GEHA (Government Employees Health Association) Drug Rehab and Behavioral Health Coverage Guide

By The Fix staff 08/13/19

Find out all you need to know about GEHA health insurance with this helpful guide.

government employees health association geha drug rehab coverage

1. What Behavioral Health Conditions are Covered by GEHA Health Plans?
2. Explaining GEHA Drug Rehab and Alcohol Addiction Treatment Coverage
3. Explaining GEHA Mental Health Insurance Coverage
4. The Advantages of Using a GEHA In-Network Provider
5. What will GEHA Health Plans Not Cover?
6. How to Find the Best GEHA Health Plans Drug Rehab and Behavioral Health Treatment Program
7. Understanding your GEHA Health Plans Coverage and Benefits

Substance use disorders and mental health conditions are serious medical issues that require rapid intervention and comprehensive treatment. But too often, financial concerns prevent people from seeking the help they need. 

If you’re insured under a GEHA health plan and need treatment for a behavioral health condition, this shouldn’t happen to you. GEHA health plans drug rehab coverage is extensive, as is its coverage for alcohol addiction and mental health treatment. Once you enter GEHA-approved substance abuse facilities or GEHA mental health care centers, financial limitations shouldn’t impact your recovery.

What Behavioral Health Conditions are Covered by GEHA Health Plans?

Alcohol addiction, drug dependency and mental health disorders are all classified as behavioral health conditions. 

Under the terms of your GEHA health plan, if you’ve been diagnosed with one or more types of behavioral health disorder you will be eligible for health insurance coverage. The diagnosis must be made by a qualified medical professional, using the appropriate diagnostic criteria. 

As long as this requirement is met, GEHA must help you pay for the treatment deemed necessary by medical professionals. GEHA health plan rules treat substance abuse problems and mental health difficulties the same as any other type of physical illness.

Explaining GEHA Drug Rehab and Alcohol Addiction Treatment Coverage

GEHA health plans drug rehab and alcohol addiction treatment coverage is extensive and impressive. It will include the initial evaluation and diagnosis, detox services, inpatient or outpatient treatment programs, and possibly aftercare services if they are considered essential to your long-term health.

Before you can obtain addiction treatment services of any type, however, GEHA health insurance representatives must certify your eligibility. That is, they must be provided with documentation proving that the treatment you’re seeking is medically necessary and has been approved by recognized medical professionals. Once you do gain approval, there may be some limits on the number of days you can remain in treatment and still receive coverage.

Precertification is a standard requirement for all types of addiction treatment, including intensive day treatment, partial hospitalization, and intensive outpatient plans, in addition to conventional inpatient or outpatient recovery programs. 

The good news is that GEHA drug rehab and alcohol rehab facilities and mental health care centers will handle precertification procedures for you. You’d only be contacted by the insurance company should your rehab center fail to take the necessary measures—and even then, you’d be given time to rectify the error. 

Explaining GEHA Mental Health Insurance Coverage

People who struggle with anxiety disorders, depression, personality disorders, PTSD and other mental health disorders can benefit tremendously from a period of time spent in GEHA-approved mental health facilities. 

As is the case with GEHA substance abuse coverage, you’ll need to be precertified by the company before you can enter GEHA-approved mental health facilities, or receive services from a GEHA psychiatrist or psychologist. The treatment center you plan to enter will provide information to GEHA about your diagnosis, treatment plan and long-term prognosis, which should make precertification a foregone conclusion in most cases.

Approved length of stay can sometimes be an issue, especially if your mental health treatment team has recommended an inpatient or outpatient program of longer than 30 days. You may or may not receive approval under GEHA health plans for an extended stay, depending on the specific nature of your mental health disorder.

The Advantages of Using a GEHA In-Network Provider

A GEHA in-network provider is a medical authority or institution that has a special relationship with the insurance company. This means lower healthcare costs for you if you choose to stay in-network when searching for healthcare services. A GEHA in-network provider is also referred to as a GEHA PPO, which stands for preferred provider option.

The coverage available in your GEHA health plan will inevitably be more extensive if you seek treatment with a GEHA in-network provider. These providers may include individual practitioners, clinics, generals-service hospitals or institutions devoted exclusively to behavioral health treatment services.

GEHA drug rehab facilities, alcohol rehab centers and mental health care facilities will all be included in the list of GEHA in-network providers. Among individual treatment specialists, coverage will be provided for therapy and other services offered by affiliated psychiatrists, psychologists, clinical social workers, licensed professional counselors, addiction treatment specialists, and marriage and family therapists. 

