One of the most difficult things about getting started with mental health services or alcohol and drug addiction treatment is confronting the cost of treatment.
Fortunately, spouses, dependents, and survivors of Veterans with a service-connected disability have access to a health insurance plan through the VA.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) offers health care benefits for mental health treatment or drug and alcohol rehab programs.
And at Otter House Wellness, we work with your CHAMPVA benefits to help you access the addiction or mental health care you need to face brighter days.
Does CHAMPVA Cover Addiction & Mental Health Treatment?
Unlike other VA Health care programs for active-duty service members, CHAMPVA provides health benefits to family members of a Veteran who is permanently disabled.
CHAMPVA insurance benefits cover a range of treatment options for mental health conditions and substance use disorders through a Tricare or Medicare-certified rehab center.
This includes inpatient treatment, outpatient treatment, detoxification, and treatment of co-occurring disorders. Hospitalization and other related healthcare services may also be covered.
At Otter House Wellness, we work with CHAMPVA to give you access to the treatment services that you need. Call us to learn more about what treatments CHAMPVA covers.
Substance Abuse Treatment Programs Covered by CHAMPVA
Similar to other insurance providers, CHAMPVA covers a range of drug and alcohol rehab treatment programs that address substance abuse and behavioral health issues.
CHAMPVA does impose some limits on what is covered without prior authorization. This includes limits of episodes in a lifetime. A single episode is defined as lasting from the day substance use disorder treatment starts until 365 days later.
Detox & Inpatient
CHAMPVA requires prior authorization before covering detox services for opioid drugs, alcohol, or other substances. They also limit the service to seven days.
Similarly, CHAMPVA requires prior authorization for an inpatient level of care and limits CHAMPVA benefits in this area to 21 days at certified rehab facilities.
Otter House Wellness does not provide inpatient treatment for mental health or substance abuse but can refer you to qualified providers who do if that is the level of care you need. Call us today to learn more about the continuum of outpatient programs that we do offer.
Outpatient Programs
Beneficiaries of the CHAMPVA program can expect to receive coverage for therapy in an outpatient level of care for drug and alcohol use.
That means you don’t need prior authorization for services in an outpatient or intensive outpatient program (IOP). These programs offer several treatment hours per week at flexible times that allow for work or school schedules.
You will need authorization, however, for a partial hospitalization program (PHP), which is an intensive treatment program that lasts eight hours a day, five days a week. Similar to inpatient treatment, a PHP is limited to 21 days.
Aftercare
Aftercare services address relapse prevention and other services. It may be covered under CHAMPVA’s outpatient program benefits. However, it imposes limits on the number of therapy sessions during treatment.
You should contact your VA benefits representative to clarify how many therapy sessions you can receive and if they provide more with prior authorization.
Mental Health Programs Covered by CHAMPVA
CHAMPVA also offers mental health care services for people facing such mental health issues as ADHD, mood disorders like depression, and post-traumatic stress disorder (PTSD).
This gives you access to multiple levels of care and evidence-based treatment through mental health facilities that are in-network with CHAMPVA. Inpatient hospitalization, residential treatment, and partial hospitalization all require prior authorization.
Mental health programs covered by CHAMPVA include:
- Acute inpatient care: This level of care can be included in a treatment plan but CHAMPVA limits the stay to 30 and 45 days for adults and children respectively.
- Residential treatment: Residential treatment is covered at a Joint Commission-accredited or Tricare-certified facility for up to 150 days a year.
- Partial hospitalization program (PHP): PHP is also covered to address mental health problems with a limit of 60 days per year.
- Outpatient programs: Psychotherapy, medication, management, and psychological testing are all covered with limits applying to the number of therapy sessions.
Otter House Wellness provides outpatient programs for both mental health and substance use disorder treatment. Call us today to learn more about using your CHAMPVA insurance for these programs.
Therapies Covered by CHAMPVA
CHAMPVA limits the number of therapy sessions without prior authorization but covers a wide range of therapies for mental health problems and addiction within that context.
Therapies covered by CHAMPVA include:
- Cognitive behavioral health (CBT): CBT helps you address the root causes of mental health or addiction issues and build new thought patterns and behaviors.
- Dialectical behavior health (DBT): DBT addresses issues of emotional regulation and helps you plot a new way of responding to stress and other situations.
- Family therapy: In family therapy, a loved one, you, and other family members work through relational difficulties to find reconciliation.
- Group therapy: Group therapy allows you to share openly while encouraging others. These groups often also function as support groups.
- Individual therapy: Individual therapy is your confidential time in a safe environment with a therapist to discuss personal issues that you can’t talk about with anyone else.
At Otter House, our licensed therapists are trained in a variety of therapies that help them meet your specific treatment needs. Reach out to us today to learn more about how therapy can help you maintain sobriety or manage mental illness.
Cost of Addiction & Mental Health Treatment with CHAMPVA
Treatment for addiction or mental health disorders can be expensive, but people who find eligibility for VA benefits through CHAMPVA can find some financial relief.
Deductibles are typically $50 for individuals and $100 for families. Coinsurance is 25% of the cost unless CHAMPVA is the secondary insurance. Then CHAMPVA would pay 100% up to the allowed amount.
CHAMPVA typically does not have copayments for behavioral health or addiction-related treatment services.
Who Qualifies for CHAMPVA Insurance?
CHAMPVA is for dependents, a spouse, or survivors of Veterans who have been permanently disabled in connection with their military service.
This includes Veterans who died as a result of a service-related permanent disability or Veterans who were permanently disabled in connection with their service at the time of death.
It also includes the spouse and dependents of Veterans who are living with a permanent total disability resulting from their service.
Surviving spouses who remarry on or after their 55th birthday can keep CHAMPVA benefits. Also, dependents who are enrolled in high school or college can keep their CHAMPVA benefits until they are 23.
Find Addiction Treatment Centers That Accept CHAMPVA
If you are facing substance abuse or a mental health disorder, you can find addiction and mental health treatment at Otter House Wellness using your CHAMPVA insurance.
At Otter House Wellness, we provide a continuum of outpatient programs delivered by providers who care about your individual needs. We give you everything we can to help you find success in maintaining sobriety or managing your mental health condition.
Call our helpline today to learn more about how you can use CHAMPVA at Otter House Wellness to start your recovery or mental wellness journey.
