VNS Health EasyCare: Outpatient Substance Abuse Services

Ongoing group and individual therapy sessions are critical for mental health maintenance, including substance abuse and addiction services.

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Cost

$35 copay

Prior Authorization Required

Yes

Provider Referral or Order Required

Yes

How To Receive

Details on how to apply

Obtain a network provider order for outpatient substance abuse services.
- The plan member may self-refer for one assessment from a network provider in a 12-month period (i.e., they do not have to have a referral from their primary care provider to be assessed for/admitted to outpatient substance abuse services).
Contact the VNS Health EasyCare Team at (866) 783-1444 (TTY 711) to discuss services and prior authorization.
- The ordering provider may help with authorization.
Select a network substance abuse treatment facility.
Schedule an initial visit with the network treatment facility.
- The network treatment facility may also help with authorization.
Attend the initial visit and, together with the substance abuse care team, identify issues and develop goals of care.
Attend future visits, as scheduled, until goals are achieved.

For behavioral- and mental health-related information, call the health plan provider partner: Carelon Behavioral Health at (888) 204-5581 -OR- Search network facilities: Click on the Behavioral and Mental Health tab on the page, then click on Alcoholism & Substance Abuse General Outpatient.

Availability

1 assessment in a 12 month period; Sessions ongoing, until goals are achieved

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Treatment for substance abuse focuses on understanding the nature of addiction, becoming drug-free, and preventing relapse.

There are many individual, group, or family therapy options and they are frequently used in combination. Therapies include talk therapy (the bedrock of therapy), cognitive-behavioral therapy, dialectical therapy, motivational interviewing, 12-step facilitation, yoga and meditation, art and music therapy, online therapy, and of course adjuvant medication therapy.

Substance abuse services are provided in an office, clinic environment, an individual’s home, or other appropriate locations. Services are provided by a physician, clinical psychologist, clinical social worker, nurse practitioner, clinical nurse specialist, certified nurse midwife, physician assistant, or other Medicare-qualified health care providers.

Covered services include but are not limited to:

Initial and ongoing evaluation/assessment
An individualized plan of care with clear treatment goals based on needs and response to treatment
Individual and group psychotherapy that focuses on behaviors associated with alcohol and/or drug use, including lifestyle, attitudes, relapse prevention, and coping skills
Family counseling and involvement as appropriate
Discharge planning that includes the identification of realistic discharge criteria

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