Does AmeriHealth insurance cover Alcohol and Drug Rehab?

If you’re struggling with addiction, know that you’re not alone. For many, entering drug and alcohol rehab is essential for recovery. While it can be costly, you may be able to use health insurance to help cover the costs. This may apply if you have a health plan through the AmeriHealth Family of Companies.

Residents of New Jersey, parts of Delaware, and Pennsylvania may be able to purchase health insurance coverage through AmeriHealth.¹ Additionally, AmeriHealth offers nationwide Medicaid and third-party administration services.¹ To find out what plan you have and what coverage may be afforded to you under those plans, call the number on the back of your insurance care and speak with an AmeriHealth insurance representative today.

Check AmeriHealth Insurance Coverage for Addiction Treatment

It’s no secret that healthcare can be expensive. But there are ways that you can help keep your costs in check as much as possible. One of these ways is to always check your AmeriHealth coverage before seeking care whenever possible. AmeriHealth can help cover treatment for addiction, but coverage may be subject to various cost-sharing requirements.

As a leader in the industry of addiction care, American Addiction Centers (AAC) is here to help you navigate all elements of addiction treatment. Call our helpline today and speak to a person who can check your benefits while you’re on the phone. AAC staff is trained to help you learn more about addiction treatment and what your coverage may include. You can also enter your insurance information and immediately see whether AAC is within your plan’s network.

What is AmeriHealth?

Founded in 1995, AmeriHealth is a growing group of healthcare insurance plans that are based in New Jersey and Pennsylvania.² Originally established to provide Pennsylvania employers and employees in Salem, Gloucester, Camden, and Burlington counties, it is now a subsidiary of one of southeastern Pennsylvania’s largest insurers.¹

What was once known as Delaware Valley HMO is now a health insurance provider to 265,000 people.¹ There are a variety of plans through different markets that may be available to you. Review your insurance card to find out what plan you have, or call the number on the back of your card to find out more about your plan’s details.

What will AmeriHealth insurance cover?

Your AmeriHealth healthcare coverage exists to help cover some or all of your healthcare costs. However, every plan is unique in what it will explicitly cover or not cover. Similarly, various elements of your plan’s design may impose coverage limits and cost-sharing requirements, such as a copay or deductible, and require you to use in-network providers in order to use coverage.

That’s why it’s so important that you verify your benefits and coverage before seeking care whenever possible, so you can best understand your coverage details. To do this, call the number on the back of your insurance card and speak with an AmeriHealth healthcare plan representative.

Depending on your plan, your AmeriHealth mental health coverage may be able to cover some or all of the costs related to any of the following 4 common addiction treatment methods:

• Inpatient or residential rehab. If you’re a patient in an inpatient or residential rehab program, you’d live at the facility for the duration of your program and receive medically supervised care, which could include medical detox.^{3, Pg 8, “What types of treatment programs are available?” Para 2,}
• Outpatient rehab or therapy. If you participate in an outpatient rehab program, you’ll travel to a facility 1–2 times each week (or less frequently) to receive counseling or therapy and then return home after each session.^{3, Pg 10, Para 2}
• Intensive outpatient programs (IOPs). In an IOP, you’ll receive similar care to a standard outpatient rehab or therapy, but it’s typically more stringent in that you are required to attend a minimum number of hours of care each week, usually at least 9 hours.^{3, Pg 10, Para 3}
• Partial hospitalization programs (PHPs). A PHP, often referred to as a day program, involves receiving care for 4–8 hours each day for multiple days a week. However, no hospitalization or overnight stay is required.^{3, Pg 10, Para 1}

Despite these common treatment methods listed here, some of these may or may not be recommended for you; you’ll want to work with your mental healthcare provider to find a treatment plan that’s right for you. Similarly, you’ll want to work with the rehab center directly or your AmeriHealth healthcare plan representative to determine what may or may not be covered under your plan.

Does AmeriHealth Insurance Cover Mental Health Treatment Facilities?

