Tricare insurance covers some Substance Use Disorder Treatment depending on your plan and specifics of your coverage. There are certain requirements and limitations that are important to be aware of before signing up for any type of rehabilitation services that you wish Tricare insurance to cover. It is important to note that you may incur some out of pocket expenses depending on your specific plan and program options.
Prior Authorization
You must receive prior authorization from your regional contractor before beginning treatment or the detoxification process. You representative will then let you know more about the specific details of your coverage and options you may be eligible for regarding substance use disorder treatment. You will also be made aware of which facilities Tricare insurance services will cover and to what extent.
Three Benefit Periods per Lifetime
With Tricare insurance, you may receive coverage for three benefit periods during the course of your lifetime. Each benefit period begins on the first day of substance use disorder treatment that is eligible for coverage and ends 365 days from that date. If you require emergency or inpatient hospital care for detoxification or complications of substance abuse, this will not count toward establishing the first date of coverage for beginning the benefit period. The three per lifetime limitation may be waived with certain policy criteria. Please speak with your regional contractor for more information.
Detoxification Coverage
Detox may be covered if it is deemed medically necessary. This means that your condition requires the medical attention at a hospital facility. Depending on the substance you are quitting, you may be able to receive medical assistance to help with detoxification and withdrawal symptoms.
Inpatient and Outpatient Therapy
You may receive one inpatient treatment of up to 21 days just one time per benefit period. You may receive outpatient rehab by an authorized facility. This substance use disorder treatment must be provided in a group therapy setting. You may receive up to 60 of these outpatient group therapy sessions during a benefit period. Individual counseling sessions for substance use disorder are not covered by Tricare insurance services.
Family Therapy
Receiving family therapy is the final step of the substance use disorder treatment process. Once rehab services are completed, you may receive up to 15 visits of family therapy sessions per benefit period.
If you or someone you know needs help with addiction or finding an alcohol detox, we can help: Call Today (800) 305-3417