Founded in 1992, MagnaCare Insurance serves plan participants in New York, New Jersey, and Connecticut. With a network of over 225 hospitals and 130,000 doctors, MagnaCare treats patients with substance abuse and addiction. Patients typically receive treatment using MagnaCare in-network doctors and centers. Costs for treatment and services are at a lower expense with in-network doctors. Patients will have to pay for services out-of-network. Payment options are available to cover the costs of treatment. If you require substance abuse and rehabilitation treatment services, contact a MagnaCare representative to determine eligibility.

Addictions Covered

MagnaCare covers standard substance abuse addictions, such as the following:

  • Alcohol
  • Marijuana
  • Cocaine
  • Heroine
  • Prescription opioids
  • Prescription stimulants
  • Methamphetamine
  • Benzodiazepines
  • Hallucinogens

MagnaCare also covers co-occurring disorders. For example, co-occurring complications, also called comorbid disorders, include mental health illness(es) that co-occur at the same time with a substance addiction.

The diagnosis of a substance use disorder is based upon a pathological pattern of behavior where patients present fulfilling a list of criteria. For example, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013), impaired control over substance is the first criterion.

The patient reports consumption over a long period (Criterion 1).

The patient usually reports unsuccessful efforts to discontinue use (Criterion 2).

The individual spends a great deal of time-consuming the substance, virtually taking the whole day (Criterion 3).

The individual reports craving and an intense desire or urge for the substance (Criterion 4).

There is recurrent substance use that affects the individual’s ability to work or attend school (Criterion 5).

The individual continues substance use even though they exacerbate personal problems (Criterion 6).

The individual gives up important social, occupational, and recreational activities due to substance use (Criterion 7).

Risk increases with substance use (Criteria 8-9).

Tolerance increases (Criterion 10).

The substance is concentrated in the individual’s blood or tissue due to prolonged use (Criterion 11).

Individuals with substance abuse and substance abuse problems still experience withdrawals even if they report tolerance.

Given the criteria for substance use and substance abuse disorder, the DSM-5 outlines examples of substance abuse, substance-induced, substance-related, and substance use disorders comorbid with a mental illness. The following are examples of substance use disorders and their comorbidity with various mental illnesses.

Alcohol Use Disorder

Alcohol use disorder (AUD) is defined as a problematic pattern of alcohol use leading to clinically significant impairment occurring within 12 months (APA, DSM-5, 2013).

AUD is typically comorbid with bipolar disorder, schizophrenia, and antisocial personality disorder.

Alcohol Intoxication

Alcohol intoxication is defined as recent ingestion of alcohol, clinically significant problematic behavior, and presenting with signs and symptoms such as slurred speech, incoordination, unsteady gait, and impairment in attention or memory (APA, DSM-5, 2013).

Alcohol intoxication is comorbid with individuals who have other substance intoxication and who present with conduct disorder or antisocial personality disorder.

Alcohol Withdrawal

Alcohol withdrawal is the cessation of alcohol use after heavy and prolonged activity; it includes the following symptoms: increased hand tremor, insomnia, nausea and vomiting, anxiety, and psychomotor agitation (APA, DSM-5, 2013).

Alcohol withdrawal is comorbid with individuals who present with conduct disorder and antisocial personality disorder.

Cannabis Use Disorder

Cannabis use disorder is the problematic pattern of cannabis use that leads to clinically significant impairment, occurring within 12 months (APA, DSM-5, 2013). Cannabis use and cannabis use disorder are comorbid with other substance use disorders.

Cannabis use is associated with anxiety disorders, suicidal ideation, and conduct disorder. Cannabis use disorder is also associated with alcohol use disorder and tobacco use disorder. Among those seeking treatment for a cannabis use disorder, 74% report problematic use of a secondary or tertiary substance: alcohol (40%), cocaine (12%), methamphetamine (6%), and heroin or other opiates (2%) (APA, DSM-5, p. 515). Major depressive disorder, anxiety disorders, and bipolar I disorder are all common comorbid with cannabis use disorder.

Opioid Use Disorder

Opioid use disorder is the problematic pattern of using opioids, leading to clinically significant impairment, occurring over 12 months (APA, DSM-5, 2013).

Opioid use disorder is comorbid with other substance use disorders and includes tobacco, alcohol, cannabis, stimulants, and benzodiazepines. It is associated with opioid-induced depressive disorder. Posttraumatic stress disorder is generally associated with opioid use disorder and other substance-related disorders.