For GEHA health insurance coverage to be guaranteed, the services obtained from GEHA therapists and other medical experts must directly address the substance use disorder or mental health disorder diagnosed.

Your benefits will be more generous if you choose GEHA in-network substance abuse facilities or mental health care centers. But you can seek evaluation, diagnostic, detox and treatment services with out-of-network providers, if you choose to do so. You’ll be responsible for a greater percentage of the costs, but GEHA coverage will still be available to help make your time in recovery more affordable. 

In general, you can expect to pay between two and five times as much for specific treatment-related services should you go outside the GEHA in-network providers list.

Fortunately, it should not be necessary for you to go out-of-network if you have a GEHA medical plan. There are more than 2.7 million GEHA in-network provider locations in the United States, including approximately 9,300 hospitals. This should give you a wealth of excellent options if you need GEHA health plans drug rehab, alcohol rehab or mental health recovery services.

What will GEHA Health Plans Not Cover?

GEHA health plans offer generous benefits for clients. But you can’t assume all of your drug and alcohol recovery expenses, or mental health care costs, will be paid for by GEHA health insurance. 

Benefits and coverage will vary from plan to plan. For example, your GEHA health plan may cover most of your detox costs but offer less coverage for substance abuse treatment, based on the number of days you’re allowed to seek assistance. Even if you have medical authorization for your extended treatment from licensed mental health or substance abuse professionals, that may not be enough to gain full insurance coverage. 

Other GEHA substance abuse health plans might cover the bulk of treatment costs but do little to help with aftercare. If you need medication, you may be restricted to certain drugs for only a limited period of time. You may run into trouble getting coverage for complementary services, such as educational classes or holistic treatment methods. GEHA health plans may not consider theme essential to your overall recovery program.

Another potential limitation involves luxury rehab centers. Luxury treatment is highly desirable to many people, but it often includes perks and amenities that are not considered critical for your health and safety. You will have to pay for these extras yourself should you enter a treatment facility that offers luxury services.

The only way to be certain about what is or is not covered by your GEHA health plan is to speak with a company representative. GEHA alcohol rehab centers, drug rehab centers and mental health care facilities can help confirm your eligibility for coverage, if you’re having difficulty finding that information yourself. 

You naturally want as much health insurance coverage as you can find. But you shouldn’t let limitations in your GEHA coverage interfere with your pursuit of drug rehab, alcohol addiction treatment or mental health intervention. GEHA-approved substance abuse and mental health treatment facilities will work with you to develop a flexible payment schedule that you and your family can afford.

How to Find the Best GEHA Health Plans Drug Rehab and Behavioral Health Treatment Program

GEHA health plans are there to help you pay for your medical expenses. No one should forego treatment for drug addiction, alcohol addiction or mental health disorders simply for financial reasons, and GEHA is there to help prevent that from happening.

But ultimately, it is the experts charged with managing your treatment program who will be most responsible for your recovery. Or more precisely, it is the collaborative relationship you establish with those treatment professionals that will make the decisive difference.

GEHA health plans can give you greater peace of mind as you strive to overcome your life challenges. That is their purpose, and the relationships the company has built with GEHA in-network providers in the behavioral health field are designed to maximize your chances of recovery. A facility chosen as a GEHA PPO will provide you with the very best in evidence-based recovery services, which is exactly what you need as you work for a brighter future.

In the end, you should choose a GEHA health plans drug rehab, alcohol addiction treatment or mental health care facility that offers the full menu of the services you need and desire. They should employ well-trained, highly compassionate mental health and addiction treatment experts who motivate you and inspire you to give your best efforts to change and heal. 

If you have everything you know you need to recover, your GEHA health plan should lift enough of the financial burden to make your treatment affordable. This should definitely be the case if you seek treatment in-network, and could even be true if you go for an outside provider.

Understanding your GEHA Health Plans Coverage and Benefits

Is GEHA insurance good? 

This is a question asked by many of the active or retired federal employees and their family members covered under GEHA health plans. When it comes to coverage for substance abuse and mental health treatment, GEHA policies are solid, dependable and generous, and that is good news for you if you require intervention for a serious behavioral health issue.

There are three types of GEHA health plans: the Standard Option, the High Option and the High Deductible Option. While they offer different levels of coverage for some conditions, all provide equally attractive benefits for substance abuse and mental health treatment. Regardless of which GEHA health plan you have, you should be able to get the assistance you require if you have a legitimate need for behavioral health rehabilitation services.


Please read our comment policy. - The Fix