The Affordable Care Act (ACA), which is a U.S. federal health care reform law that was signed into effect in 2010, requires almost all U.S. health plans to provide coverage for certain services along with other provisions.⁴ These services are called essential health benefits (EHBs), and mental health care is included in this list.⁵

What this means for you is that your AmeriHealth plan may be required to provide coverage in some capacity for mental health care services, such as substance use disorder treatment.⁶ For those with an AmeriHealth plan who may need stand-alone heroin rehab or treatment for a co-occurring disorder, you may be able to use your plan to gain coverage for such services.

A co-occurring disorder occurs when someone has both a mental illness and substance use disorder simultaneously.⁷ If you believe you may have a co-occurring disorder, know that you’re not alone. According to the Substance Abuse and Mental Health Service Administration’s 2018 National Survey on Drug Use and Health, 9.2 million American adults have a co-occurring disorder.⁷

While it is not believed that having a mental illness causes a substance use disorder or vice versa, if you have one condition, you’re twice as likely to develop the other at some point in your life.⁸ Because of the influential and interconnected nature of the 2, mental health experts recommend tandem treatment, where each condition is treated on its own but at the same time during the course of rehab.^{7 “What should I do?”}

To find out whether co-occurring disorder treatment is covered under your plan or the extent to which it is covered, call the number on the back of your insurance card. Verifying your benefits prior to seeking treatment is essential to keeping your healthcare costs as low as possible.

How Long Does AmeriHealth Insurance Cover Rehab?

You may be wondering how long your AmeriHealth healthcare plan will cover rehab. The answer isn’t necessarily straightforward, as there are a variety of AmeriHealth plans over various markets. The length of time that your plan may cover treatment will depend upon the type of plan you have, where you live, the type of care you need, and where you seek care.

Additionally, you may be subject to various cost-sharing requirements, which are out-of-pocket costs you owe in addition to your insurance coverage. The best way to figure out what you may owe and how long coverage will be provided is to call the number on the back of your insurance card.

It’s important to keep in mind, though, that your plan’s coverage details and the length of time you should remain in rehab may not align. Experts recommend that treatment last at least 90 days for the best chance at improving overall outcomes and reducing or stopping substance use.^{9 bullet 5} However, every person is different, and your healthcare provider may recommend you stay in treatment for longer or shorter amounts of time.

Be sure to work with your provider to determine how long you should be in treatment, and similarly, work with AmeriHealth to figure out how long your plan may cover treatment.

What if my AmeriHealth policy does not cover rehab?

It is possible that your AmeriHealth policy may not cover some or all of the costs associated with rehab due to a multitude of factors. If this happens to you, you may be responsible for paying for the costs. However, depending on the rehab center you choose, you may be able to apply for financing or scholarship opportunities to help offset some of the costs.

Be sure to ask rehab center staff whether this would be an option for you. It’s important to prioritize getting the treatment you need right now rather than pushing it down the road.

AmeriHealth In Network vs. Out of Network Rehab Centers

Understanding the difference between in-network and out-of-network rehab centers can be the difference between receiving covered care. A “network” refers to a group of facilities or providers that work with your AmeriHealth healthcare plan to provide services at a prenegotiated rate to covered members.¹⁰

Every AmeriHealth plan has its own network stipulations, which is why it’s so important to verify your benefits prior to seeking care whenever possible. Call the number on the back of your insurance card to learn more about your benefits and find a covered provider nearby.

AmeriHealth Plans

There are a handful of different plans that may be available, depending on your situation and location, including the following:¹¹

• AmeriHealth Pennsylvania: Affordable health insurance for Pennsylvania residents
• AmeriHealth New Jersey: Affordable health plans for employers and individuals in New Jersey
• AmeriHealth Caritas: Medicaid and Medicare managed care plans, behavioral health services, administrative services, and pharmaceutical benefit management.
• AmeriHealth Administrators: Nationwide health plan third-party administrators

To find out what health plan you have, look at the information on your insurance card. Every plan will provide different levels of coverage for mental health and addiction treatment. You can also call the number on the back of your card and talk to a representative to learn more about your plan.