First Health PPO Coverage for Drug & Alcohol Rehab

Insurance plans that use the First Health PPO Network may cover drug and alcohol rehab, detox, outpatient care, and mental health treatment — but your exact benefits depend on your underlying insurance plan, network rules, and medical-necessity review.

If your insurance card lists First Health PPO Network, you may be wondering what that means for addiction treatment coverage. This guide explains how First Health rehab coverage typically works, what services may be included, what affects your out-of-pocket costs, and how to verify benefits for care at Orlando Recovery Center.

Important: First Health is not an insurance company. It is a nationwide provider network used by many insurers and employer-sponsored health plans. Your actual coverage comes from the insurance plan behind the network.

Quick takeaways (read this first)

• First Health is a PPO network, not a health insurance carrier.
• Your insurance plan determines coverage, deductibles, and authorizations.
• Network participation matters: In-network providers usually mean lower costs.
• Medical necessity drives approval for detox, residential, PHP, and IOP.
• Prior authorization is common for higher levels of addiction treatment.
• Benefit verification is free and helps clarify coverage before treatment begins.

First Health PPO Network overview

First Health PPO Network is one of the largest preferred provider organization (PPO) networks in the U.S. Many commercial insurers, employer-sponsored plans, and third-party administrators (TPAs) use First Health to give members access to a broad network of doctors, hospitals, and behavioral health providers.

First Health does not insure members or make coverage decisions. Instead, it:

• Contracts with healthcare providers nationwide
• Negotiates discounted, in-network rates
• Expands access to care for insurance plans
• Works alongside insurers who manage benefits and authorizations

Because many plans use First Health differently, the only way to know your exact coverage is through benefit verification.

Does First Health PPO cover drug and alcohol rehab?

First Health itself does not decide what is covered. However, many insurance plans that use the First Health PPO Network include benefits for substance use disorder (SUD) treatment and mental health care when medically necessary.

If your plan includes addiction treatment benefits, First Health may influence:

• Whether a facility is considered in-network
• The negotiated rate applied to covered services
• Your out-of-pocket responsibility compared to non-network care

Coverage specifics — including deductibles, copays, coinsurance, and service limits — are determined by your insurance plan, not the First Health network itself.

Levels of care First Health plans may cover

Addiction treatment is individualized. Insurance plans using the First Health PPO Network may cover several levels of care based on medical necessity:

Medical Detox

Detox services may be covered when withdrawal symptoms pose medical or psychiatric risks. Prior authorization is typically required.

Inpatient / Residential Rehab

Residential treatment provides 24/7 structured care, therapy, and medical oversight. Plans often require proof that outpatient treatment would not be sufficient.

Partial Hospitalization Program (PHP)

PHP delivers intensive daily treatment without overnight stays. It may be approved as step-down care or as an initial level when clinically appropriate.

Intensive Outpatient Program (IOP)

IOP includes multiple therapy sessions per week while allowing patients to maintain work, school, or family responsibilities.

Standard Outpatient Care

Outpatient services may include individual counseling, group therapy, family therapy, and psychiatric medication management.

How coverage is determined: medical necessity & authorization

Insurance plans using First Health typically require treatment to meet medical necessity criteria. Insurers often rely on nationally recognized guidelines such as The ASAM Criteria to determine appropriate levels of care.

During authorization or clinical review, insurers may ask about:

• Substance use history and severity
• Withdrawal symptoms and medical risk
• Co-occurring mental health conditions
• Previous treatment attempts
• Home environment and available supports
• Safety concerns such as overdose risk

If a higher level of care is not approved, insurers may recommend step-down treatment, request additional documentation, or allow appeals or peer-to-peer review.

What affects your out-of-pocket cost with First Health PPO?

Your out-of-pocket costs depend on your insurance plan’s structure. First Health network participation can help lower costs, but key factors include:

• Deductible: Amount you pay before coverage begins.
• Copays: Fixed amounts for certain services.
• Coinsurance: Percentage of covered costs.
• Out-of-pocket maximum: Annual cap on your spending.
• Network tier: In-network First Health providers usually cost less.

Tip: Choosing a First Health–participating provider like Orlando Recovery Center may significantly reduce your financial responsibility.

Dual-diagnosis treatment and First Health

Many insurance plans using First Health PPO include coverage for co-occurring mental health and substance use disorders. Dual-diagnosis treatment may address conditions such as:

• Depression and anxiety
• PTSD and trauma-related disorders
• Bipolar disorder
• Other mood or psychiatric conditions

Integrated treatment is often considered medically necessary because untreated mental health symptoms can interfere with recovery.

Medication-assisted treatment (MAT) coverage

Many First Health–associated plans include coverage for medication-assisted treatment when clinically appropriate. MAT may include:

• Buprenorphine/naloxone
• Naltrexone (oral or injectable)
• Methadone through certified programs
• Medications for alcohol use disorder

Some medications may require prior authorization or step-therapy review.

How to check your First Health PPO rehab benefits

Because First Health works with many insurers, benefit verification is the fastest way to understand your coverage.

Option 1: Verify benefits with our admissions team (recommended)

We can confirm network participation, authorization requirements, and estimated costs by contacting your insurance plan directly. Verify your insurance online.

Rehab accepting First Health PPO Network in Florida

If your insurance plan uses the First Health PPO Network, Orlando Recovery Center can help you understand your benefits and explore treatment options before starting care.

Disclaimer: This page is for informational purposes only and does not guarantee coverage or payment. Benefits vary by insurance plan and are subject to authorization and medical-necessity review.