Substance Use Disorder Treatment with Tricare Insurance

Once known as the Civilian Health and Medical Program of the Uniformed Services, TRICARE insurance is a supplemental health care program for all military service members and their families. The United States Department of Defense Military Health System offers this program to:

  • U.S. Air Force
  • Army
  • Navy
  • Marine Corps
  • Coast Guard
  • Commission Core
  • U.S. Public Health Service
  • Commission Core of the National Oceanic and Atmospheric Association

TRICARE insurance made significant changes to their mental health benefits in 2017. They now cover substance use disorders and co-occurring mental health disorders. Members of the military have long struggled with abusing alcohol and drugs such as opioids. TRICARE’s new coverage can help retired, and present military members achieve lasting recovery.

However, many factors play a role in substance use disorder treatments covered by TRICARE insurance. These factors include the individual’s plan benefits, the state the person lives in, type of treatment, and legal requirements.

Who Can Enroll in TRICARE Insurance?

TRICARE insurance policies cover military service members and their families. If you meet any of the following, you can enroll in TRICARE insurance.

  • Active duty service members and their families
  • Retired service members and their families
  • Activated
  • Called or ordered to active duty for more than 30 days in a row
  • National Guard/Reserve members and their families
  • Non-active National Guard/Reserve members and their families who qualify for care
  • Retired National Guard/Reserve
  • Survivors
  • Medal of Honor recipients and their families
  • Qualified former spouses

TRICARE Insurance Health Plans

Like many other insurance plans, TRICARE insurance offers members a variety of insurance plans. One thing all plans have in common is they meet or exceed the standards established by the Affordable Care Act (ACA). These standards ensure people have quality options to meet their needs.

While military members and their families have eight health care plans to choose from, each one has a detailed list of what it does or doesn’t cover.

  • TRICARE Prime – provides coverage in areas of the U.S. considered prime locations
  • TRICARE Prime Remote – provides coverage in remote locations in the U.S. and some areas overseas
  • TRICARE Standard and Extra – requires a fee to be paid but doesn’t require enrollment
  • TRICARE Standard Overseas – provides comprehensive coverage for members overseas
  • TRICARE for Life – a Medicare option for members on Medicare Part A or B
  • TRICARE Reserve Select – a premium-based plan for certain reserve service members and their families
  • TRICARE Retired Reserve – a premium-based plan for retired members under 60 years of age and their families
  • TRICARE Young Adult – provides coverage for young adults not eligible for other TRICARE plans

The specific coverage offered to members will depend on the member’s service and qualifications.

Do Treatment Centers Need to Be In-Network with TRICARE Insurance?

Typically, TRICARE insurance only offers full coverage for in-network treatment centers. In-network means the treatment center agrees to charge TRICARE a set price for services. Generally, members in in-patient treatment only have a small out-of-pocket payment.

Some TRICARE insurance plans allow members to use out-of-network treatment centers. These plans include:

  • TRICARE Select
  • TRICARE Reserve Select
  • TRICARE Retired Reserve
  • TRICARE Young Adult Select
  • TRICARE Family Health
  • TRICARE Prime Remote

However, seeking out-of-network care may require members to file claims and pay higher out-of-pocket costs. Out-of-network treatment centers can charge up to 15 percent more than in-network providers. Additionally, members may have to pay the full cost upfront and seek reimbursement after treatment is finished.

What Does In-Network Mean?

TRICARE generally only offers full coverage to select providers. These in-network providers have a pricing agreement with TRICARE for addiction and mental health treatment. However, in an in-network treatment center, members pay a small portion of the cost out-of-pocket.

What Does Out-of-Network Mean?

Some TRICARE plans offer coverage of out-of-network providers. However, members may have to pay all costs upfront and file a claim for payment. Out-of-network treatment can cause members to pay a higher portion of the cost.

Does TRICARE Cover Mental Health Treatment?

In short, yes. TRICARE covers mental health treatment. In most cases, pre-authorization is not required. But for some outpatient treatments, a referral may be needed. Active duty service members are urged to seek non-emergency health care when available.

