TriWest Healthcare Alliance Drug & Alcohol Addiction Treatment & Rehab in Colorado

What Is TriWest?

TriWest isn’t actually an insurance provider. Instead, it’s a network of healthcare providers, and among those are addiction treatment facilities. When veterans have a TRICARE health plan, private insurance, VA health benefits, Medicare, Medicaid or a federal Marketplace plan, they can use their benefits to receive treatment through the TriWest network. This is also true for active-duty military members. We advise that you verify your coverage before you get treatment to ensure you understand any out-of-pocket requirements.

The TriWest Healthcare Alliance was founded in 1996 to administer the TRICARE program available from the Department of Defense. It’s now a third-party administrator of the Department of Veterans Affairs (VA) Community Care Network in regions 4 and 5, covering the western part of the country and Alaska. The network comprises around 700,000 healthcare providers, ensuring veterans receive quality care through their applicable plans.

TriWest vs. TRICARE vs. VA Benefits

The differences between TriWest, TRICARE and VA benefits include:

• TriWest isn’t a health insurance company or plan. It’s an administrator acting as a third party for the VA Community Care Network in regions 4 and 5. The network of providers works within the Community Care Network, delivering services to veterans who wouldn’t otherwise be able to receive treatment through VA facilities. TRICARE Plans and VA benefits are accepted at facilities part of the TriWest network.
• TRICARE is for veterans, active duty service members and their dependents. TRICARE plans allow enrollment and coverage for health services that are considered standard, such as VA benefits and mental health coverage. You must enroll in a TRICARE plan to be eligible to receive coverage.
• VA health benefits are available to most of the nation’s veterans and cover standard health benefits and specialist care, including treatment for substance use disorders. While having VA health benefits does provide accessibility to a range of healthcare services, veterans often use these benefits along with private plans or TRICARE plans.

Eligibility Requirements for Joining TriWest

For veterans to receive care through community care and the TriWest network, they must meet at least one of the following eligibility requirements:

• As a veteran, you need a service unavailable at a VA facility.
• You live in a U.S. state or territory that doesn’t have a full-service VA medical facility.
• You are covered under the “grandfather” provision related to distance eligibility that was part of the Veterans Choice Program.
• The VA can’t provide care within a certain designated access standard.
• The veteran’s best medical interest is to be referred to a community care provider as part of the TriWest network.
• The service line from the VA won’t meet certain standards for quality.

Does TriWest Cover Drug and Alcohol Rehab?

Drug and alcohol rehab are life-saving medical treatments, and as such, most insurance providers cover at least a portion of the costs. TriWest isn’t an insurance company, so they don’t cover drug and alcohol rehab. Instead, if you’re part of the TriWest network and have eligible coverage from TRICARE, VA or another insurance plan, you can receive care through providers who are part of the healthcare alliance.

Does TriWest Cover Mental Health Services?

Mental health services such as counseling and behavioral therapies like cognitive behavioral therapy and dialectical behavioral therapy are frequently covered by insurance providers. This includes TRICARE, and VA health benefits also include mental health services, so you may be able to receive care through the TriWest Alliance.

Does TriWest Cover Medication-Assisted Treatment (MAT)?

Medication-assisted treatment, or MAT, can be integral to treatment programs for people with alcohol and opioid use disorders. MAT integrates medications with behavioral healthcare and comprehensive rehab programs to help with withdrawal symptoms and tapering off certain substances. Because the medications used are approved by the Food and Drug Administration, such as buprenorphine and Suboxone, they’re usually covered by insurance.

What Does TriWest Not Cover?

Most insurance plans will have a list of excluded items, but TriWest doesn’t provide coverage. Instead, you should verify what’s covered versus not covered with your insurance provider, such as TRICARE, or verify your VA benefits. Then, you may be eligible to receive community care from a TriWest facility.

Where Is TriWest Available in the U.S.?

TriWest’s Community Care Network includes the western portion of the country, known as regions 4 and 5. Regions 4 and 5 include:

• American Samoa
• Arizona
• California
• Colorado
• Guam
• Hawaii
• Idaho
• Montana
• New Mexico
• Nevada
• Northern Mariana Islands
• Oregon
• Texas
• Utah
• Washington
• Wyoming
• Alaska

Help for Military Members and Veterans

Our nation’s military members and veterans often face mental health and substance use struggles, but help is available. The Recovery Village Palmer Lake is part of the VA Community Care Network, and we are part of the TriWest Alliance. Whether it’s for yourself or you’re helping a loved one, we can help. Contact a Recovery Advocate today to learn more about treatment and insurance coverage or to take the next step.

Sources

U.S. Department of Veterans Affairs. “Community Care.” April 5, 2023. Accessed June 13, 2023.