Last updated: 04/2/2019
Author: Addictions.com Medical Review
Reading Time: 3 minutes
Your relationship with cocaine is unhealthy and you know that you can’t stop using on your own. You know that you need structured, professional treatment and you are lucky that you are realizing that now. If you were looking for treatment before 2014, you would have a hard time finding any that was covered by insurance policies. However, the Affordable Care Act introduced into law the condition that all individual and small group plans must provide the same level of coverage for substance abuse that they would provide for any other medical, condition.
For the approximately 913,000 people in the United States who met the Diagnostic and Statistical Manual of Mental Disorders criteria for cocaine dependence or abuse in 2014, this is great news. As one of the people struggling under the weight of a cocaine addiction, you should take some comfort in knowing that your AmeriHealth insurance will help you to finance treatment.
It’s great news but it doesn’t really give you enough information to move confidently forward. You need to know the answers to a few of your questions.
Does AmeriHealth Insurance Cover Treatment for Cocaine Addiction?
Yes. As mentioned earlier, the Affordable Care Act (Obamacare) guarantees coverage of substance abuse treatment. However, the type and level of coverage varies from policy to policy.
There isn’t a single kind of drug and alcohol addiction treatment. There are many, like:
- Inpatient treatment plans
- Outpatient treatment plans
- Detox plans
- Aftercare plans
- Medication-assisted plans
- Rehabilitation services provided by a doctor or therapist
You can expect some of these to be covered, but very few policies will cover all of them. You can, however, rest assured that anything deemed medically necessary will be covered, but the form that takes is not static.
How Much of the Treatment’s Cost Can I Expect AmeriHealth Insurance to Cover?
The Affordable Care Act introduced a concept called a “mental health parity.’ This is a type of equivalency that forces all mental health and substance abuse treatments to be covered just as any other health condition would be. If you have used your AmeriHealth plan to cover a hospitalization or other medical treatment, you probably have some idea of the amount of coverage your policy would provide for your cocaine addiction treatment.
The amount covered will be dependent upon policy and the state you live in, but the treatment program you wish to pursue will also be a factor. In-network providers will receive more coverage than those out-of-network.
Can I Pay the Difference Between Total Cost and that Covered by My Insurance?
Not only can you pay some of the costs not covered by AmeriHealth, you will have to. No policy will cover treatment 100 percent. You have to consider things like per-day and per-stay maximums that may leave you covering the remainder and things like copays and deductibles. These are costs that should a be expected.
But, there are also costs that you can choose to assume. For example, if you really love a provider who is out-of-network, you can seek treatment from them and pay what the insurance did not cover. If you think that you need 90 days of treatment and AmeriHealth only covers 30, you can fund the other 60 days yourself.
Making payments independently will have no effect on your insurance coverage.
Is Outpatient Care Covered?
Outpatient care requires you to frequently, generally daily, make a visit to a treatment facility. At this location you receive all of the components of your treatment, and then you go back to your life. You don’t have to live on-site or exit your life for a full month to go to rehab. You go home every night and come back the following day.
This option in addition to being the less expensive one is also the more common. Data from the 2013 National Survey of Substance Abuse Treatment shows 80 to 82 percent of the responding facilities deliver outpatient treatment, while as mere 24 to 28 percent deliver non-hospital inpatient care.
This type of care is the one most likely to be covered by your insurance, but you should review your policy to make absolutely certain.