Magellan Insurance for Mental Health and Addiction

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With the number of insurance plans increasing and becoming more complex to understand, not vision rules every year, not to mention renewal every year, it can be challenging to understand your policy and its benefits as it relates to mental health and addiction. Fortunately, in no small part due to the 2008 mental health and addiction parity act, mental health, and addiction. Issues are treated the same way as other medical problems. That said, insurance can still exclude mental health and addiction treatment from their coverages, though most tend to have some coverage.

If you or a loved one is seeking treatment and have a Magellan health insurance plan, this handy guide can help you understand potential out-of-pocket expenses and learn more about benefits and coverages. Magellan will likely cover mental health concerns like anxiety, depression, PTSD, etc. Magellan policies also cover most substance use disorders, including alcoholism and drug use. The level of coverage that you will receive varies between procedures, and the best way to understand more about your possible out-of-pocket expenses is to speak to the insurance company directly by calling the phone number on your insurance card and also contact our admissions department. They can help you verify your benefits and estimate any expenses you may have had to be MHC.

Before we delve into Magellan‘s mental health and addiction coverage details, we must discuss the terms you may see within your policy.

Co-pay: co-pays are a fixed amount paid to the provider, as the insurance policy delineates. These co-pays typically vary between specialties seen and the service or procedure needed. The visit usually pays co-pays.

Deductible: Your deductible is the number of coverage services that you or the plan owner must pay for before insurance begins paying for services. Depending on the plan, deductibles can range from zero to a few thousand dollars. Some insurance costs are not applied to the deductible, so verifying your benefits with the insurance company and our mental health facility is essential.

Coinsurance: Once you have met your deductible and insurance starts paying for your care, they may also want you to pay additional fees. Depending on your plan, coinsurance may be as low as 0% or as high as 50%.

Maximum out-of-pocket: This is the amount at which you do not have to pay any more for your medical care, regardless of your plan details. This maximum is often calculated by adding deductibles, coinsurance payments, and co-pays.

Does Magellan Limit the Number of Days in Treatment?

Some plans will have treatment limits varying between programs and the conditions being treated. Proper care is crucial in getting people a utilization review specialist in the treatment industry. As it is commonly known, you are interfacing with case managers at the insurance company to ensure. Patients get the appropriate treatment. Unfortunately, most insurance companies are not willing to pay for what we consider an entire course of treatment, so we work with our patients to see their best option.

Does Magellan Require Preauthorization?

The pre-authorization process will vary between policies, and this will be discussed and verified during your discussion with our admissions team and intake specialists. Some policies may allow authorizations within the first 48 hours of mental health and addiction treatment. With a pre-authorization or if mitigating circumstances did not prevent you from getting this pre-authorization, services may not be covered even if they are explicitly stated in your policy coverages.

Pre-authorization guidelines will also depend on the level of care being provided. On the substance use side, Magellan typically covers required detox followed by intensive outpatient, outpatient, partial hospitalization, and residential services for substance abuse and addiction. For mental health services, Magellan typically covers intensive outpatient, outpatient, PHP, and residential care. The co-pays and other out-of-pocket expenses for each of these services may vary. We are happy to help you understand precisely what coverage your policy provides.

In-Network Versus Out-of-Network Coverage

As with all insurances, Magellan designates providers that have specific contracts service contracts with them as in-network providers. These providers can offer lower-cost healthcare with the expectation of referrals and hire caseloads from the insurance company. While out-of-network coverage may come with additional expenses, sometimes this is an appropriate course of action when the facility specializes in your needs. Again, we encourage you to speak to our admissions department to understand your cost and what therapeutic modalities your plan covers.

Magellan’s Commitment to Behavioral Healthcare

Magellan’s behavioral connection and focus on behavioral health started from its founding as a psychiatric hospital chain in Georgia in 1969. Today, it is a wholly-owned, behavioral health-focused subsidiary of mega-managed care company Centene Corporation. Their commitment to behavioral health is evident with one of their clinical employees recently co-chairing the National Quality Forum Committee, which develops guidance to help healthcare practitioners implement the Opioids and Behavioral health measurement framework. This framework was published in September 2022.

Can My Magellan Claim Be Denied?

As with all insurance companies, Magellan reserves the right to deny claims. However, these denials can also be appealed. The cause of most denials, when a patient has coverage and is in an appropriate treatment center, usually comes from clerical errors, which can easily be remedied. If you experience a rejection from Magellan, the first step is to call the number on the back of your insurance card and get a written explanation. From there, we can help you address the denial and hopefully have it overturned. If multiple claim resubmissions are denied, the appeal can be escalated for independent review.

What if Magellan Does Not Cover the Therapies I Need?

During the intake process, we will work with you to develop an appropriate plan based on your prior care, prior and new diagnoses, and individual needs. This treatment plan can and will change as you progress through our program. Treatment modalities not covered by your insurance plan may be needed. We will work with you and other stakeholders in your care to find the best way to pay for these services or get them covered. Our focus is on providing holistic healthcare and easing the financial burden on our patients.

Are You on the Fence About Mental Health and Addiction Treatment?

It’s often said that asking for help is the hardest part of the treatment process. For many, it may be difficult to admit that there is a problem. However, the first step is to call our admissions team and verify your Magellan benefits. This information will allow you to understand more about your coverages and learn about the treatment process for your specific condition. It’s also a great time to get to know us. We encourage you to make the call and get started with the help you need.

*Note: Insurance coverages and policies can vary, so please speak to your insurance company and our intake specialists to get up-to-date information on your policy.


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