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Does TRICARE Cover Substance Abuse?

 Destination hope is in-network with TRICARE, the medical benefits administrator for the US military, and a program of the US Department of Defense Military Health System. Coverage is provided for Air Force, Army, Navy, Marine Corps, Coast Guard and other military branches. Until recently, TRICARE did not cover addiction treatment, however today, TRICARE does often cover many common inpatient and outpatient drug and alcohol rehabilitation services including:

  • Detox
  • Residential
  • Partial Hospitalization
  • Medication Assisted Treatment
  • Intensive Outpatient

These are programs TRICARE considers to be proven treatments. They do not, however cover any treatments that they deem to be experimental or unproven. Tri-care plans generally fall into the following:

TRICARE Prime
TRICARE Select
TRICARE Prime Remote
TRICARE Reserve Select
TRICARE Retired Reserve
TRICARE Young Adult

Plans may have different coverages and requirements, and enrollees should contact the number on the back of their insurance card or contact the admissions department at Destination Hope to get a verification of benefits.

What does it mean to be in network? Not all TRICARE plans cover drug and alcohol treatment in out of network facilities. Destination Hope is in network, which means we have negotiated special pricing for our services; and enrollees generally have fewer out-of-pocket expenses versus using an out of network provider. Further, some out-of-network claims may require that the client cover the entire cost of their treatment before submitting for reimbursement to TRICARE.

Impatient TRICARE coverage

TRICARE often covers a full spectrum of inpatient treatment starting with detoxification and continuing to lower levels of care such as residential or partial hospitalization, depending on the enrollees diagnosis and condition. The admissions department at Destination Hope can assist with a verification of benefits as well as submitting for pre-authorization.

Tri-Care Enrollment and Claims Filing

Tri-Care is split into two regions in the United States:

East Region, which, includes the following states and areas: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso), Vermont, Virginia, West Virginia, and Wisconsin

ATTN: New Claims
PO Box 7981
Madison, WI 53707-7981
Tel: 1-800-444-5445

West Region, which includes the following states and areas: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island arsenal area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner including El Paso), Utah, Washington and Wyoming.

Claims Contacts (West Region)
Claims Department
P.O. Box 202112
Florence, SC 29502-2112
Tel: 1-844-866-WEST (9378)

Next Steps

The first and hardest step is to realize that you or your loved one may have a problem with addiction or mental health issues. Contacting a qualified treatment center like Destination Hope is the next step towards living a healthier and more productive life. Our admissions specialists can help verify your benefits and understand any out-of-pocket expense responsibilities. They can also help you understand the treatment process and introduce you to our program.

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