If you are in search of treatment for drug and alcohol addiction and are covered by HealthSmart insurance, you might wonder, “Do HealthSmart Insurance plans cover rehab?” Do you have questions about the extent of coverage for various services and the potential out-of-pocket expenses? Continue reading for insights into HealthSmart insurance coverage and guidance on verifying your benefits.

Who is HealthSmart Insurance?

HealthSmart operates as a third-party administrator (TPA), not an insurance company. Specializing in healthcare services for self-funded employers and insurance carriers, HealthSmart delivers inventive administrative solutions, cost management strategies, and health improvement programs. Their focus is on effectively managing healthcare benefits for the insured.

HealthSmart was founded in 1996 and is headquartered in Irving, Texas. Established to offer healthcare solutions to employers and various stakeholders in the healthcare industry, HealthSmart has evolved into one of the largest TPAs in the United States. The company now serves clients across all 50 states.1

HealthSmart provides various healthcare solutions such as claims processing, network management, managed care, wellness programs, health savings accounts (HSAs), and pharmacy benefits management. These services are designed to assist employers and other stakeholders in lowering healthcare expenses while enhancing the health and well-being of their employees and members.

Some Healthsmart Insurance Brands, Products, and Services

HealthSmart offers a broad range of brands, products, and services designed to cater to diverse healthcare needs. Collectively, these offerings contribute to HealthSmart’s commitment to delivering comprehensive and effective healthcare solutions. Below is a glimpse into some of HealthSmart’s offerings:

  • Managed Care Solutions ensure effective coordination and management of healthcare services for individuals and organizations.2
  • Network Solutions offers access to an extensive network of healthcare providers, facilitating seamless and quality healthcare delivery.
  • Telemedicine Services provide convenient, accessible telemedicine services, allowing policyholders to access healthcare remotely through virtual consultations.3
  • Wellness Advocate Program promotes proactive health management, encouraging policyholders to adopt and maintain healthy lifestyles.4
  • Benefits Administration streamlines managing and overseeing various healthcare benefits for individuals and groups.
  • Pharmacy Benefit Management services aim to optimize medication-related outcomes while controlling costs, ensuring efficient and cost-effective prescription drug coverage.5
  • Population Health Management employs strategies to enhance overall health outcomes by addressing health disparities and promoting preventive care.6
  • Data Analytics and Reporting provide insights and reporting tools to facilitate informed decision-making, helping clients navigate and optimize their healthcare strategies.
  • Customized Insurance Solutions are tailored to meet clients’ unique needs, providing flexibility and personalized health coverage options.
  • Employee Assistance Programs (EAP) support employees’ mental and emotional well-being by offering confidential counseling and assistance to help them navigate personal and professional challenges.

What is HealthSmart Addiction Treatment Coverage?

HealthSmart is not an insurance provider and does not offer insurance coverage for addiction recovery or other healthcare services. However, HealthSmart may collaborate with insurance carriers or self-funded employers that include addiction treatment coverage as a part of their employee benefits package.7

Your addiction treatment coverage will depend on your employer and health insurance carrier, as HealthSmart is a third-party plan administrator. Your company may offer personalized, cost-effective plans for employees that include addiction treatment coverage,8 which refers to the amount a health insurance policy reimburses for services such as inpatient and outpatient care and programs for substance abuse, detoxification, counseling, psychotherapy, and aftercare. The coverage level can be affected by various factors, such as the insurance policy and required rehabilitation treatments.

Do HealthSmart Insurance Plans Cover Rehab for Alcohol and Drugs?

The extent of coverage for drug and alcohol addiction recovery is contingent upon the particulars of your policy and plan managed by HealthSmart. While HealthSmart operates as a claims management entity rather than an insurance company, it typically oversees claims related to substance abuse and mental health treatment within the scope of its comprehensive behavioral health services.

For a detailed understanding of your plan and a more precise grasp of the extent of your coverage for substance addiction rehabilitation, call (888) 995-6311. Our dedicated team can guide you through the details and address any questions you may have. Alternatively, you can check your insurance via our confidential online form for precise information on the coverage applicable to your specific situation.

Does HealthSmart Insurance Cover Medical Detox Services?

