The availability of drug and alcohol rehabilitation services through Medical Mutual may differ depending on whether the facility is an in-network facility, the type of insurance plan available, and the intensity of the services needed. For instance, services such as medical detoxification and inpatient rehabilitation may need prior authorization and may need to meet the criteria for medical necessity.

The availability of services through Medical Mutual may differ depending on the specific provider network and the individual programs available in the state.