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Insurance Coverage for Partial Hospitalization in Massachusetts

In Massachusetts, accessing insurance coverage for the Partial Hospitalization Program (PHP) is pivotal in ensuring individuals receive comprehensive mental health care. As per the Massachusetts Health Insurance Connector Authority (MA HICA), most health insurance plans in the state are mandated to include coverage for substance use disorder (SUD) treatment – which includes PHPs in their coverages.

Foundation of Insurance Coverage for Partial Hospitalization Program In Massachusetts

The foundation of insurance coverage for PHP in Massachusetts rests on the state’s robust healthcare laws. 

The Massachusetts Health Care Reform Act mandates that all residents must have health insurance. So, by extension, this requirement proposes to include coverage for substance abuse treatment, including PHP. 

This commitment underscores the state’s dedication to addressing mental health concerns comprehensively.

Understanding the Eligibility Requirements

Understanding the eligibility and specifics of insurance coverage is essential. Most health insurance plans in Massachusetts cover substance abuse treatment, which includes both inpatient and outpatient rehab services, detoxification, counseling, and follow-up care. 

Federal Regulations:

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 reinforces that mental health and addiction services must be covered on par with medical and surgical services. 

This federal law guarantees individuals seeking PHP in Massachusetts equitable coverage, promoting fairness and accessibility in mental health care.

Check Insurance Coverage Plans:

To maximize insurance coverage benefits, individuals are advised to choose PHP programs and healthcare providers that are in-network with their insurance plans. 

This strategic selection can substantially reduce out-of-pocket expenses, potentially bringing costs as low as $20-$200 per day. Thereby, making PHP more financially feasible for individuals seeking intensive mental health care.

Prior Authorization:

Individuals must also be aware of any prior authorization requirements specific insurance plans may have for PHP treatment. 

Therefore, individuals should check in with both – their insurance provider and the PHP facility –before locking in the care program. It will help with the pre-approval process and streamline the path to receiving care.

Partial Hospitalization Program Massachusetts

Wrapping it Up

When it comes to mental wellness, costs become a secondary factor. Nonetheless, the right kind of quality care covered under insurance matters, so if you’re seeking mental wellness support under insurance, Resilience Behavioral Health might help you. 

They work with insurance companies and offer sliding scale fees that can reduce costs to as low as $20/day. Contact 888.401.1179. to learn more