AmeriHealth Insurance Coverage for Drug & Alcohol Addiction Treatment

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Calendar icon Last Updated: 09/16/2021

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Obamacare, more officially known as the Affordable Care Act, introduced ten groups of services and items that have to be included on every small group and individual health care plan. One of those groups is mental health and addiction services. Each type of AmeriHealth policy will provide different levels of coverage, but they will offer some level of care because the law does not allow for people to be denied care or charged exorbitantly for it. It also places a ban on lifetime dollar limits that would stand in the way of receiving care.

You should take comfort in the fact that the law enforces “parity;” treatment limits for substance abuse must not be more strict than the limits placed on other medical and surgical services. It is excellent that you will be provided by the same level of coverage on your drug and alcohol treatment that you would be for any other medical disorder.

Did you know that only 11.2 percent of the Americans who needed treatment for a drug or alcohol addiction received care in 2009?  A big reason that so few people who needed help received it was a difficulty accessing health care coverage. That is no longer the case.

These changes and many of the others in the Affordable Care Act have had an impact on your AmeriHealth benefits, but what are those impacts exactly? You are still probably wondering how much coverage you can expect for your drug and alcohol rehabilitation. The questions answered in the following post are very common ones and they should provide you with a good jumping off point.

Does AmeriHealth Cover Drug and Alcohol Addiction Treatment?

First, you need to understand that there are many types of treatment for drug and alcohol addiction. These include:

  • Care specifically from your therapist or doctor
  • Detox care
  • Aftercare
  • Inpatient care
  • Outpatient care

You can be confident that some level of care is covered in your policy, but you may not have all types of care covered. The level of coverage is dependent upon your policy; all AmeriHealth policies will not be identical.

Generally, your path to coverage will follow the following pattern:

  • Gain diagnosis from a doctor
  • Have a treatment type recommended
  • Contact an addiction treatment program
  • Receive pre-authorization

After all of these steps, you will be able to take advantage of your coverage.

How Much of the Treatment Costs Are Covered?

AmeriHealth will offer the same amount of coverage that they would for any other type of medical problem. If you have used your insurance previously in such a situation, then you probably have a pretty good idea how much coverage you can expect. Without doubt, your coverage will extend to what is considered medically necessary. However, no policy will completely cover every cost.

How Long Will My AmeriHealth Insurance Cover my Treatment?

Drug and alcohol treatment comes in a variety of lengths. Common lengths are 30, 90, and 120 days. The Affordable Care Act does prevent a lifetime limit from barring you from care, but you may still encounter per-occurrence and per-day maximums on your policy, which will limit the length of stay that you can expect to have covered. Consult your policy to determine the exact amount of time.

Can I Pay Above What Is Covered by My Insurance?

Not only is it acceptable for you to pay the difference between the total costs and those covered by insurance, you will have to. But, rest assured that paying out-of-pocket expenses will not have an impact on your insurance coverage. If you would like a longer length of treatment or additional treatment beyond what is covered, you are welcome to pay yourself.

Keep in mind that there will be out-of-pocket expenses no matter what your level of coverage is because all policies will have co-pays and deductibles. To limit the amount you will pay, seek in-network care. Also, be sure to speak with the financing department at the facility you are considering attending. They can evaluate your policy in comparison to their offerings.

If you will have problems paying the difference, consider seeking care elsewhere. Other options include loans, credit cards and financial assistance offered by the program.