Optima Health Insurance Coverage For Drug Rehab

With headquarters in Virginia Beach, VA, Optima Health was founded in 1984 and offers health insurance to almost 600,000 people across the state.

The insurance company offers a range of plan types such as commercial health insurance as well as Medicare and Medicaid plans.

Optima also offers an employee assistance program (EAP) for people who have behavioral health needs.
Optima Health recently joined Sentara Healthcare and is changing its name to Sentara Health Plans, which will still cover members in Virginia.

Does Optima Health Cover Rehab?

Yes, Optima Health covers rehab programs for drug and alcohol addiction. This includes medically necessary services such as detox, residential treatment, and others.

Members of Optima Health’s network can find addiction treatment through one of its 35,000 general providers, specialists, hospitals, and physicians.

Substance Abuse Treatment Services Covered By Optima Health

Optima Health covers a range of treatment services that, for decades, have helped people overcome addiction.

Use the table below to learn more about which services are covered. Some may need prior authorization depending on your plan and circumstances.

Optima Health Coverage By Treatment Type

If you still have questions about what Optima Health covers, or to what extent it covers it, you can find more answers in the tabs below.

Optima Health Plan Types

Optima has a wide variety of types of health plans, from managed care plans to private insurance plans for individuals or families.

Optima Health insurance plan types include:

• plans that work with HSAs and HRAs
• Point of Service (POS), Plus (PPO), and Vantage (HMO) plans
• tiered plans
• employer-sponsored group plans for large and small companies
• individual and family plans
• narrow network plans
• Medicaid
• Medicare
• community care plans
• dual eligible special needs plan

Deciding which plan is best for you may require contacting a specialist at Optima or a trusted health insurance broker.

How To Use Optima Health Coverage For Substance Abuse Treatment

Optima Health has several suggestions for how to access your coverage options for addiction treatment.

You should be able to choose an option below whatever your comfort level with technology is.

Options for accessing your substance abuse treatment benefits include:

• asking your primary care provider to refer you to in-network treatment services
• calling a care coordinator at Optima Health
• finding a provider in the directory
• finding a provider at optimahealth.com
• calling 888-946-1168 for a behavioral health services representative

If you have already found an addiction treatment provider that accepts Optima Health, you can ask them to coordinate your coverage with Optima directly.

Optima Health Co-Pays And Deductibles For Addiction Treatment

As with other insurance companies, Optima Health offers combinations of monthly premiums, co-pays, deductibles, and coinsurance to create plans that meet a variety of needs.

Some plans are designed to fit the needs of employers, while others are designed for individuals who just want catastrophic insurance.

For example, one OptimaPlus plan requires a co-pay of $25 for outpatient office visits or inpatient treatment plus a 20% coinsurance for addiction treatment.

An Optima Vantage HMO, for another example, requires a $10, $125, and $300 co-pay for office visits, outpatient treatment, or residential treatment respectively for addiction treatment.

Finally, an OptimaFit Gold plan requires a $35 co-pay for an office visit and 20% coinsurance for everything else.

What Addictions Does Optima Health Cover?

Optima Health covers many different behavioral health issues including different forms of substance abuse.

This includes alcohol, opiate, and opioid use disorders. Optima also covers prescription drug abuse, such as addiction to benzodiazepines.

What If My Insurance Plan Doesn’t Cover The Treatment Program I Need?

If your insurance plan doesn’t cover your addiction treatment plan, you can still find affordable treatment through other payment options.

Additional payment options for addiction treatment include:

• block grants or awarded grants through the Substance Abuse and Mental Health Services Administration (SAMHSA), which help rehab centers offset costs for qualifying clients
• government-funded health insurance programs such as Medicare or Medicaid, aimed at people of a certain age bracket or income level
• payment plans available at some rehab centers
• sliding fee scales that some treatment facilities offer, basing the cost of treatment on a client’s income level
• scholarships through rehab centers, non-profit organizations, or religious institutions such as churches

Finding A Rehab Center That Accepts Optima Health

If you want to find a rehab center that accepts Optima Health, start by looking in Virginia, where the health plans apply.

You can also find out if rehab centers in your area are in-network with Optima Health. Some treatment facilities list the insurance plans they accept on their website or even have an online insurance verification form you can use.

Find Addiction Treatment Today

If you are looking for addiction treatment for yourself or a loved one, you can find it today. Call us to learn more about treatment options, the recovery process, and how to get started.

Written by the Addiction Resource Editorial Staff