Last updated: 07/15/2019
Author: Addictions.com Medical Review
Reading Time: 3 minutes
It’s no secret that the United States is in the middle of an opiate epidemic, marked by heroin use as well as a growing number of prescription opiate users. Although, there is often an overlap between the two, with prescription opiate users transitioning to heroin use when they can no longer access the prescription meds they need.
Four of every five new heroin users, according to the American Society of Addiction Medicine, started their opiate use by nonmedically using prescription opiates. This, in turn, led to an increase in the total number of heroin-related overdose deaths, the rate of which increased four-fold between 2000 and 2013. The increase has become more dramatic in recent years, rising at a rate of 37 percent per year between 2010 and 2013.
One of the more difficult addictions to break, opiate addiction requires the intervention of structure, professional addiction rehabilitation treatment. But, how will your AmeriHealth policy enable you to finance that treatment? What follows are answers to some common questions. However, coverage changes from policy to policy and state to state, so you will want to get input from an expert.
Out insurance specialists are ready to help you understand your AmeriHealth policy and walk you through the coverage you can expect.
Has the Affordable Care Act (Obamacare) Had an Impact on AmeriHealth Insurance Coverage?
You should be thankful for the Affordable Care Act because it increased the amount of coverage offered by most individual and small group policies. When passed in 2014, it required ten essential benefits be provided to all policyholders, and mental health and substance abuse treatment are one of the ten.
Now, you can depend upon your AmeriHealth plan to:
- Give you coverage even if you have a pre-existing condition
- Cover substance abuse treatment deemed medically necessary
- Provide substance use disorder services without the threat of a yearly or lifetime dollar limit
Does AmeriHealth Insurance Cover Treatment for Opiate Addiction?
Yes. If your doctor determines that you have an opiate addiction and it requires medical intervention, you can expect the same level of coverage that would be provided by your policy for any other medical condition. However, the level of coverage varies based on plan and state of residence.
You won’t necessarily have your pick of inpatient, outpatient, medically-assisted, or therapy-based treatments. You need to check with your policy to see what you can expect. This is really important because opiate addiction often requires medication assistance and you need to know if you can depend on your policy to cover it.
How Much of the Cost of Treatment Will AmeriHealth Insurance Cover?
You need to know that no AmeriHealth policy will cover 100 percent of the costs associated with opiate addiction treatment. The level of coverage is dependent upon plan and policy. When you research your policy, be sure to fully understand the level of coverage provided so that you can prepare for out-of-pocket expenses ahead of time.
Because of the Affordable Care Act, AmeriHealth and other insurers will cover your addiction treatment to the same degree that they would other medical issues, but that means that you will still pay deductibles and copays and be subject to maximum per-day costs.
Is It OK for Me to Pay Above My AmeriHealth Insurance Coverage?
You may wonder if your coverage will be affected by your out-of-pocket payments; it won’t. If you want to attend treatment for 90 days, but AmeriHealth will only cover 30, you can fund days 31-90 independently. If you want to attend out-of-network opiate addiction care, you can pay the difference.
When you receive a recommendation for treatment, you should contact a facility you feel would meet your needs and speak to the financial department to see what coverage your AmeriHealth policy provides. Ideally, if you feel the coverage is adequate, you will be pre-authorized. This lets you know that your policy is ready to provide for you.
You are insured and you are ready to research treatment, now it the perfect time to get the input of an insurance specialist versed in addiction treatment.