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Does AmeriHealth Insurance Cover Drug Rehab?
Obamacare, officially known as the Affordable Care Act (ACA), introduced 10 groups of services and items that must be covered on every small group and individual health care plan. Those groups include mental health and addiction services. While each type of policy provides different levels of coverage, all AmeriHealth insurance policies offer some coverage for drug rehab.
Thanks to the ACA, insurance companies are no longer allowed to deny care for addiction treatment or charge exorbitant prices for drug rehab. It also places a ban on lifetime dollar limits that would stand in the way of receiving care.
There are many types of treatment for drug and alcohol addiction, including:
- Detox Services
- Inpatient Care
- Outpatient Care
- Aftercare
- Medication-Assisted Treatment (MAT)
While you can be confident that some level of addiction treatment care is covered in your AmeriHealth policy, every form of care or treatment setting may not be covered.
Generally, your path to coverage will follow the following pattern:
- Obtain a diagnosis from your doctor
- Have a treatment type recommended
- Contact an addiction treatment program
- Rehab program confirms your AmeriHealth Insurance drug rehab coverage
- Receive treatment pre-authorization
After all of these steps, you can take advantage of your coverage.
Types of AmeriHealth Insurance Drug Rehab Coverage
AmeriHealth is a national insurance company providing a variety of healthcare plans and coverage options, including addiction treatment, for more than 265,000 members.
Because the coverage tends to vary by state, it’s always best to verify the details of your specific substance abuse treatment plan before committing to your chosen rehab center. Some AmeriHealth insurance drug rehab plans may require a referral from your primary care doctor for certain types of addiction treatment.
Types of AmeriHealth plans include the following:
- Health Maintenance Organization (HMO): With an HMO plan, your primary care doctor will manage your care, including referring you to specialists within the network.
- HMO plans only cover in-network doctors and facilities. Typically, only emergency services are covered if you go outside the plan’s network.
- Point-of-service (POS): A POS plan works best if you want a primary care physician to coordinate your care, but you’d still like to choose where you go, whether it be in- or out-of-network.
- POS (NG): With a POS NG plan, you’ll get all the benefits of the POS plan, but you don’t need a referral in order to receive treatment.
- Preferred Provider Organization (PPO): You’ll have access to a large pool of doctors and specialists who can be in- or out-of-network.
- You don’t need a referral.
- You will pay lower out-of-pocket costs by seeing in-network providers.
- Exclusive Provider Organization (EPO): This plan is best for anyone who wants the ability to see any in-network doctor or specialist without a referral.
- EPO plans don’t cover out-of-network care unless it’s an emergency.
Verifying AmerHealth Insurance Coverage
To verify your insurance coverage through AmeriHealth, the first step is to log in to your Member Portal.
There are several ways you can do this, including:
- Online at amerihealth.com
- Through the AmeriHealth app
- Calling the Customer Service number on your insurance card
Once you’re in the Member Portal, you can go to your account details to see more in-depth details on your benefits information, including a digital version of your member ID card. This is also the place you’ll go if you need to manage any current claims.
Keep in mind that benefits can vary by state, as well as the specific AmeriHealth insurance product you have.
How Much of the Treatment Costs Are Covered?
AmeriHealth Insurance offers the same amount of coverage for addiction treatment as they would for any other medical problem. If you have used your insurance previously, you probably have a good idea of how much coverage you can expect from your own plan. Without fail, however, your coverage will extend to what is considered medically necessary.
What Treatment Lengths Are Covered by AmeriHealth Insurance?
Dependence on different substances requires different lengths of treatment. Determining factors in the number of days your policy covers are the type of plan you have and the deductible it carries.
The typical lengths of residential (inpatient) care include the following:
- 28 to 30 Days: This generally covers both detox and a treatment phase.
- 60 Days: This generally covers treatment for an addiction that requires more care and allows for more in-depth therapy.
- 90 Days: Treatment of this length allows for involved care that delves into the underlying roots of the addiction and preparation to safely transition back home.
The ACA 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 will be covered. Consult your policy to determine the exact length of time you can expect AmeriHealth Insurance drug rehab coverage to be active.
Frequently Asked Questions
Curious about other topics related to AmeriHealth insurance? Here are answers to two of the most commonly asked questions.
How do AmeriHealth’s tiered networks work?
AmeriHealth offers a tiered network plan to help lower out-of-pocket costs. The highest tier is called Tier 1.
If you choose a provider listed under Tier 1 (known as a preferred provider), your out-of-pocket costs will be lower, along with your deductible and cost-sharing expenses.
Conversely, healthcare providers in lower tiers (like Tier 2) can also provide care, but their services will typically come with a higher copay.
Note that all tiered network providers are still technically part of your AmeriHealth network. Going this route simply expands your access to a greater number of providers.
Can I get MOUD coverage under AmeriHealth?
Yes. AmeriHealth does offer coverage for Medication for Opioid Use Disorder (MOUD) programs.
Also called Medication-Assisted Treatment (MAT), MOUD uses FDA-approved medications, including methadone, naltrexone, and Suboxone, in conjunction with behavioral therapy, to support the addiction recovery process.
The amount of coverage you receive will depend on several different factors, including:
- Your specific AmeriHealth insurance plan
- The state you live in
- Prior authorization requirements
- Whether you use an in-network or out-of-network provider
Health insurance can make the cost of your addiction treatment more affordable. To learn more, reach out to your provider. For a list of local treatment centers near you, browse the Addictions.com online directory.
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