Common mental health issues in service members include:

  • Anxiety
  • Depression
  • Adjustment disorder
  • Alcohol Dependence
  • Bipolar disorder
  • Post-traumatic disorder (PTSD)
  • Psychosis
  • Substance Use Disorder (SUD)
Does TRICARE Cover Detox and Withdrawal Management?

Detox is the first step to recovery. Medical detox helps people safely rid their bodies of substances. Also, a detox program can give medications to ease the pain of withdrawal. TRICARE covers detox and medication management of withdrawal symptoms. However, detox must be followed by inpatient or outpatient treatment.

Does TRICARE Cover Addiction Therapy?

Members with TRICARE insurance are eligible for a range of addiction treatments. From detox to medication-assisted therapy, TRICARE covers most addiction treatments. For this reason, TRICARE coverage allows members to seek the treatment needed to find Recovery for Life.

Covered Treatments

TRICARE covers psychological and medically necessary substance use and mental health disorders. This includes inpatient and outpatient services.

  • All Mental Illnesses (AMI)
  • Applied Behavior Analysis
  • Autism Spectrum Disorder
  • Cognitive Therapy
  • Continuing care therapy
  • Drug testing
  • Eating Disorders
  • Electroconvulsive therapy
  • Family therapy
  • Gender dysphoria
  • Intensive outpatient programs
  • Detox
  • Medication-assisted treatment
  • Office-based opioid therapy
  • Opioid treatment programs
  • Partial hospitalization
  • Psychanalysis
  • Psychological testing
  • Psychotherapy
  • Substance use disorder
  • Therapeutic services

TRICARE also covers alternative therapies in inpatient treatment. They include yoga, art therapy, equine therapy.

Is Sana Lake Recovery Center a TRICARE Insurance In-Network Provider?

Sana Lake Recovery is a TRICARE insurance in-network substance use disorder treatment center. Depending on a member’s insurance plan, TRICARE may fully cover the following treatment programs.

Typically, TRICARE insurance plans include substance use disorder treatment coverage for three benefit periods over the member’s lifetime. TRICARE requires pre-authorization, which will require proof that treatment is medically necessary. Once a member receives pre-authorization, TRICARE insurance should approve coverage.

TRICARE Insurance Coverage for Residential Treatment

TRICARE insurance typically covers residential or inpatient treatment programs. However, coverage will depend on various conditions such as having a formal diagnosis, experiencing severe withdrawal symptoms, and struggling with functioning in daily life.

If members meet these conditions, TRICARE insurance will cover emergency and non-emergency residential substance use disorder treatment. Emergency addiction treatment happens when a member has a medical or psychiatric crisis requiring immediate medical treatment.

TRICARE insurance covers:

  • Medical detox
  • Emergency stabilization
  • Any medical complications

Non-emergency substance use disorder treatment is when members decide to attend substance use disorder treatment. Non-emergency treatment requires pre-authorization. TRICARE typically covers detox and stabilization of substance use disorders and co-occurring mental health disorders.

Does TRICARE Insurance Cover Drug and Alcohol Detox in Missouri?

Typically, TRICARE insurance covers medical detox programs in Missouri. However, a member must also enroll in a treatment program such as inpatient or outpatient treatment. TRICARE offers coverage for various detox programs, including medication-assisted treatments such as office-based opioid treatment.

Does TRICARE Insurance Cover Intensive Outpatient Programs?

If members meet specific criteria, TRICARE insurance may cover intensive outpatient programs (IOPs). For instance, a member must have a diagnosed substance use disorder that is not severe enough for inpatient treatment.

Some TRICARE insurance plans allow members to enter outpatient treatment without pre-authorization. TRICARE’s outpatient treatment programs include intensive outpatient programs and partial hospitalization programs.

Why is Coverage of Substance Use Disorders Crucial for the Military?

Substance use disorder is a serious issue for many people in the United States. However, the military’s unique stressors and mental and physical requirements increase the risk of drug and alcohol abuse and substance use disorders.

Current statistics for substance abuse in the military are self-reported and are likely much higher.

