UK Rehabs That Take TRICARE Health Insurance

As an official website of the United States (US) Government, TRICARE is owned and operated by the US Department of Defence, not the Department of Health (1).

As a healthcare insurance provider, TRICARE provides support for those struggling with a variety of health issues, as well as mental health issues and pharmacy services specifically.

With a rapidly expanding care service that is spreading across the US (dependent on state laws and contracts), TRICARE also has an international programme that is separate from the US Department of Defence.

Primarily, the TRICARE Overseas Programme is geared toward Active-Duty Service Members and Active-Duty Family Members but may also be suitable for individuals that are “in geographical areas and waters outside of the US” (2).

This means that those struggling with addiction and the treatment of addiction may be suitable for TRICARE Health Insurance but that this is very much dependent on their specific situation and many other deciding factors.

This article will cover some of the key features of a TRICARE Health Insurance plan, as well as the services offered by the plan and any potential limitations of this.

Does TRICARE Health Insurance cover addiction rehabilitation treatment?

Through TRICARE Health Insurance plans, an individual may be covered for a range of different substance use disorder treatments wherever it is deemed as medically necessary.

This means that an individual may be able to access treatment for their addiction/substance use disorder if it has become a risk to their physical health.

In these situations, an individual can be covered for rehabilitative treatments as it is deemed that their medical condition may worsen if they are not treated, meaning that any treatment that they receive is absolutely essential for their long-term health and wellbeing.

Which rehabs accept TRICARE Health insurance

The specific rehabs accepting TRICARE Health insurance, rather frustratingly, keep changing, and so we’ve since decided not to list the specific rehabs that do, because this is subject to change.

Please contact our helpline on 0800 140 4690 for the full list of rehabs currently accepting payment via TRICARE Health insurance.

Which services are typically covered by a TRICARE Health Insurance plan?

For a substance use disorder, TRICARE may cover the following forms and types of treatment:

• Inpatient services – in an emergency or non-emergency setting where an individual requires living within a residential rehab centre in order to recover.
• Intensive outpatient programmes – potentially including detoxification sessions, for example, where an individual must attend sessions often and regularly while continuing to reside at home.
• Withdrawal symptoms management – often included as part of the detoxification process, this is essential for preparing the body for further psychological treatments.
• Medically-assisted treatment – sometimes required in the context of an alcohol or heroin withdrawal, for example, this can ease the individual’s negative withdrawal symptoms, sometimes preventing life-threatening and physically uncomfortable symptoms.
• Mental health therapies – always recommended after undergoing detoxification, these therapies are essential for long-term recovery and a lower risk of relapse.
• Office-based opioid treatment – a specialised form of opioid treatment that can prevent long-term damage to health and potentially life-threatening consequences of addiction to opioids.
• Partial hospitalisation treatments – where an individual may require hospitalisation on a short-term basis for their long-term recovery.

Types of cover that TRICARE do not cover include aversion therapy and treatments that are unproven (i.e., with little to no medical research by US standards).

Outpatient care and medically assisted treatment through TRICARE Health Insurance

As mentioned above, an individual is able to access both outpatient care and medically assisted treatment – two forms of rehabilitation that are often not covered by healthcare insurance plans.

Outpatient care is not generally recommended for individuals struggling with addiction due to the part-time nature of the programmes, but it can be usefully employed in a number of different circumstances for specific individuals, meaning that it is suitable in some cases and only with a medical professional’s opinion.

Medically-assisted treatment is also covered, meaning that an individual can access professionally-lead detoxification – a far safer and generally highly recommended way of undergoing a detox session.

Does TRICARE Health Insurance require a referral or pre-approval process?

As mentioned in the early paragraphs of this article, a TRICARE Health Insurance plan must be deemed as medically necessary – one of the main stipulations for an individual receiving insurance through TRICARE.

However, it may also be necessary for individuals to gain pre-authorisation of different rehabilitation treatments from their local doctor or general practitioner (GP), for example, to ensure that the types of treatment that the individual is expecting to undergo will actually be beneficial for their recovery.

Does TRICARE Health Insurance include in-network and out-of-network providers?

Depending on the type of plan that an individual opts for through TRICARE will dictate which providers of care they may be able to access insurance for i.e., in-network or out-of-network.

In-network providers refer to the pre-approved providers of care that TRICARE have identified and liaised with in the past. These providers will be trusted by TRICARE and are available for treatment programmes through most of their insurance plans.

Out-of-network providers, however, are not pre-approved by TRICARE and are therefore not accessible through some of the types of healthcare insurance plan. Select and Reserve plans, for example, do not allow out-of-network providers.

However, some plans may allow out-of-network providers for individuals to partake in programmes through, but this may incur a greater cost in most cases. Speak to TRICARE directly for specific examples.

Starting the process of cover through TRICARE Health Insurance

To start the process of receiving cover through TRICARE Health Insurance, there are several important steps that an individual must take before they can access care.

These are briefly outlined below:

• Contact a Primary Care Manage (PCM) or TRICARE representative in order to discuss the different options that are available to you and what will be suitable in your individual case.
• Obtain a medical referral and clinical referral from a TRICARE-approved provider or care to ensure that the individual will gain access to the most effective and efficient treatment types possible.
• Obtain pre-authorisation from the individual’s chosen provider of care to ensure that it is TRICARE-recognised (without this, an individual may incur greater costs, or it may not be authorised on their current plan type).
• Verify and check the total costs and billing arrangements to ensure no future surprises and delays in care. Setting up a direct billing account will avoid this and ensure the least disruption to an individual’s care programme.

TRICARE Health Insurance not for you? Other sources of support

In the cases where TRICARE Health Insurance may not be suitable for an individual, there is no need to worry; there are countless different options for financial support and insurance for addiction.

Rehab 4 Addiction is a specialised referral service that has many years of experience in supporting those who require access to rehabilitation as soon as possible.

Through our services, individuals can access financial support options, as well as receiving free and confidential advice for anything in the field of addiction.

To learn more, or to find out how we can help you, a loved one, or someone else that you know who may be struggling with addiction, get in contact with our addiction support line on 0800 140 4690 today.

References

[1] TRICARE; https://tricare.mil/

[2] TRICARE International SOS; https://www.tricare-overseas.com/