TriWest Insurance: Paying for Addiction and Mental Health Treatment
Your coverage for addiction treatment under TriWest can vary based on your TRICARE plan and the type of service you want. It’s important to verify your specific benefits and any authorization requirements before starting treatment. TRICARE insurance plans include:
- TRICARE Prime
- TRICARE Select
- TRICARE for Life
Important Considerations
In-Network vs. Out-of-Network Providers
TriWest insurance usually encourages the use of in-network providers. This can help lower out-of-pocket expenses.
Prior Authorization
Many of the addiction treatment services, particularly intensive outpatient or residential programs, might require prior authorization from TriWest to make sure you have coverage.
Deductibles and Copayments
Depending on your plan, you may be responsible for making a copayment or meeting a deductible before TriWest begins covering expenses.
What is TriWest Insurance?
TriWest Healthcare Alliance is a contractor for the government that manages the TRICARE program for the Department of Defense. This includes providing healthcare services to active duty and retired service members, their families, and their survivors. As part of their commitment to service membersTriWest often covers a host of addiction treatment services, while recognizing the immense importance of addressing substance use disorders (SUDs) in the military community.
Does TriWest Insurance Cover Drug and Alcohol Rehab?
In general, TriWest covers a variety of evidence-based treatment programs, which might include:
- Detox: A medically monitored withdrawal from substances
- Residential/Inpatient Treatment: individuals in treatment live at the treatment facility and receive intensive therapy and support in these structured programs.
- Partial Hospitalization Program (PHP): Sometimes called “day treatment,” this program is as intense as residential treatment, but it’s technically an outpatient program where the individuals can return home at night.
- Intensive Outpatient Program (IOP): IOP is less intensive than a PHP, which enables people to continue with their daily responsibilities while receiving therapy several times a week.
- Outpatient Program (OP): Individual therapy and group therapy sessions are regularly held, usually once or twice a week.
- Medication-Assisted Treatment (MAT): Using medications to treat SUDs in combination with behavioral therapies and counseling.
TriWest Insurance Coverage for Veteran Drug & Alcohol Rehab
TriWest covers many healthcare services for veterans and current military members, including:
- Urgent, emergency, and primary care
- Mental and behavioral health: Providers in the TRiWest group cover mental health services. Though TriWest offers various behavioral and mental health options, many of those services may be covered partially under VA health benefits. Behavioral health treatment includes addiction counseling, such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), although some limitations may apply.
- Dental and vision care
- Reproductive health
- VA Community Care Network (CCN): The CCN provides services to veterans when the VA can’t meet their needs. CCN enhances partnerships with the providers in the community to provide better service for veterans.
- Case management: TriWest provides case management services for individuals with complex health needs.
- Substance use disorder (SUD) treatment: Through the provider network, TriWest covers a variety of addiction treatment choices.
What Mental Health & Substance Abuse Treatment Does TriWest Cover?
TriWest Healthcare Alliance covers a variety of mental health and SUD treatment services for veterans and their families. This includes:
- Medical Detox: TriWest covers medically necessary detox to help people safely and successfully manage withdrawal symptoms. Without a medically supervised detox, many people relapse before completing detox because of the uncomfortable and sometimes life-threatening symptoms.
- Residential/Inpatient Treatment: Residential programs for people needing intensive, 24-hour care. In residential treatment, individuals live in a safe, structured environment, away from the triggers that may cause a relapse.
- Outpatient Treatment programs: There are various levels of outpatient programs:
- Partial Hospitalization Program (PHP)–PHPs are similar to residential programs in intensity and structure. However, it does not include overnight supervision. Participants are free to go home each evening.
- Intensive Outpatient Program (IOP)–An IOP requires fewer hours in treatment, about three times per week at the treatment facility. TriWest covers outpatient counseling, including group, family, and individual therapy.
- Outpatient Program (OP)–Standard outpatient programs require treatment sessions, typically one time per week.
- Medication-Assisted Treatment (MAT): MAT combines medication with therapy. It’s covered for opioid use disorder and sometimes alcohol use disorder. There are FDA-approved medications that can ease withdrawal symptoms and help in maintaining abstinence by reducing the likelihood of relapse.
- Dual Diagnosis treatment: TriWest insurance covers treatment for people with both SUDs and co-occurring mental health conditions, known as a dual diagnosis. Both disorders must be treated at the same time.
- Evidence-based Therapy: TriWest prioritizes evidence-based psychotherapy, such as:
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Prolonged Exposure therapy (PE)
Does TriWest Cover Medications?