Yes, HealthSmart typically manages claims for medical detoxification services as part of its comprehensive behavioral health services. The specific coverage details are outlined in your policy and will depend on your insurance provider and particular plan. Our team is available to provide specific information, answer questions, and guide you through accessing medical detox services if necessary.

Your well-being and recovery are our priorities, and at Summit Behavioral Health, we are committed to supporting you through every step of the process. For inquiries about your benefits for medical detox services, please contact us directly.

Does HealthSmart Insurance Cover Mental Health Treatment and Therapy?

HealthSmart, while not an insurance provider, is known for its inclusive approach, often encompassing mental health treatment and therapy as integral components of their comprehensive behavioral health management and services. This entails a diverse array of therapeutic methods and targeted interventions designed to address many different mental health conditions.

The specifics of this coverage can be found within your policy documentation, or you can reach out to our team at Summit Behavioral Health for guidance in comprehending and accessing the services included. Should you have inquiries or seek personalized assistance regarding your mental health coverage, call (888) 995-6311. Your journey to mental health and wellness is central to our commitment, and we stand ready to support your well-being.

Other Addiction Treatment Programs Covered by HealthSmart Insurance

HealthSmart extends its management services to various addiction treatment programs, recognizing the importance of comprehensive care. These programs are tailored to address diverse aspects of addiction, offering a range of therapeutic interventions and support services.  As we explore the specific addiction treatment programs, you’ll recognize that HealthSmart’s commitment to comprehensive care extends to various modalities to meet individuals’ unique needs.

HealthSmart Insurance Coverage for Partial Hospitalization Programs (PHPs)

A Partial Hospitalization Program (PHP) is an intensive, structured form of outpatient care for individuals requiring comprehensive care for mental health or substance use disorders. PHPs offer a therapeutic environment that combines daily, structured programming and allows individuals to return home in the evenings.

These programs often include individual and group therapy, psychiatric care, and various therapeutic interventions, providing a higher level of support than traditional outpatient care while allowing for some level of independence. By typically including PHPs in their coverage, HealthSmart underscores its commitment to offering various treatment options to address diverse needs. The coverage specifics are subject to the terms and conditions outlined in your insurance policy. Contact Summit Behavioral Health at (888) 995-6311 to better understand your extent of coverage for PHPs.

HealthSmart Coverage for Intensive Outpatient Programs (IOPs)

HealthSmart commonly covers Intensive Outpatient Programs (IOPs), which provide structured yet flexible care for individuals dealing with mental health or substance use disorders. This coverage highlights the significance of offering comprehensive treatment while allowing individuals to retain their independence. Refer to your policy documents or call (888) 995-6311 for more information on IOPs and coverage specifics.

HealthSmart Insurance Coverage for Acute Treatment Programs

Acute treatment programs provide intensive, short-term care for individuals facing severe mental health or behavioral crises. These programs often involve inpatient hospitalization or residential care to address immediate and critical needs. Acute treatment programs aim to stabilize individuals, manage crises, and establish a foundation for ongoing mental health support.

HealthSmart typically provides coverage for these programs, recognizing the urgency and importance of addressing acute mental health challenges. Coverage specifics can be found in the policy documentation, or you can call (888) 995-6311 for guidance on the extent of coverage for acute mental health treatment and how you can access timely, critical care when needed.

HealthSmart Insurance Coverage for Residential Rehab

Residential rehab, or inpatient rehabilitation, is an immersive treatment program for substance abuse or mental health disorders involving residing in a facility where you or a loved one receives intensive care and support. HealthSmart typically covers residential rehab, though coverage details can vary. Review your plan specifics or contact us for information on accessing these services.

Rehab Center in New Jersey That Takes HealthSmart Insurance

Embark on your journey to recovery and sobriety with Summit Behavioral Health in New Jersey, where our dedicated treatment center is committed to guiding individuals and their loved ones through the crucial steps of addiction recovery and challenges associated with mental health disorders. Our mission is clear: Providing unwavering support at every stage.

