Amerihealth Insurance for Rehab: Essential Coverage Explained

Navigating the world of insurance coverage for addiction treatment can be an overwhelming task for individuals and their families. AmeriHealth Insurance, a national insurance company, strives to make the process simpler by offering a variety of healthcare plans, including coverage for substance abuse treatment. With more than 250,000 members, AmeriHealth is dedicated to providing quality care and support to those in need of drug or alcohol rehab.

AmeriHealth Insurance is mandated by the Affordable Care Act (ACA) to provide some degree of coverage for substance abuse treatment in their plans. This means that policyholders have the opportunity to access professional help for mental health and substance use disorders, such as substance misuse, alcohol abuse, and other addictive issues. Having a clear understanding of your AmeriHealth plan coverage can help alleviate any financial concerns and allow you or your loved one to focus on the path towards recovery.

AmeriHealth Insurance Overview

Health Insurance Coverage

AmeriHealth is a national insurance company that provides a variety of healthcare plans and coverage options, including addiction treatment, for more than 250,000 members. As mandated by the Affordable Care Act (ACA), AmeriHealth is required to provide some degree of coverage for substance abuse treatment in their insurance plans.

AmeriHealth insurance plans cover mental health and substance use issues such as substance misuse, mental health disorders, alcohol abuse, and other addictive issues. The coverage for drug and alcohol rehab treatment depends on whether the treatment is deemed medically necessary.

Types of Plans

AmeriHealth offers multiple types of insurance plans to cater to the varying needs of its members. These include:

  • Health Maintenance Organization (HMO): HMO plans require members to select a primary care physician (PCP) from a network of healthcare providers. Specialist referrals are necessary for HMO plans, and out-of-network care is typically not covered.
  • Preferred Provider Organization (PPO): PPO plans offer more flexibility in choosing healthcare providers, as they allow members to see any doctor or specialist without a referral, both in-network and out-of-network. However, out-of-network care usually costs more.
  • Exclusive Provider Organization (EPO): EPO plans operate similarly to HMO plans but may offer a larger network of providers. Out-of-network care is generally not covered, barring emergency situations.
  • Point-of-Service (POS): POS plans are a hybrid of HMO and PPO plans. They require members to select a primary care physician from a designated network but also offer flexibility to see out-of-network providers at a higher cost.

In addition to these plans, some AmeriHealth members may also qualify for government-sponsored plans like Medicaid and Medicare, depending on their eligibility.

It’s essential for members to verify the details of their specific substance abuse treatment plans before committing to a rehab center, as coverage may vary by state and plan type.

Rehab Coverage Details

AmeriHealth insurance offers a variety of coverage options for addiction treatment, providing benefits to more than 250,000 members across the United States. The coverage details may vary by state, making it important to verify the specific terms of your plan before committing to a rehab center. Here we discuss the common types of treatment covered by AmeriHealth plans.

Inpatient Treatment

Inpatient treatment, also known as residential treatment, typically includes 24-hour care at a rehab center. Patients stay at the facility and receive round-the-clock support from medical professionals during their recovery. AmeriHealth generally covers inpatient treatments for various addictions, including alcohol, drugs, and others based on the individual’s specific needs.

Outpatient Treatment

Outpatient treatment allows patients to receive treatment while still living at home, attending to work or other responsibilities. AmeriHealth insurance also covers outpatient services for individuals struggling with substance abuse and mental health disorders, providing flexibility for those who cannot commit to full-time residential care.

Partial Hospitalization Programs

Partial Hospitalization Programs (PHPs) are a more intensive form of outpatient treatment that usually involve spending several hours a day at a rehab facility for structured therapy and support sessions. AmeriHealth may provide coverage for PHPs depending on the individual’s specific treatment needs and the details of their insurance plan.

Intensive Outpatient Programs

Intensive Outpatient Programs (IOPs) offer a higher level of care compared to standard outpatient treatment – usually requiring 9 or more hours of therapy per week. These programs are suitable for patients who need more structured care but do not require a full-time residential setting. AmeriHealth coverage typically includes IOPs as part of their substance abuse treatment benefits.

Medical Detox

Medical detox is often the first step in addiction treatment, helping individuals safely withdraw from drugs or alcohol under medical supervision. AmeriHealth plans generally cover medical detox services as part of their overall addiction treatment benefits.

