Jeffrey Wade
Sierra Health and Life (SHL) is a Nevada-based health insurance company that offers a range of medical and behavioural health services, including addiction treatment. SHL provides affordable healthcare plans for thousands of individuals across the United States, including Preferred Provider Organization (PPO) plans, Medicare plans, and dental and vision plans. SHL covers substance abuse and mental health services through Behavioural HealthCare Options (BHO), which includes mental health and substance use treatment, inpatient and outpatient treatment, and online education and resources. SHL members can manage their health plan information through the HPN & SHL app, which provides easy access to benefits information, notifications, and urgent care services.
| Characteristics | Values |
|---|---|
| Company Name | Sierra Health and Life (SHL) |
| Location | Nevada, United States |
| Type of Plans | Preferred Provider Organization (PPO) plans, High Deductible Health Savings Account (HSA) compatible PPO plans, Group PPO plans, Medicare plans, Dental plans, Vision plans |
| Coverage | Medical expenses, Prescription drugs, Mental health services, Substance abuse treatment, Addiction treatment, Urgent care, Digital health tools and apps, Health education and wellness classes |
| Providers | In-network and out-of-network options available. In-network providers have pre-negotiated rates. |
| Costs | Copays, Deductibles, Coinsurance |
| Authorization | Prior authorization may be required for certain treatments, such as inpatient treatment. |
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What You'll Learn
Mental health and substance abuse treatment
Sierra Health and Life Insurance (SHL) covers mental health and substance abuse treatment. SHL is a Nevada-based health insurance company that covers a range of medical and behavioral health services, including addiction treatment. SHL offers different healthcare plans that can help cover the costs of drug rehab. SHL covers treatment for most major addictions, including detox, inpatient or residential treatment, and standard outpatient treatment.
To find a provider or treatment center, you can search SHL's online provider directory or call them toll-free at 1-800-873-2246, TTY 711. You can self-refer to a mental health provider without a referral from your primary care provider (PCP). SHL offers coverage for substance abuse and mental health services through Behavioral HealthCare Options (BHO). BHO covers various types of addiction and mental health services, including mental health and substance use treatment, inpatient and outpatient treatment, and online education and resources.
It's important to note that you may be required to pay a copay for an in-network or out-of-network provider for any level of care. A copay is a cost that you pay each time you see a provider. A deductible is a fixed amount of money that you must pay before your insurance will cover services. Coinsurance is a share of the cost you are required to pay before or after you've met your deductible. Prior authorization may also be required after admission and within the first 48 hours of treatment. Some plans may require authorization before admission. During prior authorization, an insurance company determines whether they will cover a specific service, such as inpatient treatment. If you do not complete a prior authorization, your insurance company may not cover your treatment.
Both federal and Colorado state laws provide protections for consumers accessing mental and behavioral health services. Parity laws prohibit health insurance plans from being more restrictive in providing mental health, behavioral health, and substance use disorder benefits than they would be for medical and surgical benefits. These laws ensure that individuals with mental and behavioral health conditions receive equal and fair treatment.
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Inpatient and outpatient treatment
Sierra Health and Life Insurance offers coverage for inpatient and outpatient treatment for substance abuse and mental health services through Behavioral HealthCare Options (BHO). BHO covers various types of addiction and mental health services.
Inpatient treatment involves a patient staying at a facility for the duration of their care, receiving round-the-clock medically supervised care. Sierra Health and Life Insurance may cover the cost of inpatient or residential treatment, which provides daily therapy sessions, medical treatment, medications, and peer support. This type of treatment program is often the beginning of the recovery phase for people with substance use disorder, and it may involve detoxification with the use of medications that are overseen by a doctor. The inpatient setting provides a safe environment for people to withdraw from the substance they were taking.
Outpatient treatment, on the other hand, involves the patient visiting a facility 1-3 times per week to receive treatment but not staying overnight. Standard outpatient treatment commonly involves group and/or individual therapy sessions, and the patient lives at home while they are in treatment. Outpatient programs are usually advised for people who have completed an inpatient program and are transitioning to a lower level of care. Partial hospitalization, also known as day treatment, is a form of outpatient treatment that offers comprehensive treatment similar to an inpatient program, but the person returns home at the end of each day.
It is important to note that the coverage provided by Sierra Health and Life Insurance may vary depending on the specific plan and other factors such as the length and intensity of treatment, and whether the treatment is deemed medically necessary. There may be out-of-pocket costs associated with both inpatient and outpatient treatment, and prior authorization may be required to ensure coverage. It is recommended to verify your insurance coverage and understand the specific details of your plan before initiating treatment.
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Prescription coverage
As a member of Sierra Health and Life, your prescription coverage will depend on the type of health plan you have. Sierra Health and Life offers two types of plans: a Preferred Provider Organization (PPO) plan and a high-deductible Health Savings Account (HSA)-compatible PPO plan.
The PPO plan covers most of your medical expenses when you visit an in-network provider, urgent care center, or hospital. This gives you access to a large network of providers with low out-of-pocket costs. Treatment outside of the preferred network is covered but only at a reduced rate. The PPO plan is appealing due to its low premium paired with a wide range of coverage solutions in the event of a catastrophe.
