For people who have AmeriHealth insurance, coverage for drug and alcohol addiction treatment varies depending on the type of plan they have.
AmeriHealth offers high quality, affordable health care that serves people in the New Jersey and Pennsylvania areas. AmeriHealth offers Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point of Service (POS), dental, vision, supplemental life, prescription drug, AmeriHealth Administrators third-party administrator for self-insured businesses, AmeriHealth Casualty Services- workers compensation coverage, Medicare programs, AmeriHealth, and AmeriHealth Caritas for Medicaid, Medicare, and related services.
For individuals that have Amerihealth insurance plans, their coverage could vary depending on the type of plan they have. Each plan works a little differently and is associated with a network of doctors, hospitals, and other healthcare providers. AmeriHealth offers five different plans which include individual plans, family plans, Medicare plans, plans for businesses with over 50 workers, and plans for business with less than 50 workers.
Does AmeriHealth Cover Drug Rehab?
Those who wonder does AmeriHealth cover rehab can find out that some AmeriHealth plans cover some alcohol and drug rehab costs while others do not. The Amerihealth HMO program and PPO program both cover some alcohol and drug rehab costs. A person seeking drug or alcohol addiction treatment can find a facility in or out of the network, but it is generally cheaper to find a drug or alcohol program that is in-network.
AmeriHealth HMO Program
For example, the AmeriHealth HMO program covers 60 visits per calendar year or 120 visits per lifetime of Outpatient/Partial Facility Visits with a 40 dollar copayment and no deductible. Outpatient programs offer individuals more freedom and flexibility. Individuals who enter an outpatient program will be able to live their normal life and work while they receive treatment. In this treatment setting, you will attend either group or individual sessions with a counselor, usually once a week for an hour.
However, some individuals might need a more comprehensive treatment approach that can be obtained through a residential, inpatient rehabilitation program. Inpatient programs give a person a complete break from their normal life enabling them to fully focus on their recovery journey. Here you will reside at the treatment facility while participating in individual and group therapy sessions, activities, and 12-step meetings. The AmeriHealth HMO program covers 70 percent after a deductible of 30 days per calendar year or 9- days lifetime maximum of rehabilitation.
Additionally, this program covers 70 percent after a deductible of 7 days per admission, 4 admissions per lifetime of detoxification services. Detoxification services are where a person is monitored during withdrawal from drugs or alcohol and receives medical care, medications, as well as mental health care as needed. It is very helpful in giving people the time and resources they need to safely end their drug or alcohol use and expel those substances from their body. A medical detoxification process usually occurs before an individual begins their addiction treatment process.
AmeriHealth PPO Program
The other Amierhealth program that offers rehabilitation coverage is the AmeriHealth PPO program. This insurance program has better coverage for a person who is suffering from a drug or alcohol addiction. For their outpatient services, if you find an in-network rehab, you only have to pay a 10 dollar copayment. For an out-of-network rehab, this insurance program covers 80 percent after you have reached your deductible. For inpatient rehab, this insurance program covers 100 percent of costs as long as you see an in-network provider. For an out-of-network rehab, the PPO program covers 8- percent after you have reached your deductible.
AmeriHealth Addiction Treatment Types
AmeriHealth plans offer coverage from most major addictions. The typical types of addiction that are covered are alcohol, benzodiazepines, cocaine, heroin, marijuana, methamphetamine, opioid painkillers, and stimulants. The majority of treatment programs will be well equipped to treat a wide range of addictions. However, some treatment facilities specialize in a particular type of substance use disorder treatment such as specifically alcohol addiction.
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AmeriHealth Drug Rehab Coverage Additional Information
Some AmeriHealth plans will cover detox while others will not. Additionally, some plans cover detox, but not rehab programs or rehab, but not detox. Therefore, it is helpful to contact your insurance company to find out exactly what your policy covers.
Also, when trying to get into either an inpatient or outpatient drug or alcohol rehabilitation clinic it is essential that the policyholder’s Primary Care Physician (PCP) make the referral for these services. For both of these insurance programs, it is essential that the services you are receiving are deemed medically necessary in order for treatment to be covered.
How Do I Get Started?
To find your best treatment options for addiction, first, verify your benefits. Our insurance verification team works quickly and efficiently to verify your insurance benefits to place you into one of our centers as soon as possible. We can help you choose the best program based on your coverage and unique needs. Due to our industry expertise, we will be able to verify this information in a timely manner and can advocate for more coverage or more time in treatment. We strive to do this as quickly as possible while maximizing your coverage. Our insurance verification process is of no cost to you, completely confidential, and there are absolutely no obligations.
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.