Substance Abuse Treatment

AmeriHealth plans offer coverage for most major addictions, such as cocaine, methamphetamine, heroin, opioid painkillers (e.g., oxycodone), benzodiazepines (e.g., Xanax or Klonopin), alcohol, marijuana, and stimulants (e.g., Vyvanse or Adderall). The type and intensity of substance abuse treatment covered may vary depending on the individual’s needs and their specific insurance plan.

Considering these various forms of treatment, AmeriHealth insurance aims to provide comprehensive coverage for individuals seeking help with addiction and mental health issues.

Choosing a Rehab Center

In-Network vs Out-of-Network

When selecting a rehab center, it’s important to understand the difference between in-network and out-of-network providers. In-network providers have contracts with AmeriHealth Insurance to provide services at a reduced cost, making treatment more affordable for policyholders. Out-of-network providers, on the other hand, do not have these agreements in place, which can result in higher out-of-pocket expenses. As an AmeriHealth Insurance policyholder, it’s essential to research and identify drug and alcohol rehab centers that accept your insurance plan.

Co-Occurring Disorders

Many individuals seeking addiction treatment also grapple with co-occurring mental health issues. AmeriHealth Insurance provides coverage for treatment of both substance abuse and mental health disorders, such as depression and anxiety. When choosing a rehab center, ensure the facility is equipped to address these co-occurring disorders with a comprehensive, integrated approach.

Therapy and Medication-Assisted Treatment

Effective addiction treatment typically involves a combination of therapy and medication-assisted treatment (MAT) as part of a well-rounded care plan. AmeriHealth Insurance covers a range of therapies, including individual and group counseling, as well as MAT for addictions such as opioids and alcohol. When comparing rehab centers, make sure to choose a facility that provides evidence-based treatment, including various therapy options and MAT when appropriate.

Resources and Support

The path to recovery extends beyond initial treatment, and it’s crucial to have access to resources and support for continued sobriety. AmeriHealth Insurance may cover aftercare services such as intensive outpatient programs (IOP) and other outpatient care. When selecting a rehab center, investigate the availability of aftercare programs and resources to help maintain long-term recovery.

Remember to consult with an AmeriHealth Insurance representative or use their helpline to verify your plan’s specific coverage and limitations before committing to a rehab center.

Financial Considerations

When considering AmeriHealth insurance coverage for rehab, you should be aware of the costs and financial resources available. This section will provide information on deductibles and out-of-pocket costs, federal and state assistance, and American Addiction Centers resources.

Deductibles and Out-of-Pocket Costs

AmeriHealth insurance determines coverage for substance abuse treatment based on medical necessity through a preauthorization process, which can happen before or after admission to a program1. Out-of-pocket costs for addiction treatment under AmeriHealth typically include:

  • Deductible
  • Co-payments
  • Co-insurance

There may be variations in coverage depending on the healthcare plan and the specific addiction treatment program, such as inpatient rehab, outpatient rehab, or partial hospitalization programs2. It is essential to verify the details of your plan before committing to any rehab center.

Federal and State Assistance

Some individuals may qualify for federal and state assistance programs, such as Medicaid and Medicare, to help cover the cost of rehab. Original Medicare covers a certain number of days of inpatient rehabilitation during each benefit period3. However, eligibility and coverage details may vary by state and individual circumstances.

American Addiction Centers Resources

American Addiction Centers (AAC) resources can help you understand AmeriHealth insurance and its provisions for mental health and substance use disorders4. By working with AAC, you can find more information on AmeriHealth rehabilitation coverage, financial assistance options, and treatment plans tailored to your specific needs.

Remember to consult your AmeriHealth provider or customer service to get up-to-date, accurate information regarding your coverage and out-of-pocket costs for addiction treatment.

State-Specific Amerihealth Insurance Information

New Jersey

In New Jersey, Amerihealth offers various insurance plans, including HMO and POS options, which cover some degree of substance abuse treatment. Coverage varies by plan, and it is advised to verify the details of your specific plan before committing to a rehab center.

Pennsylvania

Amerihealth Insurance in Pennsylvania also covers addiction treatment, including medication-assisted treatment (MAT) for opioid addiction. Coverage details may vary, so it is essential to check your plan’s specific benefits.

