TriWest Healthcare Alliance Drug Rehab Insurance Coverage
Written by Abby Doty
Receive Addiction Treatment as Part of TriWest’s Care Network.
Too often, people see addiction treatment costs as a barrier to life-saving care. Insurance nearly always covers some or all of a person’s rehab costs, including inpatient treatment.
What Is TriWest?
TriWest is unique because it’s not an insurance plan — it’s a network. TriWest, technically known as the TriWest Healthcare Alliance, was founded in 1996. The company focuses on serving the healthcare needs of veterans and the military community. TriWest, as a network, administers the Department of Defense (DoD) TRICARE Program. In 2013, the company was chosen to provide community care support for the Department of Veterans Affairs.
Since 2014, the TriWest network has been working to facilitate healthcare for veterans through the VA’s Community Care Network Regions 4 and 5. Then, in December 2022, the DoD awarded TriWest a contract for a new West Region comprising 26 states.
The Community Care Network, or CCN, is part of the VA’s community care program for veterans. It’s a way for the VA to work directly with community healthcare providers to ensure veterans receive timely, high-quality care.
TriWest vs. TRICARE vs. VA Benefits
TriWest, TRICARE and VA benefits are often used in conjunction, but important distinctions exist between these programs.
- TriWest is an administrator acting as a VA Community Care Network third party. This provider network works within the Community Care Network when veterans can’t receive care through VA facilities. At TRICARE facilities, TRICARE plans and VA health benefits are accepted.
- TRICARE is available to active-duty service members, veterans and their dependents. This covers standard health services such as VA health benefits and mental health services coverage. You enroll in TRICARE plans to receive coverage.
- VA health benefits are available to most veterans, covering many standard services like annual physicals and substance use disorder treatment. Veterans can use their VA benefits with other types of insurance, including private plans or TRICARE.
Eligibility Requirements for Joining TriWest
Network providers must go through a credentials review with TriWest participants to make sure they meet the minimum requirements for the program. Since TriWest acts as the third-party administrator for the VA Community Care Network, providers must meet all CCN requirements. Veterans located within regions 4 and 5 with eligibility for CCN can use TriWest services; however, their families cannot.
VA providers must determine eligibility for a veteran to use services and give veterans prior approval from the VA before they can get care through TriWest. A veteran must also be enrolled in VA healthcare or eligible for VA healthcare to be eligible for TriWest services.
To use TriWest, you have to meet one of six criteria, which include:
- The use of TriWest Community Care Network is the best decision medically for your health needs.
- Designated standards can’t be met if you were to try to receive care at a local VA provider or facility.
- There’s not a full-service VA facility near your home.
- You qualify for the Veterans Choice Program because you’re grandfathered based on a distance eligibility rule.
- You’re unable to receive needed services at a local VA facility.
- The current medical service line wouldn’t meet the quality standards set by VA for medical care.
Does TriWest Cover Drug and Alcohol Rehab?
TriWest isn’t insurance but a network of Community Care providers. The providers that participate in the TriWest network are required to cover drug and alcohol rehab, but the benefits do have certain qualification requirements and restrictions.
Insurance May Cover the Cost of Rehab
Cost should not stop you from getting the help you need. See if your insurance is accepted at The Recovery Village.
Does TriWest Cover Mental Health Services?
Network providers in the TriWest group will cover mental health services. Still, as with other insurance programs, there will be restrictions on receiving care and limitations. TriWest provides numerous behavioral and mental health options, and many services may be covered at some level under VA health benefits, TRICARE or another type of health plan. Different types of behavioral health treatments may be covered, such as cognitive behavioral therapy and dialectical behavioral therapy.
Does TriWest Cover Medication-Assisted Treatment (MAT)?
A treatment plan for addiction may include medications with approval from the Food and Drug Administration. There are substance use disorders that respond well to available medications, including alcohol use disorder and opioid use disorder. Prescriptions may be covered through the TriWest provider network. Medication-assisted treatments include naltrexone, buprenorphine and suboxone, among others.
What Does TriWest Not Cover?
Since TriWest isn’t a health plan, there aren’t particular services not covered. Instead, verifying what your TRICARE or VA health benefits will cover is important when choosing a provider who’s part of the TriWest network. Additionally, you should know that TRICARE and VA health benefits typically won’t cover unproven or unapproved mental health treatments.
Where Is TriWest Available in the U.S.?
The states and locations currently part of the TriWest Healthcare Alliance include:
- American Samoa
- New Mexico
- Northern Mariana Islands
Help for Military Members and Veterans
At The Recovery Village Ridgefield, we understand the unique health and substance use disorder challenges you may face as a veteran or the loved one of someone who served in the military. We are part of the VA Community Care Network and a TriWest provider. Please reach out today to learn more about addiction treatment, verify your benefits or take the next steps.
Veteran Recovery Is Our Mission
Our facilities have helped thousands of veterans overcome a drug or alcohol addiction. At The Recovery Village Ridgefield, our treatment programs offer veterans:
- Veteran Advocates who can navigate the VA on your behalf to enter treatment faster
- Experienced clinicians trained in military culture and trauma-informed care
- Dual diagnosis to treat addiction and mental health disorders together