Understand your plan benefits
Before you schedule treatment, it helps to get clear on how your insurance works. Each plan—whether Medicaid, Cigna, or a PPO—has its own rules around in-network providers, prior authorizations, copays, coinsurance, and deductibles. By taking a few simple steps, you’ll know exactly what to expect:
- Contact member services: call the number on your insurance card and ask about coverage for partial hospitalization, intensive outpatient care, medication-assisted treatment, and counseling.
- Review your summary plan description: look for sections on substance use disorder treatment, mental health services, and prescription coverage.
- Verify in-network status: confirm that Pax Healing is included in your insurer’s provider directory to minimize out-of-pocket costs.
- Ask about prior authorization requirements: many plans require pre-approval for Full Day Program or IOP before scheduling.
- Understand cost-sharing: note your copays or coinsurance for each service and any deductible you must meet.
By verifying these details up front, you can focus on your recovery instead of unexpected bills. It also ensures you access our tailored treatment programs without delays.
Explore Medicaid coverage
Medicaid is the nation’s largest payer of mental health and addiction services, assisting more than 85 million people across the U.S. [1]. Under federal parity laws, Medicaid plans must cover mental health and substance use treatment on par with medical and surgical benefits [2]. Typical Medicaid benefits include:
- One-on-one counseling with licensed clinicians when deemed medically necessary
- Medication-assisted treatment using FDA-approved drugs for opioid and alcohol use disorders
- Structured intensive outpatient services that let you maintain daily commitments medicaid covered iop treatment
- Day treatment in a partial hospitalization program (Full Day Program) to stabilize your condition Full Day Program program covered by medicaid
- Residential inpatient care for severe cases, subject to state medical-necessity guidelines
- Crisis intervention and stabilization services
Despite high demand, only about one-third of behavioral health providers in some counties serve Medicaid enrollees [3]. At Pax Healing, we prioritize access by accepting Medicaid and maintaining a network of licensed clinicians near you. That way, you get the comprehensive care you need without traveling long distances.
Compare Cigna and PPO options
If you also have Cigna or a PPO plan, comparing benefits can help you lower your costs. Cigna typically covers Full Day Program, IOP, and MAT through in-network providers:
- Partial hospitalization (Full Day Program) for moderate to severe substance use challenges partial hospitalization program cigna accepted
- Intensive outpatient treatment (IOP) to fit therapy sessions around work or family responsibilities intensive outpatient treatment covered by cigna
- Medication-assisted treatment integrated with counseling at approved clinics cigna-approved-mat-and-therapy-clinic
A PPO plan offers flexibility to see out-of-network providers, but you may face higher copays or coinsurance. To get the most from your PPO:
- Check the in-network directory
- Compare projected costs for in-network versus out-of-network care
- Ask your Pax Healing intake coordinator for an estimate
Because Pax Healing is in-network with Cigna and major PPO carriers, you’ll enjoy lower cost-sharing and a support team that understands your benefits.
Assess treatment levels
Selecting the right level of care depends on your clinical needs, life obligations, and treatment goals. Below are the three primary options covered by Medicaid, Cigna, and PPO plans, along with key distinctions.
Partial hospitalization programs
Partial hospitalization programs provide a high level of structure without overnight stays. You’ll:
- Attend treatment 5 days per week for 4–6 hours a day
- Receive medical oversight, individual therapy, group sessions, and family support
- Transition to less intensive care as you build coping skills
Intensive outpatient programs
Intensive outpatient programs balance strong support with flexibility. You can:
- Participate in 9–19 therapy hours weekly, scheduled in blocks
- Combine individual counseling, group work, and skills workshops
- Maintain work, school, or family commitments
Medication assisted treatment and counseling
Medication-assisted treatment pairs FDA-approved medications with counseling to address both physical and psychological aspects of substance use:
- Regular medication management visits
- Weekly individual therapy to explore triggers and develop coping strategies
- Group sessions for peer support and relapse prevention
Table: Comparing levels of care
| Level of care | Setting | Typical weekly hours |
|---|---|---|
| Partial hospitalization program | Day treatment center | 20+ |
| Intensive outpatient program | Clinic or community site | 9–19 |
| Medication-assisted treatment | Clinic or telehealth | Varies |
All three levels of care are generally covered by your Medicaid plan, in-network Cigna options, and most PPO policies when medically necessary. Verifying benefits ensures you know the treatment setting and cost-sharing ahead of time.
Evaluate MAT and counseling
Medication assisted treatment is an evidence-based approach proven to reduce cravings and prevent relapse. Pairing medication with counseling addresses both the body’s dependence and the emotional factors that influence substance use.
Suboxone maintenance
Suboxone (buprenorphine/naloxone) helps:
- Stabilize opioid receptors and ease withdrawal symptoms
- Lower risk of misuse under medical supervision
- Support a gradual taper when clinically appropriate
Coverage: Your Medicaid plan typically covers Suboxone when prescribed by an in-network provider medicaid approved suboxone treatment.
Vivitrol injection
Vivitrol (extended-release naltrexone) offers:
- A monthly injection that blocks opioid receptors
- Reduced cravings without daily medication dosing
- Support for alcohol and opioid use disorder
Coverage: Medicaid covers Vivitrol injections, often with prior authorization vivitrol program covered by medicaid.
Counseling integration
Counseling is essential to long-term recovery. Your plan may cover:
- Weekly one-on-one sessions with licensed clinicians
- Group therapy focused on life skills and relapse prevention
- Family education to involve loved ones in your healing journey
In many states, telehealth sessions count toward your counseling benefit, making it easier to stay connected with your care team [4]. Whether in person or online, consistent counseling provides the support necessary for lasting recovery.
Choose Pax Healing for care
At Pax Healing, we recognize your journey is unique. Our supportive environment and comprehensive care model include:
- Licensed clinicians experienced in addiction medicine and behavioral health
- Evidence-based Full Day Program and IOP programs that adjust as you progress
- Integrated MAT services with on-site pharmacy coordination
- Tailored treatment plans developed in collaboration with you
- Holistic wellness activities, including mindfulness, nutrition, and fitness
Because we’re in-network with Medicaid, Cigna, and major PPO plans, you’ll experience seamless transitions between levels of care without unexpected costs. Our case managers handle prior authorizations, coordinate referrals, and connect you with community resources. At every step, we provide the individualized plans and encouragement you need to rebuild your life.
Verify coverage and next steps
Ready to move forward? Follow these steps to confirm your benefits and begin treatment:
- Gather your insurance details: plan name, member ID, group number, and referring provider information
- Contact Pax Healing’s admissions team by phone or online form for a benefits check
- Review your personalized coverage summary, including copays and prior-authorization requirements
- Schedule your intake assessment with a licensed clinician to create your individualized recovery plan
By verifying your in-network benefits today, you’ll eliminate financial uncertainty and focus on healing. Reach out to Pax Healing now to take the first step toward a healthier, more empowered you.
