Are you holding an insurance card with “First Health PPO” on it and wondering if it covers the high cost of rehab? If so, you’re not alone. This coverage is simpler than it seems. The key is knowing that First Health is a network, not an insurance company, and that verifying your specific plan is the crucial first step toward affordable treatment.
In this article, I explain what First Health is, how it functions, what it typically covers, and how to verify personal benefits.
What Is the First Health PPO Network?
First Health exists primarily to solve the problem of access and affordability in large, fragmented geographic areas [1]. First Health Group Corp. is a subsidiary of Aetna, Inc. If you have an insurance card that mentions First Health, Cofinity, or Aetna, you are likely holding a plan that provides access to the same large family of providers.
It is one of the nation’s largest Preferred Provider Organization (PPO) networks, not a health insurance carrier. It’s a network of contracted providers (like rehab facilities) that negotiate rates.
With an extensive network of providers for addiction treatment, First Health PPO networks are used by many employer- and self-funded plans. Though exact terms vary by underlying policy, First Health often covers rehab for addiction and mental health as essential benefits under the ACA.
Coverage requires verification for deductibles, preauthorizations, and medical necessity and typically includes lower rates at in-network providers for services like detox and therapy.
1. It Solves the “Out of Network” Problem (Access)
The Problem: If you have a PPO plan through a regional insurer or a small employer, that insurance company might not have its own network of doctors and hospitals in every state. If you got sick while traveling or needed treatment far from home, you would be “out of network,” leading to exorbitant bills.
The Solution: First Health provides one of the largest national networks. Insurance companies and employer-sponsored plans “rent” access to the First Health network to give their members more in-network choices all across the country and access to discounted, pre-negotiated rates. It turns a local plan into a national one.
2. It Leverages Buying Power for Lower Costs (Affordability)
The Problem: Small insurance plans don’t have enough members to offer to hospitals in return for negotiated discounts.
The Solution: First Health combines millions of members from various smaller plans into one massive pool. This gives them great leverage to negotiate deep discounts with hospitals and doctors.
The insured person benefits from these pre-negotiated rates, paying the discounted, in-network price rather than the full retail price for healthcare. Actual coverage—what is paid for—comes from the underlying insurance plan (e.g., Aetna, Cigna, or a self-funded employer plan) that uses the First Health network.
What Rehab Services Does First Health PPO Typically Cover?
Because of the Affordable Care Act and mental health parity laws, most plans using the First Health network cover substance use disorder and mental health treatment when it is deemed “medically necessary”.
Levels of Care
The following levels of care are typically covered:
- Medical Withdrawal Management (Detox)
- Inpatient/Residential Rehab
- Partial Hospitalization Program (PHP)
- Intensive Outpatient Program (IOP)
- Outpatient Therapy and Counseling
- Dual Diagnosis (Addiction and Mental Health, such as anxiety and depression, with no referrals needed in PPO setups)
- Medication-Assisted Treatment (MAT) for medications such as buprenorphine or naltrexone is often included when medically necessary per ASAM criteria.
What Determines Your Out-of-Pocket Costs?
While the network sets the rates, the patient’s specific insurance plan dictates the cost-sharing details.
Key cost factors that will determine the final bill:
- Deductible
- Copays and Coinsurance
- Out-of-Pocket Maximum
- Medical Necessity: Approval for specific levels of care (especially residential) is based on medical necessity, often evaluated using ASAM criteria. Prior authorization is often required.
Treatment length (often 40-72 days across levels of care) depends on plan limits, progress reviews, and preauthorizations, which insurers require for inpatient or residential services.
Compared with out-of-network care, in-network providers offer reduced coinsurance and negotiated rates, but out-of-pocket costs hinge on your deductible, copays, and out-of-pocket maximum.
Benefits are dictated by your primary plan (e.g., employer-sponsored), so First Health acts as a network facilitator rather than an insurer.
How to Verify Your First Health PPO Rehab Benefits
Step 1: Have your insurance card ready with your member ID and group number.
Step 2: The Two Verification Options
Option A (Recommended): For a free, confidential verification, reach out to the Northbound Treatment Services Admissions team. They will check your in-network status, explain your benefits in simple terms, and estimate out-of-pocket costs based on your specific plan.
Option B: Log in to the client portal [2]. Or call the member services number on the back of your insurance card.
Why Choose Northbound Treatment Services?
At Northbound, we have extensive experience helping patients overcome their substance abuse addictions, and we have a Christian faith-based track for those wishing to participate.
We offer a wide range of evidence-based therapies, counseling, and trauma-informed support to help you heal. We personalize each treatment plan around the needs of our patients.
The first steps are detoxification and stabilization, under 24-hour medical supervision in our Withdrawal Management center for whatever time you may require.
Our inpatient residential program offers 24/7 live-in treatment for substance abuse. Our outpatient treatment provides a flexible step-down from our residential program, allowing you to live at home and participate for several hours a day.
For more than 30 years, Northbound Treatment Services in California has been at the forefront of providing lifesaving, compassionate residential care and specialized services to help people from all walks of life feel better, discover themselves, and live free from addiction.
We have facilities located throughout California to help guide you on your recovery journey. Reach out to our admissions team now.
Sources
[1] First Health Insurance Solutions
[2] First Health Client/Provider Portal
Author
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Clinical Director, Clinical Supervisor, EMDR Provider
I am a Licensed Clinical Social Worker and graduated with a degree from the USC School of Social Work in 2015 with an emphasis in mental health. I began my career working with the Orange County Welfare to Work Program providing mental health services to reduce barriers to employment. I have spent the last 5 years working various levels in behavioral health, providing direct service to those struggling with co-occurring disorders.Using an eclectic and integrative approach, I incorporate the AIP model with EMDR, Person-in-Environment (PIE), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), family systems, interpersonal and solution-focused therapy along with Rogerian positive regard into my practice.
