Humana Health Insurance Coverage for Addiction Treatment
Last Updated Dec 2, 2021
Humana is one of the largest for-profit commercial insurers in the United States. If you have health insurance from an employer, it’s quite likely that you have a Humana plan.
Humana operates in 43 states and Puerto Rico. Every state has different rules about covered benefits. And Humana can tailor the plans they offer based on an employer’s wishes.
If you think it seems complicated, you’re right. But know this. Most Humana plans offer at least some coverage for addiction treatment. But you’ll need to ask targeted questions to determine what is covered, what isn’t, and what you must pay.
How Does Humana Insurance Work?
About half of all Americans get health insurance through their jobs. When you took a new job, or your company held an open-enrollment period, you were shown those plan details, and you had a chance to ask questions. But if you forgot the answers, you’re not alone.
Health insurance language is incredibly complicated. Reading through the details can be tedious and confusing. And when your plan was introduced, you may not have imagined that you’d need care for an addiction issue.
When the Affordable Care Act (ACA) was written, legislators included language about addictions. They forced companies to create marketplace-compliant plans with coverage for essential benefits, including addiction.
Your employer may not buy plans from the marketplace. But most health insurance plans, including Humana, used the ACA plans as a template when determining what they will and will not cover. Because of the ACA, your Humana plan probably includes addiction care.
How Can Humana Help Your Addiction?
Your Humana healthcare provider should screen you for substance use disorders. And if you need help quitting use of drugs and alcohol, your doctor should guide your next steps.
Humana also has a Behavioral Health Department that assists with the following:
- Referrals: This team can help you fill out the proper paperwork to enroll in a treatment program.
- Communication: Humana can connect with your treatment provider and ensure that your records are transferred. Humana can also keep your doctor apprised of your progress.
- Payment: Humana can pay your provider fees directly (if services are covered). They can also help you determine what is and isn’t covered.
Your Humana identification card should have a contact number for behavioral health. An internet search may bring you to places like Kentucky, but the numbers shown here might not apply to you. Always use your identification card to ensure you’re contacting the right number.
Humana Coverage Explained
While most Humana plans offer some kind of addiction coverage, the details can vary from plan to plan.
Your Humana plan may cover the following:
- Detox: An inpatient or outpatient program can help you achieve sobriety from drugs or alcohol. Detox on its own isn’t enough, but it is often a critical first step in the recovery process.
- Inpatient care: After detox, you move into a facility to continue working on your addiction. Here, you’ll focus on therapy and other treatment approaches around the clock in a sober environment.
- Outpatient care: You live at home while working on your addiction. You may visit a facility daily, or you may have regular appointments with a professional instead.
- Medication-assisted treatment (MAT): You use prescription drugs to quell cravings and help you stay sober. You also participate in therapy and behavioral treatment to support recovery.
You may face limits involving these things:
- Location: Some Humana plans require people to work within a network of providers. This step can keep costs down.
If you go to a facility that’s not in the network, you may pay more. With some plans, you’ll pay the entire bill for out-of-network care.
- Treatment length: Some Humana plans won’t let you stay in the program for more than a set period. If you need care for longer than this time, it may not be covered at all.
- Treatment initiation: Some Humana plans require a doctor’s approval and diagnosis before you can get care.
- Cost: Some Humana plans have caps on how much you can spend on your addiction treatment. Once you hit that cap, you must pay for the rest out of pocket.
Most states have no healthcare transparency laws. Health plans like Humana aren’t always required to tell you how much your care will cost you before it begins. Asking questions is the best way to ensure that you can pay the bills when they arrive.
What Should You Do Next?
You’ve found an addiction treatment provider you trust. You’d like to get started, but you’re worried about the price. What should happen next?
Call the behavioral health number on the back of your Humana card and ask for help. Be prepared to talk about your history of addiction, your need for help, and the provider you’d like to use. The representative should tell you how much you’ll expect to pay for care and what you should do next.
Get Help With Boca Recovery Center
At Boca Recovery Center, we work closely with Humana. If you’d like to come to us for treatment, we can smooth the enrollment process for you.
We can work with Humana and get your authorization paperwork completed. And we can tell you exactly how much (if anything) you’ll pay for care. Contact us to get started.
The Big Five Health Insurers’ Membership and Revenue Trends: Implications for Public Policy. (December 2017). Health Affairs.
U.S. Health Care System: A Patchwork That No One Likes. (October 2017). The Conversation.
Mental Health and Substance Abuse Coverage. HealthCare.gov.
Substance Use Disorders. Humana.
Behavioral Health Services. Humana Kentucky.
Few States Have Robust Healthcare Price Transparency Laws. (May 2020). Rev Cycle Intelligence.
The Affordable Care Act Transformation of Substance Use Disorder Treatment. (January 2017). American Journal of Public Health.
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