Stimulant-Related Disorder

The stimulant-related disorder includes stimulant use disorder, stimulant intoxication, stimulant withdrawal, and other related stimulant use disorders. Individuals typically present with a pattern of an amphetamine-type substance, cocaine, and other stimulants leading to clinically significant impairment occurring over 12 months (APA, DSM-5, 2013).

The stimulant-related disorder is comorbid with other substance use disorders, especially disorders involving sedative properties. Stimulant use disorder may be associated with posttraumatic stress disorder, antisocial personality disorder, attention-deficit/hyperactivity disorder, and gambling disorder (APA, DSM-5, p. 567). The stimulant-related disorder is associated with medical problems involving cardiopulmonary issues resulting from cocaine use.

Hallucinogen-Related Disorders

Hallucinogen-related disorders fall under multiple categories and are generally defined as a pattern of using phencyclidine (PCP), which is angel dust, which has a mind-altering effect. A pattern of use leads to clinically significant impairment occurring over 12 months (APA, DSM-5, 2013).

Hallucinogen-related disorders are typically comorbid with nonsubstance mental disorders such as anxiety, depressive, and bipolar disorders. They are also associated with rates of adult antisocial behavior and comorbid with hallucinogen use disorder.

This list of substance abuse and substance use disorders comorbid with mental illness disorders is not exhaustive. Speak with a MagnaCare insurance professional to determine if you are eligible for coverage.

Covered Treatment

MagnaCare covers different addictions and patients with multiple withdrawal symptoms, including those co-occurring with mental disorders. MagnaCare may cover assessments, exams, therapy, medications, and residential treatment services, which may include room and board.

A clinical assessment conducted by a substance use professional is typically required before the provision of treatment and services. The following represents the treatment and services MagnaCare may cover depending on your plan:

Detox

Detox helps patients seeking substance use withdrawal. Detox includes support for early recovery, which provides for monitoring and prescription medications. Detox is not a comprehensive treatment for addiction.

Standard Outpatient

With standard outpatient treatment, patients can visit the facility at different times or by appointment, receive assessments, medication, and therapy, and then return home.

Inpatient

Inpatient treatment is called residential treatment, which provides 24-hour care. Patients have access to room and board where they can eat, sleep, and attend therapy sessions. They receive medical care. Family members can visit.

Intensive Outpatient

Intensive outpatient treatment is for patients who do not need 24-hour monitoring. Patients attend treatment a week for several hours. Although patients do not need 24-hour supervision, they still require considerable care during recovery.

Partial hospitalization

Partial hospitalization is day treatment. It involves patients who need partial hospitalization to receive treatment. Patients are monitored during the day but return at night. Partial hospitalization is similar to residential/inpatient rehabilitation programming.

How Coverage Works

MagnaCare coverage depends on the plan and the state in which you live. Covered treatment facilities are usually within the MagnaCare’s network. To receive full benefits of insurance coverage, you must visit a treatment facility or physician in-network. You may pay out-of-pocket expenses in-network.

If you seek treatment for substance use disorder at an out-of-network treatment facility, you will need to discuss a payment plan with your provider. Besides, pre-authorization may be required before treatment. The authorization will reference the number of days you will need to spend inpatient and visits allowed through outpatient care.

Out-of-pocket expenses typically include a deductible, a copay, and coinsurance. Coinsurance requires you to pay before or after your deductible a fixed percentage of the treatment.

Contact

To get started, contact MagnaCare to find out your coverage eligibility. You can visit us on our site, fill out the form, and a representative will contact you directly. The information is below in our Resources section.

When speaking with a MagnaCare representative, be sure to ask the following questions: Does MagnaCare cover:

  • Inpatient treatment?
  • Outpatient treatment?
  • Deductibles or copays?
  • Medically-supervised detox programming?
  • Out-of-pocket costs?

Finding a MagnaCare insurance provider will include getting answers to these fundamental questions.

To learn more, visit our site and contact a treatment specialist.

Resources

MagnaCare Contact Us:
https://www.magnacare.com/contact-us/

MagnaCare Health Plan Management:
https://www.magnacare.com/health-plan-management/ppo/

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition. Washington, D.C.: American Psychiatric Publishing.