The HSA-compatible PPO plan, on the other hand, has a lower premium, but you must meet a deductible—often $3,000 or more—before your insurance coverage kicks in. This plan is paired with an HSA, which allows you to save money on a tax-deferred basis for healthcare costs. The HSA-compatible PPO plan includes prescription coverage, making it easier for members to reach their deductible.
Regardless of your plan, Sierra Health and Life offers prescription drug coverage through OptumRx, their online pharmacy benefit manager. Members can register on OptumRx to view their medication history and copays, find a network pharmacy, see medication costs, and check for any restrictions. Sierra Health and Life members can also use OptumRx as a contracted mail-order pharmacy to save time and money.
For individual health plan members, local retail pharmacies can fill your prescriptions for up to 30 days at a time. This does not affect any high-cost specialty drugs received through the mail from BriovaRx. Additionally, Sierra Health and Life covers a 90-day supply of medication through local Walgreens pharmacies if certain procedures are followed.
It is important to note that copayments for prescription drugs are based on different tiers, with lower costs on tiers 1 and 2, and higher costs on tiers 3 and 4. A copay is a cost that you pay each time you see a provider. Coinsurance, which is the percentage of the drug cost that you pay after paying your deductible, also applies to prescription drugs.
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Urgent care
As a member of Sierra Health and Life, your health plan covers urgent care. Urgent care is usually the best option unless you are experiencing a life-threatening emergency.
Sierra Health and Life offers a Preferred Provider Organization (PPO) plan and a high-deductible Health Savings Account (HSA)-compatible PPO plan. Under the PPO plan, your health plan covers nearly all of your medical expenses, including urgent care, as long as you stay within their preferred network of doctors, urgent care centres, and hospitals. Treatment outside of this network is covered but only at a reduced rate. The PPO plan offers a low premium paired with a wide range of coverage solutions in the event of a catastrophe.
The HSA-compatible PPO plan offers a low premium, but the insurance does not kick in until you meet your deductible, which is often $3,000 or more. It is not clear whether urgent care is covered under this plan, but it is likely that it is, given that the PPO plan covers nearly all medical expenses.
Sierra Health and Life also offers 24/7 access to NowClinic Virtual Visits for common care needs that are not urgent or emergencies. This service allows you to connect with a provider from a computer or mobile device without an appointment. However, these visits may require a copay.
If you are unsure about whether to seek urgent care or emergency care, you can contact Sierra Health and Life's 24/7 advice nurse toll-free at 1-800-288-2264, TTY 711, to discuss your options.
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Addiction treatment
Sierra Health and Life Insurance (SHL) is a Nevada-based health insurance company that covers a range of medical and behavioral health services, including addiction treatment. SHL offers different healthcare plans that can help cover the costs of drug rehab. Using health insurance through SHL can help reduce your out-of-pocket costs for quality substance abuse treatment.
Sierra Health and Life offers coverage for substance abuse and mental health services through Behavioral HealthCare Options (BHO). BHO covers various types of addiction and mental health services, including mental health and substance use treatment, inpatient and outpatient treatment, and online education and resources.
Sierra Health and Life typically covers treatment for most major addictions. The specific services covered may include medical detox, inpatient or residential treatment, and standard outpatient treatment. SHL also covers treatment for co-occurring mental health and substance use disorders, as mandated by the Affordable Care Act.
To utilize your Sierra Health and Life Insurance for addiction treatment, you can follow these steps:
- Verify your insurance coverage: Contact SHL or visit their Online Member Center to understand your specific plan's benefits and coverage levels for addiction treatment.
- Find an in-network provider: Using SHL's provider directory or by contacting SHL directly, identify rehab centers or treatment providers that are within your insurance network. Staying in-network can help minimize out-of-pocket costs.
- Prior authorization: For certain levels of care or treatment types, you may need to obtain prior authorization from your insurance company. This ensures that the treatment is deemed medically necessary and covered by your plan.
- Choose a treatment program: Based on your specific addiction and personal needs, select a suitable treatment program. This could include medical detox, inpatient treatment, outpatient therapy, or aftercare services.
- Understand your out-of-pocket costs: Even with insurance, you may be responsible for certain out-of-pocket expenses, such as copays or deductibles. Review your insurance plan's details to understand these costs beforehand.
By following these steps and utilizing your Sierra Health and Life Insurance coverage, you can access the necessary addiction treatment services to support your journey towards recovery.
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Frequently asked questions
Sierra Health and Life (SHL) is a Nevada-based health insurance company that covers a range of medical and behavioural health services. As a member, you will either have a Preferred Provider Organization (PPO) plan or a high-deductible Health Savings Account (HSA) compatible PPO plan. Your health plan covers nearly all of your medical expenses as long as you stay within their preferred network of doctors, urgent cares, and hospitals. Treatment outside of this network is covered but only at a reduced rate.
SHL provides affordable health care plans for thousands of individuals throughout the United States, including group PPO plans, Medicare plans, dental, vision, and more. SHL also covers substance abuse and mental health services through Behavioural HealthCare Options (BHO). This includes mental health and substance use treatment, inpatient and outpatient treatment, and online education and resources.
While SHL generally covers treatment for addiction, coverage for certain drug addictions may depend on the specific plan. You may be required to pay a copay for an in-network or out-of-network provider for any level of care. It is best to verify your insurance benefits beforehand and contact Sierra Health and Life for the most up-to-date information on your coverage.
