TRICARE Rehab Coverage

TRICARE, the health care program that services those in the military and their families, does offer addiction treatment services and benefits.

Emergency detoxification is covered in an inpatient or hospital setting. This wording specifies that medical necessity for hospitalization is indicated. This is most often not necessary, but must be determined to be so and referral by a physician is required. TRICARE mandates that the hospitalization must be approved before payment for services rendered will be made.

TRICARE also offers rehab services, such as those found in a treatment center, but not in a hospital setting. Therefore, the recommendation of a physician and prior authorization for services must be obtained before payment will be guaranteed. The member should make certain that benefits are payable for treatment before they enter into an agency or agreement with one. The coverage allows for 21 days per coverage period, which is 365 days (one year) after the beginning of the treatment. This is separate from medical detox and may extend in some instances.

Another option for treatment services for those with TRICARE benefits is outpatient group therapy sessions. Sixty sessions are allowed per treatment period, which is again, 365 days from the beginning of the treatment. No individual therapy sessions are covered for substance use. They allow for an additional 15 sessions of family therapy on top of the group therapy. This is an important feature for family members of the addict seeking help with their addiction. Again, this does not include individual therapy sessions.

Benefits for inpatient treatment will reduce the total number of days available to the member of their allocated services for psychiatric hospitalization benefits. Depending on the plan the member has, it is either 30 or 45 days per period, again, beginning with the first day of covered treatment and for the 365 days following that day.

For those who are covered, there are no copay or out-of-pocket costs. Keep in mind, however, that because the plans are designed for those who are active military, retirees or dependents of military personnel, the bulk of the services provided will be with doctors, hospitals and providers who are contracted with the military or on military installations. There may be exceptions, but it is required that all members receive authorization prior to receiving treatment services.

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