Moda Therapy Coverage

Moda Health is an insurance provider that offers several plans and levels of benefits, including Moda addiction treatment coverage and Moda therapy coverage for mental health concerns. 

Founded in 1955 originally as an option for Oregon residents to get dental plans, today the company offers Oregon-based health insurance with employer plans, third-party administrative services, individual, and family plans. 

Moda Health’s PPO Structure

Utilizing a PPO structure, Moda Health contracts with specific providers so that members can get preferred rates. If you are a member, you can choose a non-PPO provider, but the benefits you can apply might differ. 

A PPO provider is considered an in-network provider, while others are considered out-of-network. 

In-Network vs. Out-of-Network with Moda Therapy Coverage

An “in-network” therapist is a therapist who has a pre-existing contract with your insurance provider. This contract includes specific pricing for their services, which makes it easier for your insurance company to estimate the cost of your treatment.

An “out-of-network” therapist is one who does not have an existing contract with your insurance company and, therefore, generally costs more because the insurance company doesn’t know exactly what to expect for your overall treatment cost.

To locate a provider that is in-network, Moda provides the Moda Health directory. 

Copays and Coinsurance

With the various Moda Health plans, you might have to pay a copay or coinsurance for each of your therapy sessions. 

• Copays are a fixed amount that you pay each time you have a session
• Coinsurance is a percentage of the cost that you pay for your therapy sessions 

This depends on the type of service you are receiving, whether it is inpatient or outpatient, and the plan that you have.

There may be other requirements as well.

Deductibles

For some Moda Health plans, before you can apply your Moda addiction treatment coverage or therapy coverage, you might need to meet a deductible. The deductible refers to the total amount that you have to pay out of pocket first every year. This amount is based on all of your health care costs, so if you have gone to the doctor several times for unrelated issues or had surgery, you might have already met your deductible for the year. 

This is a very important thing to check, especially if your program will run the course of several months from one year to the next. 

Limits and Prerequisites 

Moda Health plans might also have limits on the number of therapy sessions covered each year, and this is based on the plan you have. With Skycloud, our programs can last several months, and most insurance coverage will apply to at least 12 weeks of outpatient care. However, we can review your benefits with you so that you better understand what time limits apply to your benefits versus what you have to pay out of pocket.

There are also prerequisites for specific therapy services. This prerequisite means you need prior authorization from your insurance company before you start treatment. We can help you better understand this and whether or not it applies to your situation. 

Finding Covered Therapists with Moda

If you have Moda and want to apply your benefits to therapy for a mental health condition or addiction, you can use their in-network directory to find qualified mental health professionals. You can also reach out to Skycloud directly. Our team is ready to help you confirm your plan and connect you to a qualified therapist in your area. 

Therapy Costs with Moda Therapy Coverage

The costs are based on things like copays, which are based on the plan you have. If you opt for an in-network provider, each session will typically require a copay ranging between $0 and $75 per session.

With some Moda Health plans, you might need to pay the full session fee for your therapists until you meet your annual deductible, after which your insurance will jump in to cover the cost minus a copay.

Other Moda Health plans will cover all of the cost before that deductible is met if you choose someone who is in-network. 

For example:

If you need mental health and you choose an outpatient program, working with a network provider might require a $10 copay per office visit or a $5 copay for every virtual visit with a 35% coinsurance requirement for other outpatient services but if you choose an out of network provider your benefits don’t apply. Similarly you might need pre-authorization to avoid a penalty of 50% up to a maximum deduction of $500. 

This is all based heavily on the specific plan you have, information that you can determine by reviewing your summary of benefits, calling the number on the back of your insurance card, or reaching out to Skycloud to have our team verify on your behalf. 

Moda Addiction Treatment Coverage

Moda addiction treatment coverage applies to things like outpatient services and opioid treatment.

In order to apply your benefits to treat substance use disorder, you must work with a state-licensed professional and a properly licensed and accredited treatment facility. Moda Health will not approve treatment if:

• You meet the ASAM criteria for discharge
• You do not medically need treatment

However, direct treatment services can be approved for outpatient programs, including the use of FDA-approved medication-assisted treatment like the Suboxone opioid program offered with Skycloud. 

Costs with Moda Addiction Treatment Coverage

Costs for addiction treatment will vary based on the type of plan you have, including any requirements for copays, coinsurance, or deductibles.

For example:

If you need addiction services and you choose an outpatient program, working with a network provider might require a $10 copay per office visit or a $5 copay for every virtual visit with a 35% coinsurance requirement for other outpatient services, but if you choose an out-of-network provider, your benefits don’t apply. Some situations need pre-authorization to avoid a penalty of 50% up to a maximum deduction of $500. 

Find The Help You Need

Overall, when you take the time to get proper pre-authorization and understand your coverage requirements, it makes it much easier to apply your benefits and bring down the cost of treatment. With Skycloud, our team is here to help you understand your health insurance benefits and what your actual out-of-pocket costs will be for mental health or addiction treatment.

Call our team today to verify your benefits and learn more.