Delaware

In Delaware, as in other states, Amerihealth Insurance provides coverage for substance abuse treatment. As coverage tends to vary by state, it is recommended to verify the details of your specific plan prior to choosing a rehab center.

California

Amerihealth covers addiction treatment in California. The type of coverage depends on the plan chosen, and it is advised to verify your specific plan.

Florida

In Florida, Amerihealth Insurance provides coverage for addiction treatment. Before committing to your chosen rehab center, it is recommended to clarify your plan’s specific coverage details.

Louisiana

For Louisiana residents, Amerihealth Insurance offers varying coverage for addiction rehab, including medical detoxification. Checking your plan for specific coverage details is essential.

Michigan

Amerihealth insurance plans in Michigan cover various addiction treatments, including inpatient and outpatient services. As coverage varies, it is suggested to verify your specific plan details before committing to a rehab center.

Missouri

As with other states, Amerihealth Insurance provides coverage for addiction treatment in Missouri. It is recommended to verify your plan’s detailed coverage information to determine the specific services covered.

North Carolina

North Carolina residents with Amerihealth insurance have access to coverage for substance abuse treatment. Plan details may vary, so it is essential to verify your specific plan coverage.

South Carolina

Amerihealth insurance in South Carolina offers options for addiction treatment coverage. As coverage tends to vary by state, it is always best to verify the specific details of your plan before committing to a rehab center.

Arizona

In Arizona, Amerihealth Insurance covers addiction treatment to varying degrees. It is advised to verify the details of your specific plan to understand your coverage options.

New York

Amerihealth insurance in New York provides coverage for addiction treatment. As with other states, it is crucial to verify your specific plan details before choosing a rehab facility.

Minnesota

Minnesota residents with Amerihealth insurance have access to coverage for substance abuse treatment. Since coverage varies, it is important to verify your plan’s specific benefits.

New Hampshire

In New Hampshire, Amerihealth insurance offers coverage for addiction treatment. To better understand your coverage options, it is advised to verify the details of your specific plan.

Washington, D.C.

Residents of Washington, D.C., with Amerihealth insurance are also provided coverage for addiction treatment. Verifying the specific details of your plan is crucial in understanding the extent to which treatment services are covered.

Important Terms and Processes

Pre-Authorization

Pre-authorization is a crucial first step in accessing drug and alcohol rehab with AmeriHealth insurance. This process involves obtaining approval from the insurance company before beginning treatment. It helps ensure that the proposed rehab program aligns with your coverage and minimizes out-of-pocket costs.

To obtain pre-authorization, contact AmeriHealth and provide information about the specific rehab facility and treatment plan you’re considering. The insurance company may request additional documentation or assessments to evaluate the necessity of the proposed treatment.

Diagnosis

A proper diagnosis plays a significant role in determining the appropriate drug and alcohol rehab program for an individual. Mental health professionals conduct assessments to diagnose potential disorders, such as post-traumatic stress disorder (PTSD), substance abuse, and other related conditions. Accurate diagnosis helps create an effective, personalized treatment plan for each individual entering rehab.

AmeriHealth insurance covers various services, including mental health and substance use issues. It’s essential to work closely with a healthcare provider, who will help you understand the available treatments for your specific needs.

Referral

When a healthcare professional diagnoses a patient with a substance abuse disorder or other related conditions, obtaining a referral for treatment becomes necessary. The referral process is an essential step to accessing AmeriHealth insurance coverage for drug and alcohol rehab.

Referrals from your primary care physician or a specialist can help ensure that your treatment is recognized as medically necessary by AmeriHealth. This, in turn, increases the likelihood of your insurance covering the costs of your addiction treatment at the rehab facility.

Remember to communicate with your healthcare provider about your insurance coverage, as this will help make sure the referral is well-suited for the type of treatment covered by your specific AmeriHealth plan.

Footnotes
  1. https://americanaddictioncenters.org/insurance-coverage/amerihealth-insurance 
  2. https://rehabs.com/insurance-coverage/amerihealth/ 
  3. https://www.healthline.com/health/medicare/medicare-guidelines-for-inpatient-rehabilitation 
  4. https://treatmentsolutions.com/treatment/insurance-information/amerihealth-covered-drug-rehab/ 

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