Medical Mutual provides health insurance to people in Ohio and is the largest insurance company based in that state.
Founded in 1934, Medical Mutual has about 1.5 million members, with 99% of Ohio hospitals in its provider network.
The insurance company offers point-of-service, HMO, and PPO health plans for Ohio residents.
Does Medical Mutual Cover Rehab?
Yes, Medical Mutual covers substance abuse treatment services as part of inpatient and outpatient treatment programs.
However, you have to receive these treatment services from an in-network provider. Services through out-of-network providers are not covered.
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Substance Abuse Treatment Services Covered By Medical Mutual
The table below clarifies which substance abuse treatment services are covered by Medical Mutual.
It’s worth noting that long-term residential treatment (as well as other services) may require preauthorization depending on your insurance plan.
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Medical Mutual Coverage By Treatment Type
Let’s take a look at what Medical Mutual covers by treatment type. Click the tabs below for details.
Medical Mutual Plan Types
Medical Mutual has gold, silver, and bronze plan types for individuals and families.
Within these levels, plans vary according to deductible, co-pay, or coinsurance. But generally, they provide different balances between monthly premiums and deductibles.
Small, mid-size, and large Ohio employers can also get group plans for their employees through Medical Mutual. This company also provides Medicare Advantage and Supplement plans.
How To Use Medical Mutual Coverage For Substance Abuse Treatment
If you want to use Medical Mutual to cover your treatment program, keep in mind that you will need to work with an in-network provider.
Many treatment centers have an insurance verification page on their website. Simply enter your Medical Mutual insurance information to find out if the facility will work with your policy.
Medical Mutual Co-Pays And Deductibles For Addiction Treatment
Like other insurance companies, Medical Mutual offers several plans for individuals and families, many of which have a range of co-pays, coinsurance, and deductibles.
For example, one Bronze plan has a $9,450 deductible with 0% coinsurance after you have met the deductible. This means that you will owe $9,450 for healthcare services and then nothing after that.
Some Bronze plans have a lower deductible but a coinsurance percentage that you must pay after you have paid your deductible. A common Gold plan requires a $25 co-pay for office visits and 25% coinsurance up to a max out-of-pocket cost of $5,750 for an individual.
Whereas a Silver plan requires 30% coinsurance with a max out-of-pocket cost of $5,850 for an individual.
What Addictions Does Medical Mutual Cover?
This insurance company covers opiate and opioid use disorders and other forms of drug addiction, such as methamphetamine or cocaine addiction.
Medical Mutual also covers alcohol use disorder. Its website for providers includes the American Psychiatric Association’s practice guidelines for alcohol addiction.
What If My Insurance Plan Doesn’t Cover The Treatment Program I Need?
It’s important not to let lack of insurance coverage be a barrier to getting the treatment that you need. If your insurance company doesn’t cover your treatment plan, you still have options.
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers block grants and awarded grants for substance abuse treatment across the nation.
Awarded grants go to qualifying drug rehab centers that apply for and are awarded them. Block grants are given to all 50 states to distribute to qualifying rehab centers.
These treatment centers then pass the savings on to clients who meet qualifications regarding income or the specific treatment need that the grant helps meet.
Rehab centers, non-profit organizations, and religious organizations will sometimes offer scholarships to people who can’t pay for addiction treatment.
It may take a little research to find such an organization in your area, but the result could prove beneficial.
Government-Funded Health Insurance
Look into Medicare, Medicaid, or other government-funded health insurance programs to reduce or eliminate the cost of care.
Medicaid is meant for people with little or no income. If your insurance company won’t pay for addiction treatment, you may be eligible for primary or secondary coverage through Medicare or Medicaid.
Rehab centers themselves may offer scholarships for people who can’t afford treatment.
They may also provide payment assistance in the form of a payment plan or a sliding fee scale that adjusts the cost of treatment to your income.
Finding A Rehab Center That Accepts Medical Mutual
The Medical Mutual website has a provider search tool available for members facing drug and alcohol addiction.
You simply log in through the portal and search for substance abuse treatment providers in your zip code.
You can always call the customer service number and get help from a representative. Or, if you are already in contact with a treatment center, you can ask them to check the coverage details of your policy.
Finally, 99% of Ohio hospitals are in-network with Medical Mutual, so if you have an emergency associated with a substance use disorder, you will likely find at least some emergency services are covered.
Find Substance Abuse Treatment Today
If you or a loved one is looking for substance abuse treatment, you can find it today. Call Addiction Resource to learn how to begin the recovery journey.
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
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