TriWest Insurance Coverage for VA Drug & Alcohol Rehab

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Published July 22, 2021 

 

TriWest insurance, also called TriWest Healthcare Alliance, is a healthcare company that provides services for veterans and military communities.1 If you are a veteran suffering from the challenges of a substance use disorder, you may be able to access TriWest for assistance. There are over 700,000 healthcare workers who are in the TriWest network of providers. 2

Table of Contents:

What is TriWest?

TriWest is a type of health insurance designed to help veterans access healthcare in the United State. Established in 1966, the TriWest Healthcare Alliance helps administer services from the Department of Defense program, TRICARE.1

In addition, TriWest VA insurance is administered through the Department of Veterans Affairs (VA) Community Care Network (CCN) in certain regions.1 The Community Care network is a VA program to connect veterans with private facilities when the VA facilities cannot meet their healthcare needs.  The Community Care program helps: 4

  • Streamline all the VA’s community care programs into one program
  • Ensure veterans receive good care in a timely manner
  • Develop relationships with community providers

The CCN is operational throughout the United States and is separated into 6 different regions across the country.5 It’s important to determine which region you are in in order to take full advantage of the program. As part of the addiction services, veterans can receive behavioral health care.5

TriWest Eligibility Requirements

TriWest functions as a third-party administrator for Community Care partners in regions 4 and 5.3 This allows them to administer healthcare benefits for the VA system in the western United States, Texas, and Alaska.

It’s important to understand that you must get the VA’s approval prior to seeking treatment, even though you may be eligible for TriWest insurance.6 The treatment is disbursed through the Community Care network, so it’s vital to be within their network. Here are the eligibility requirements for VA TriWest insurance:6

  • You must have Community Care, which involves either being enrolled in VA benefits or be eligible for VA care without having to enroll.
  • Eligibility for Community Care is based on your individual health care needs or circumstances.
  • VA staff will determine who is eligible.
  • If you meet one of the following criteria, you may be eligible:
    • You’re a veteran needing services not offered at a VA center.
    • You live in an area that doesn’t have a full-time VA facility.
    • You are eligible to be grandfathered in.
    • The VA cannot deliver appropriate care in your case.
    • It’s in your best interest to be connected with a facility.
    • A VA service line is not fulfilling quality standards.

TriWest vs TRICARE vs VA Benefits: What’s the Difference?

The best way to understand the difference between TriWest, TRICARE, and VA benefits is to look at who is covered under each one and what the plan involves. Let’s compare the 3:7

TriWest: This is for veterans who are enrolled in the VA Community Care Program. It is a third-party administrator that has a contract with the VA. It will administer the benefits of the Community Care Program when the VA is not able to meet a Veteran’s health care needs for whatever reason.

TRICARE: This insurance is for active-duty service members, the national guard or reserve, and their families. They provide health care benefits when services cannot be provided at a Military Treatment Facility. They receive funding from the Department of Defense through the defense budget.

VA: These benefits are for veterans. It offers benefits for those who served in the military but have now separated or retired and become veterans. They also must meet certain health criteria in order to be eligible. VA benefits are funded by the Department of Veterans Affairs, which is not the same as the Department of Defense.

Does TriWest Cover Rehab?

Finding the appropriate care for a veteran substance use disorder is critical. Each person has their own unique needs when it comes to addiction treatment. It’s important to speak to a medical professional and build a proper treatment plan. If you’re enrolled in TriWest, it’s important to reach out to them to see what substance abuse programs (if any) you are covered for. Substance abuse programs that may be covered through TriWest include:8

  • Inpatient treatment program.
  • Residential treatment.
  • Partial hospitalization program.
  • Detox.
  • Outpatient treatment.
  • Medication management counseling.
  • Support group therapy.

Does TriWest Cover Medications?

TriWest covers medications that may help ease withdrawal symptoms.8 One such program that involves medications is Medication-Assisted Treatment (MAT). MAT programs use both medication and behavioral therapy to help with (usually) an opioid use disorder. 10 The FDA approved three drugs for MAT purposes. These drugs are as follows:10

  • Buprenorphine: used to treat opioid addiction.
  • Methadone: used for heroin or other opiates.
  • Naltrexone: used for opioid or alcohol use disorder.

What Does TriWest Not Cover?

It’s important to remember that TriWest’s coverage has limitations. The insurance only comes into play in certain regions, and only applies to facilities that are part of the VA’s community care network. Some places may not accept the benefits, and others may not be considered a VA-approved facility. It’s important to check with the center to find out if they accept TriWest. Alternatively, you could contact the VA and ask them if TriWest will be able to cover a particular rehab. If the substance abuse treatment center is part of TriWest’s network of providers, then you shouldn’t have any problems.

What States Does TriWest Service?

As stated above, TriWest administers benefits for participants in regions 4 and 5. The states included in these areas are as follows:3

  • Alaska.
  • Arizona.
  • California.
  • Colorado.
  • Hawaii.
  • Idaho.
  • Montana.
  • New Mexico.
  • Nevada.
  • Oregon.
  • Texas.
  • Utah.
  • Washington.
  • Wyoming.

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Sources

  1. TriWest.(2021). About TriWest.
  2. TriWest. (2021). Substance Use Disorders.
  3. TriWest. (2021). TriWest Serves Community Care Network Regions 4 and 5.
  4. TriWest. (2021). Community Care Network Overview.
  5. TriWest. (2021). VA Community Care Network (CCN) Enhances Access to Care.
  6. U.S. Department of Veterans Affairs. (2021). Community Care.
  7. TRICARE. (n.d.). Billing Frequently Asked Questions.
  8. TriWest. (2021). Treatment Options for Substance Use Disorders.
  9. National Institutes of Health (NIH). (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
  10. U.S. Food & Drug Administration. (2019). Information about Medication-Assisted Treatment (MAT).