At Summit Behavioral Health, we recognize the complexity of this journey, and our state-of-the-art facilities employ an integrative treatment approach. This approach seamlessly blends reliable clinical practices and evidence-based intervention strategies. Choosing Summit Behavioral Health means choosing the path to achievable recovery. Let our experienced team lead you towards a healthier life, free from substances, and assist you in developing the mental and emotional tools necessary for sustained sobriety and fulfillment.

Take the first step towards a transformed life by calling (888) 995-6311 or visiting our outpatient New Jersey-based treatment facility at the following address:

Summit Behavior Health – Princeton Junction, New Jersey
4065 Quakerbridge Road, Suite 102
Princeton Junction, NJ 08550

How Much Does Addiction Recovery Cost with a HealthSmart Insurance Policy?

The cost of addiction recovery with an insurance policy managed by HealthSmart varies depending on specific details, such as the particular plan and treatment program. A significant portion of addiction treatment expenses are typically covered, including inpatient and outpatient programs and other essential services. For reference, an individual psychotherapy session without insurance costs $100 – $200 per session.9
The exact costs and coverage details can be determined by calling (888) 995-6311. Understanding the coverage limits, copayments, deductibles, exclusions, and other expenses associated with the prescribed treatment plan is essential to making informed decisions about addiction recovery costs.

How To Check HealthSmart Insurance Coverage Levels for Addiction Treatment

It’s crucial to comprehend the specifics of your insurance policy and locate addiction recovery centers that take HealthSmart insurance policies. We recognize that insurance details can be complicated and time-consuming, so we streamline this process for you. Evaluate your coverage for addiction treatment by calling (888) 995-6311 or completing our confidential online form:

After contacting your insurance provider, our team will promptly reach out to discuss the specifics of your coverage. At Summit Behavioral Health, our commitment is to offer crucial support and guidance throughout your journey, enabling you to make informed decisions about your rehabilitation and fully comprehend your insurance coverage.

How To Get HealthSmart to Pay for Addiction Treatment

To secure coverage for addiction treatment from HealthSmart, carefully review your policy details. This involves checking for specifics on detoxification, counseling, and rehabilitation coverage. Ensure you select treatment centers that accept HealthSmart. Clarify details like co-pays, deductibles, and prior authorization requirements. Be sure to submit any necessary documentation from your healthcare provider, such as a treatment plan or referral.

Additionally, confirm that the treatment center will submit claims on your behalf. Effective communication with both the treatment facility and the insurance provider increases the likelihood of HealthSmart covering your addiction treatment needs in New Jersey.

How Many Times Will HealthSmart Insurance Pay for Drug & Alcohol Rehab?

HealthSmart covers addiction recovery services deemed medically necessary. The frequency of coverage depends on your specific plan and policy—certain plans may have treatment limits or restrictions, while others may provide unlimited coverage. Regardless of coverage quality, most insurance carriers typically require a recommendation from your primary care doctor.

To embark on a journey toward a new and deserving life, access the required treatment through Summit Behavioral Health’s outpatient programs tailored to your needs. Remember, each person’s journey is unique, and others’ experiences shouldn’t discourage you. Call (888) 995-6311 for clarity on coverage details and answers to how often and how long does HealthSmart pay for inpatient addiction recovery or other programs.

Drug & Alcohol Addiction Statistics in New Jersey

  • According to data extracted from New Jersey Hospital Discharge records, there was an approximately 23% rise in the percentage of total hospitalizations that included either a primary or secondary diagnosis of alcoholic liver disease from 2019 to 2021.10
  • New Jersey has an average of 4.14 deaths per 10,000 adults due to excessive alcohol use. This means that one person aged 18 or older dies for every 3,088 people.11
  • As indicated by the National Drug Intelligence Center, New Jersey faces a high risk of substantial illicit drug distribution, primarily attributed to criminal organizations operating illegal distribution networks within the state’s borders.12
  • Commercial Township School District in Cumberland County, New Jersey, reported 142.86 cases of drug or alcohol-related cases per 1,000 students during the 2018-19 school year.13
  • From January 1, 2023 – August 31, 2023, there were 2,132,703 opioid prescriptions and 1,790 suspected overdose deaths in the state of New Jersey.14
  • In 2021, in New Jersey, the drug overdose death rate per 100,000 population was 37.5.15

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