Does MHN Insurance Cover PHP at ChoicePoint?
Does MHN insurance cover PHP?
MHN (Managed Health Network) may cover Partial Hospitalization Programs (PHP) when a licensed clinician determines it is medically necessary. However, your exact coverage depends on your MHN plan, the treatment facility, your state, and location, and prior authorization. Our team at ChoicePoint verifies your MHN partial hospitalization program benefits to ensure a stress-free PHP treatment experience.
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How MHN Insurance Covers PHP Treatment?
MHN is a subsidiary of HealthNet that covers behavioral health benefits. It does not provide therapy or rehab services directly. Instead, it partners with licensed treatment centers to ensure eligible members receive appropriate PHP care. MHN is responsible for:
- Reviewing and authorizing requests for PHP
- Coordinating benefits between in-network providers and your health plan
- Monitoring treatment progress when required by your specific plan
MHN works across many plan types, including employer-sponsored HMOs, PPOs, and EPOs. Your exact coverage for PHP depends on how your employer or insurer has set up the plan.
Why You Should Choose a Partial Hospitalization Program (PHP)?
PHP is an intensive daytime treatment program for people with substance use addiction who need more support than standard outpatient care but do not require 24-hour MHN-covered inpatient rehab. Patients attend therapy during the day and return home each evening.
PHP typically includes:
- Around 20 hours of weekly therapy, 2-5 days a week
- Behavioral therapy sessions
- Medication management and mental health evaluation
- Coping skills training
Does MHN Insurance Cover PHP for Drug and Alcohol Treatment?
Yes, MHN may cover PHP for drug and alcohol addiction when the treatment is medically necessary. According to the Mental Health Parity and Addiction Equity Act (MHPAEA), alcohol and drug use are medical conditions; MHN plans offer treatment coverage for PHP. To qualify, a person should:
- Have a diagnosed substance use disorder, such as alcohol, opioid, or stimulant use disorder
- Be medically stable but at high risk of relapse without daily support
- Have not responded adequately to outpatient care
- Have a safe home environment to return to each evening
When approved, PHP typically includes alcohol and drug evaluation, individual therapy, group therapy, CBT, DBT, EMDR therapy, medication-assisted treatment, relapse prevention planning, and family therapy sessions.
Does MHN Cover Partial Hospitalization Programs for Substance Use Disorders?
Yes, MHN may cover a partial hospitalization program for a wide range of substance use disorders when treatment is clinically necessary. At ChoicePoint, we treat the following substance use disorders in our PHP program:
Does MHN Insurance Cover PHP for Mental Health Treatment?
Yes, MHN may cover PHP for mental health conditions when symptoms are affecting daily life and a lower level of care is not sufficient. The common qualifying conditions include major depression, anxiety disorders, post-traumatic stress disorder, bipolar disorder, ADHD, OCD, and eating disorders. To qualify, a person generally must:
- Have a diagnosed mental health condition with symptoms that interfere with daily functioning
- Are not at immediate risk of harming themselves or others
- Need daily psychiatric monitoring or medication management
Mental health PHP through MHN can include psychiatric evaluations, individual therapy, CBT, DBT, group sessions, psychiatric medication management, trauma therapy, and family counseling.
Does MHN Insurance Cover PHP for Dual Diagnosis Treatment?
Yes, MHN may cover PHP for dual diagnosis treatment when treatment of both a mental health disorder and a substance use disorder is clinically necessary. The treatment of both conditions together produces better outcomes than addressing each one separately. To qualify, a person has to:
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- Carry an active diagnosis of both a mental health condition and a substance use disorder
- Have both conditions significantly affecting their ability to function day to day
- Require an integrated treatment approach rather than separate standalone programs
Dual diagnosis PHP combines psychiatric and substance use evaluation, addiction individual counseling, integrated group therapy, medication management, and trauma-focused treatment. At ChopicePoint, our addiction specialists treat both conditions and work with MHN to verify your MHN coverage.
