First Health PPO Network plans may cover drug and alcohol rehab, detox, outpatient programs, and mental health treatment — but your actual benefits depend on your underlying insurance plan, network rules, and medical-necessity decisions.

If your insurance card references First Health PPO Network, you may be wondering whether addiction treatment is covered and what your out-of-pocket costs might be. This page explains how First Health rehab coverage typically works, what levels of care may be included, which factors affect approval, and how to verify your benefits for treatment at The Recovery Village Palm Beach at Baptist Health.

Important: This guide is informational only. Coverage varies by plan and is always subject to eligibility, network participation, prior authorization, and medical-necessity review. We can help you verify exact benefits before treatment begins.

Quick takeaways (read this first)

  • First Health is a PPO network, not an insurance carrier. Your underlying health plan determines coverage.
  • Network access matters: Plans often use First Health to expand their provider network.
  • Coverage varies widely: Employer plans, commercial plans, and administrators set the benefits.
  • Medical necessity drives approval: Plans often reference ASAM criteria for addiction treatment.
  • Prior authorization is common for detox, inpatient/residential, PHP, and IOP.
  • You can verify benefits without committing: Insurance verification is free, confidential, and non-binding.

What is the First Health PPO Network?

First Health PPO is a large national provider network used by many insurance companies and employer-sponsored plans to expand members’ access to in-network providers. It is not a standalone insurance plan. Instead, your actual coverage comes from the underlying insurer (your employer plan, commercial plan, or third-party administrator).

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Your plan may use First Health PPO to:

  • Provide access to a larger network of physicians, therapists, and treatment facilities
  • Offer negotiated rates with participating providers
  • Support behavioral health access through contracted providers
  • Expand in-network options when the main plan’s network is limited

Because First Health is a network, not a payer, your benefits, deductibles, authorizations, and exclusions come from the insurance plan behind it.

Does First Health cover drug and alcohol rehab?

In most cases, yes — if your underlying insurance plan includes coverage for substance use disorder (SUD) treatment, and if the provider is in-network or recognized under the plan. First Health PPO may help reduce costs by offering negotiated in-network rates.

Typically, employer and commercial plans that use First Health PPO offer coverage for:

  • Medical detox
  • Residential or inpatient rehab
  • Partial Hospitalization Programs (PHP)
  • Intensive Outpatient Programs (IOP)
  • Outpatient therapy and counseling
  • Psychiatric care and medication management
  • Medication-assisted treatment (MAT)

However, what’s covered — and at what cost — depends on your specific plan design and its relationship with First Health.

How First Health PPO manages network access

Because First Health is a network rather than a benefit administrator, it primarily influences network status and contracted provider rates. Authorization, review, and benefit decisions are usually handled by the underlying plan or a behavioral health manager.

This means that even if a provider is in-network with First Health, your actual insurer may still require:

  • Prior authorization
  • Medical-necessity review
  • Clinical documentation
  • Step-down or step-up recommendations

Your insurance card may list both First Health and another organization (the payer), which can cause confusion. Benefit verification helps identify who manages which process.

Levels of care First Health PPO plans may cover

Addiction treatment is often covered across several levels of care depending on medical necessity. These include:

1. Medical Detox

Detox may be covered when withdrawal is medically risky, such as with alcohol, benzodiazepines, opioids, or polysubstance use. Plans may authorize inpatient detox or medically monitored detox depending on symptoms.

2. Inpatient & Residential Rehab

Residential treatment offers 24/7 support, therapy, medication management, and structured programming. Plans often require documentation that lower-intensity services would not be safe or effective.

3. Partial Hospitalization Program (PHP)

PHP provides intensive daily therapy without overnight stay. It’s commonly approved as either a step-down or an initial level of care depending on severity.

4. Intensive Outpatient Program (IOP)

IOP offers therapy several days per week and may be approved when patients do not require 24/7 monitoring but need structured support.

5. Outpatient Therapy

Most plans cover outpatient counseling, relapse prevention, group therapy, and ongoing psychiatric support.

How medical necessity is evaluated

Most insurers using First Health PPO follow nationally recognized criteria — often The ASAM Criteria — to determine whether the level of care is medically necessary. Medical necessity reviews help ensure treatment is appropriate for the individual’s clinical condition.

You may be asked about:

  • Your substance use history
  • Frequency and severity of use
  • Withdrawal symptoms or risk
  • Mental health symptoms
  • Medical complications
  • Home environment stability
  • Past treatment attempts
  • Safety concerns or inability to function

If a higher level of care is not approved, your plan may recommend a lower level of care or allow a peer-to-peer review.

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

Your share of treatment costs is determined by the underlying insurance plan, not First Health alone. Common cost factors include:

  • Deductible: What you must pay first each year.
  • Coinsurance: The percentage you pay after meeting your deductible.
  • Copays: Fixed costs for specific services.
  • Out-of-pocket maximum: Annual cap on qualifying expenses.
  • Network status: In-network care usually provides the lowest rates.
  • Authorization: Lack of authorization may limit coverage or increase cost.

Because First Health provides discounted in-network rates, choosing a provider within the network usually results in lower out-of-pocket expenses.

Dual-diagnosis coverage under First Health PPO

Many plans using First Health PPO cover treatment for co-occurring mental health and substance use conditions. Dual-diagnosis services may include:

  • Psychiatric evaluation
  • Medication management
  • Therapy for anxiety, depression, trauma, or bipolar disorder
  • Integrated addiction and mental health programming

Coverage depends on the underlying insurance plan, but dual-diagnosis treatment is often recognized as essential to long-term recovery.

Medication-assisted treatment (MAT) coverage

MAT may be covered under medical or pharmacy benefits depending on your plan. These medications may include:

  • Buprenorphine/naloxone for opioid use disorder
  • Naltrexone (oral and injectable) for opioid and alcohol use disorder
  • Methadone (covered through certified opioid treatment programs)
  • Medications for alcohol use disorder

Some medications require prior authorization or step therapy depending on the plan.

How to verify your First Health PPO rehab benefits

To verify benefits, have your insurance card available, including your member ID, group number, and any behavioral health contact information.

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

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

Option 2: Call the number on your member ID card

Ask about “behavioral health and substance use disorder benefits” and request details on:

  • Authorization requirements for detox, inpatient, PHP and IOP
  • Your deductible and coinsurance
  • Your out-of-pocket maximum
  • Whether The Recovery Village Palm Beach at Baptist Health is considered in-network

Rehab accepting First Health PPO Network in Florida

If you have insurance connected to First Health PPO Network, The Recovery Village Palm Beach at Baptist Health can help you verify your benefits and understand treatment options before you begin care. Our admissions team is available to walk you through your coverage and answer any questions you may have.

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