Treatment insurance programs for SUDs may include medications. Alcohol Use Disorder and Opioid Use Disorder respond well to medications.
What Does TriWest Insurance Not Cover?
TriWest isn’t a health plan, so there aren’t any specific services that aren’t covered. Confirming what your TRICARE or VA benefits cover is essential when you’re deciding on a provider who’s a member of the TriWest network. TRICARE and VA benefits don’t cover unproven or unapproved mental health treatment.
TriWest Eligibility Requirements
Aside from basic VA healthcare eligibility, the specific criteria needed to qualify for Community Care through TriWest include:
- Lack of available services. The VA doesn’t have the service necessary at a nearby facility.
- Extreme wait times. If an appointment at a VA facility would exceed wait-time standards (more than 20 days for mental health and primary care, or over 28 days for specialty care).
- Long travel distances. When the veteran’s home is too far from a VA facility that can provide the necessary care.
- Best medical interest of the veteran. If both the VA provider and veteran agree that receiving care from a community provider is in the best interest of the veteran.
- VA quality standards. When the VA can’t provide the care in a way that meets the VA’s established quality standards.
Eligibility for TRICARE (also managed by TriWest) is separate. It applies to active service members, retirees, their families, and some other beneficiaries. Although TriWest is the area contractor, the VA decides the veteran’s eligibility for community care, and a referral from a VA provider is usually needed before getting community care through TriWest.
TriWest vs TRICARE vs VA Benefits: What’s the Difference?
TriWest, TRICARE, and VA benefits are all related to healthcare for military personnel and their families. However, they cover different groups and have different characteristics.
- TRICARE is the Department of Defense’s healthcare program for active-duty military, retirees, their families, and some survivors. Coverage is worldwide, including the U.S. and overseas.
- TriWest is a third-party administrator for the VA Community Care Network. It provides access to care for veterans in certain regions of the country who might not be able to access VA facilities. TriWest is also the company that manages TRICARE benefits in certain areas of the U.S, mainly in the Western region.
- VA benefits are for veterans who have served and are eligible for healthcare through the Department of Veterans Affairs.
What States Does TriWest Serve?
TriWest Healthcare Alliance serves different groups of states depending on whether they’re administering the TRICARE West region or the VA Community Care Network. Beginning on January 1, 2025, TriWest is the regional contractor for the TRICARE West region, covering these states:
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Hawaii
- Idaho
- Illinois
- Iowa
- Kansas
- Louisiana
- Minnesota
- Missouri
- Montana
- Nebraska
- Nevada
- New Mexico
- Dakota
- Oklahoma
- Oregon
- Dakota
- Texas
- Utah
- Washington
- Wisconsin
- Wyoming
Verify Your Insurance at Bayview Recovery Center
Bayview Recovery Center in San Diego, CA, is proud to be part of the TriWest providers to veterans and their families. If you’re still confused about your benefits, our admissions specialists will be happy to check for you and set you up with an appointment. We have several treatment programs for men and a comprehensive package of treatment options.
We Embrace Your Commitment to Recovery
Addressing addiction honestly is a courageous step. Bayview Recovery and TriWest aim to support service members and their families in their journey to well-being. Programs we can provide include:
- Detox
- Outpatient Program
- Intensive Outpatient Program
- Partial Hospitalization Program
- Dual Diagnosis Program
A dual diagnosis program is especially important for veterans. Many men who have combat experience also have post-traumatic stress disorder (PTSD), which they have been self-treating through the use of substances for years.
- LGBTQ + Program: We know that the LGBTQ+ population has unique challenges in their daily life, plus the discrimination and higher rates of abuse than heterosexual and cisgender people. The goal of our LGBTQ+ program for men is to provide a safe place to share, learn, and heal.
- Sober Living: A sober living home is a safe, drug and alcohol-free place to live before transitioning to independent life. Some people stay in sober living while completing outpatient treatment programs. Sober living gives you a home base while you find employment, continue aftercare, and build confidence in your sobriety.
You don’t need a miracle. This is something you can do. You just need someone who believes in your ability to achieve wellness and sobriety with a little guidance and support. Contact us today.
Alyssa is a licensed Clinical Social Worker and received her Master’s degree from San Diego State University. She has experience working with individuals in recovery of all ages for over eight years. Alyssa has also worked with at-risk homeless foster youth transitioning into independent living along with the families in the neonatal intensive care unit at UCSD.