What to Expect During MHN-Covered PHP at ChoicePoint
Starting PHP can feel overwhelming, especially when you are also managing insurance questions. At ChoicePoint, we make the process as smooth as possible from day one. Here is what a typical PHP experience looks like:
| Intake and Substance Addiction Assessment | On your first day, our team of DEA-certified professionals conducts a full assessment covering your mental health history, substance use, medications, and treatment goals. |
| Personalized PHP Plan | Then we build a PHP treatment plan around your diagnosis and goals. The program is reviewed and updated regularly based on your progress. |
| Daily Therapy Schedule (Personal Therapy, CBT, DBT, Group Therapy, Family Sessions) | Patients attend four to six hours of therapy daily. This includes individual counseling, group therapy, skills training, and family involvement when appropriate. |
| PHP Medication Management | If medication is part of the treatment plan, our psychiatric team monitors and adjusts prescriptions throughout the program. |
| Step-Down Planning | As progress is made, we plan the transition to a lower level of care such as IOP or outpatient therapy while coordinating with MHN to maintain coverage. |
How Much Does MHN Insurance Pay for PHP Treatment?
MHN generally covers a major portion of PHP costs when treatment is approved, and the facility is in-network. However, you may still have to pay some out-of-pocket costs, which depend on:
- Plan Type: HMO plans require in-network care. PPO plans may offer partial out-of-network coverage at a higher cost.
- Deductible: You pay out of pocket until your annual deductible is met. After that, insurance begins to share the cost.
- Co-Pay or Coinsurance: For example, if your plan covers 80% and the daily rate is $400, you may owe $80 per day.
- Coverage Limits: Some plans cap the number of PHP days covered per year.
How to Verify Your MHN Partial Hospitalization Program Coverage at ChoicePoint
At ChoicePoint, MHN insurance verification is simple and fast. Here is how the process works:
Step 1: Verify Insurance Online
Call us 844.445.2565 or āverify your insuranceā
Step 2: Submit Your Details
Fill out our secure form with your personal and insurance information.
Step 3: Receive Benefit Detail
Our team will contact you and explain your benefits, coverage, and eligible PHP services.
Frequently Asked Questions
People with MHN insurance looking for PHP also ask,
1. Does MHN require prior authorization for PHP?
Yes. MHN requires prior authorization before PHP treatment begins. For that, a licensed clinician documents medical necessity and submits it to MHN for review. Without this approval, your treatment may not be covered. At ChoicePoint, our team manages the authorization process for you to prevent any delays in starting PHP.
2. How long does PHP treatment usually last?
PHP programs typically last between 2 and 6 weeks. However, the exact duration depends on your clinical progress and whether MHN continues to approve additional days of treatment. MHN may also require periodic reviews during treatment to confirm that PHP remains the appropriate level of care. Our clinical team can help with prior authorization.
3. Can I use an out-of-network PHP provider with MHN?
It depends on your specific insurance plan.
- PPO plans often include some out-of-network benefits, which means you can attend an out-of-network PHP, but you may need to pay higher costs.
- HMO plans typically cover in-network care, and they don’t cover out-of-network treatment at all.
Our team will check your specific plan details to guide you on the treatment coverage.
4. Can I move from outpatient therapy directly into PHP?
Yes. MHN can authorize a step-up in care if your clinician documents that your symptoms have worsened and outpatient therapy is no longer enough. It is called a level of care upgrade. Book a free addiction evaluation to know the right level of care for your condition.
5. What if MHN denies my PHP coverage?
If MHN denies your PHP claim or authorization request, you can appeal the decision. At ChoicePoint, we gather all necessary documentation to challenge the denial and support your right to receive medically necessary care.
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24/7 ADMISSION HELPLINE 844.445.2565Medical Disclaimer:
ChoicePoint aims to improve the quality of life for people struggling with substance use disorder and mental health issues. Our team of licensed medical professionals research, edit and review the content before publishing. However, this information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice please consult your physicians or ChoicePoint's qualified staff.
Medical Disclaimer:
ChoicePoint aims to improve the quality of life for people struggling with substance use disorder and mental health issues. Our team of licensed medical professionals research, edit and review the content before publishing. However, this information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice please consult your physicians or ChoicePoint's qualified staff.