  • One in ten military veterans have a substance use disorder diagnosis
  • Eight percent of active service members use illicit drugs
  • Illicit drug use rates increase as members leave the service
  • Over four percent of active service members admit to prescription drug abuse
  • Almost six percent of military members are heavy drinkers

The military has a zero-tolerance policy for using illicit drugs. Someone can be discharged for a positive drug test.  However, this doesn’t stop all substance abuse by active-duty service members.

Why are Service Members More Likely to Develop Substance Use Disorder?

Mental health disorders among military members increase the risk of developing substance use disorders. Active-duty and retired military members often struggle with mental health disorders, including:

  • Post-Traumatic Stress Disorder (PTSD)
  • Depression
  • Generalized Anxiety Disorder
  • Trauma disorders
  • Suicidal ideations

Active combat, especially for long periods, significantly increases the risk of developing one or more mental health disorders. The severe anxiety, fear, trauma, and injuries in combat increase the risk of substance use disorders.

Military members who are not deployed still cope with factors that increase the risk of substance use disorders. For instance, alcohol on military bases is extremely inexpensive. This contributes to underage and binge drinking. Unfortunately, the stigma and fear of punishment stop many members from seeking help.

The Scope of Addiction in Service Members

According to the National Institute on Drug Abuse, uniformed and retired service members are at risk of addiction. For example, the stress of deployment and military life culture can increase SUD and mental health issues.

Stigmas around addiction still exist. Despite making changes, many service members are afraid to seek help. However, drug use in service members is lower than the general public. Yet, binge drinking and prescription drug misuse are higher.

The Department of Defense (DOD) has policies for all aspects of SUD. They provide education and awareness, medical testing, and evidence-based therapies. Additionally, after SUD treatment, active members return to duty.

The DOD provides drug education and prevention to each service member. Additionally, each military service operates its substance use program. The military also offers a medication take-back program. This program eliminates those battling addiction from using leftover drugs.

Connection Between Alcohol Use Disorder and PTSD in Veterans

Our military veterans are seen as heroes for fighting for their country. However, many of them silently struggle with the mental scars of war. This leaves our veterans vulnerable to substance use disorder and co-occurring mental health disorders.

Studies estimate that 30 percent of Vietnam veterans and 20 to 30 percent of Afghanistan and Iraq veterans struggle with post-traumatic stress disorder (PTSD). Combat isn’t the only cause of PTSD in the military. Over half of female service members experience sexual harassment, while more than one-fifth experience sexual assault.

Many veterans use alcohol to cope with the distressing thoughts and feelings of PTSD. However, alcohol can intensify the symptoms of PTSD and lead to the development of alcohol use disorder (AUD). Many veterans struggle in silence, so it’s crucial to know the signs of AUD and PTSD.

Signs of alcohol use disorder include:

  • Inability to limit the amount you drink
  • Want to stop or cut back but can’t
  • Spending most of the day buying, consuming, and recovering from alcohol
  • Intense cravings
  • Ignoring daily responsibilities at work and home
  • Lack of interest in friends, family, and hobbies
  • Developing a tolerance requires you to drink more to achieve the same effects
  • Experiencing withdrawal symptoms such as nausea, sweating, and shaking

Symptoms of PTSD include:

  • Reminders of the traumatic event
  • Avoiding places, people, activities that trigger memories
  • Panic attacks – racing heartbeat, shaking, physical discomfort
  • Negative feelings
  • Survivor’s guilt

PTSD symptoms can vary, and most diagnoses are based on experiences, behaviors, and symptoms.

Sana Lake Recovery is a TRICARE Insurance Approved Treatment Center

Do you have TRICARE insurance and looking for substance use disorder treatment? Many people trying to find treatment are also fighting withdrawal symptoms and cravings. This can make it difficult to focus on getting your TRICARE insurance coverage approval.

At Sana Lake Recovery, we help you get the most coverage out of your TRICARE insurance plan. We handle all the insurance details making the admissions process quick and easy. This allows members to focus on their recovery.

Get Help Today at Sana Lake Recovery

Are you or someone you love a military service member and struggle with substance use disorder? At Sana Lake Recovery, we offer various treatment programs to meet the needs of military members and the general public. Contact us today and find out how we can help you.