AmeriHealth Insurance Coverage for Drug & Alcohol Rehab
NOTICE: Step One Rehab works hard to make sure our information is accurate. Due to constant changes in insurance company policies, we suggest you contact your insurance company with your member ID for any policy questions. This FAQ is only intended as a guide to point you in the right direction.
AmeriHealth Drug and Alcohol Rehab Coverage – FAQ
Where does AmeriHealth Operate?
AmeriHealth is made up of several branches: AmeriHealth Caritas, AmeriHealth New Jersey, AmeriHealth Pennsylvania, AmeriHealth Administrators, and AmeriHealth Casualty.
They operate in over 20 states, including: Arizona, Florida, New Jersey, California, Michigan, Missouri, New York, Nevada, North Carolina, Pennsylvania, Rhode Island, South Carolina, and Texas. Their plans range from local to national.
Does AmeriHealth Cover Rehab?
AmeriHealth usually will cover drug rehab as part of their Behavioral Health Program. They base coverage on a number of factors which vary based on your plan. Some AmeriHealth plans are: AmeriHealth® HMO/POS, AmeriHealth® PPO, and AmeriHealth 65 (HMO)®.
AmeriHealth coverage ranges from partial to full. You are responsible for whatever they do not cover. If your plan has a deductible, you have to pay the deductible amount before your insurance coverage takes over.
For inpatient or outpatient drug treatment, you may need a doctor’s evaluation and recommendation, and you may need prior authorization from AmeriHealth.
Here are two examples of different plans and what they cover:
This NJ AmeriHealth HMO plan requires pre-approval. Substance abuse outpatient Co-payments are $50. For inpatient treatment, Copayments are $500 a day. You can have a maximum of 5 visits.
This NJ AmeriHealth PPO Plan – has a $10 Copayment for outpatient substance abuse visits, and 100% coverage for in-network inpatient treatment. Out of network coverage is 80%.
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Most AmeriHealth plans have coverage for the following:
Intensive outpatient programs (IOP)
Various mental health and behavioral health programs
To manage your AmeriHealth plan, or learn more about it, you can visit Website.
How Long will AmeriHealth Cover Addiction Treatment?
AmeriHealth coverage length varies. They may not always cover rehab, only detox. If they do cover rehab, typical coverage lasts from 3 days 90 days.
Are out of network providers allowed with AmeriHealth?
It depends on the plan:
AmeriHealth HMO Plans (Health Maintenance Organization) – coverage for network doctors only. Your primary doctor can coordinate your care and refer you to specialists within the network you choose.
AmeriHealth HMO Plus – Coverage for network doctors. Your PCP can coordinate your care, but you can choose a doctor or hospital without a referral.
AmeriHealth POS (Point-of-Service) –Have the highest level of benefits when you visit providers that participate within the network, but you have the option to get care out-of-network. Your PCP can coordinate your care, but you can choose a doctor or hospital in- or out-of-network.
AmeriHealth POS Plus – Your PCP can coordinate your care, but you can choose a doctor or hospital in- or out-of-network, without a referral.
AmeriHealth EPO (Exclusive Provider Organization) – You can see any doctor or specialist you want with no referral, if they’re within the network you choose.
AmeriHealth PPO (Preferred Provider Organization) – you can choose any doctor or specialist without a referral, in or out of network.
Contact AmeriHealth to confirm your level of coverage, if any, for out-of-network providers, and to determine any additional costs.
Does AmeriHealth Allow for Treatment at Luxury Rehab Facilities?
Usually not with an HMO, but possibly with a PPO, POS, or EPO Plan. Luxury (private) drug rehabs are often where wealthy people and celebrities will go for addiction help. They are often as nice as any hotel or resort you may use for a vacation spot. They usually have massages, acupuncture, hot-tubs, pools, and quality dining, in addition to other exclusive privileges.
Inpatient Addiction Treatment vs. Outpatient Treatment
This is one of the biggest and most important choices that a patient or their family will make when looking for addiction help. Where you go, and what you do from here on matters and can determine your level of success.
Both options are better than not seeking treatment and could save your life. They each have their own strengths and weaknesses.
An outpatient facility is usually a local option. They give you the chance to meet with AmeriHealth professionals like doctors, alcohol and drug counselors, or therapists, attend group sessions, and go to recovery meetings while being able to head home afterwards. Co-pays may be required for each visit.
Inpatient facilities, also called residential programs, are most often 28 day programs. They provide structure and are typically remote destinations where you stay in the facility for the duration of the program.
Do I need Insurance to go to Rehab?
You are not required to have insurance to get addiction treatment. However, without insurance, the cost of drug rehab facilities is usually very expensive and impractical for most people. You would need to pay out of pocket. You can certainly pay with a credit or debit card, work out a payment plan, or use other methods that each facility accepts.
Typical inpatient rehabs may cost anywhere from $6,000-$20,000 for a 28 day program.
Outpatient Rehab can range from $4,000-$10,000 for 90 days. The cost of outpatient rehab will vary and is mostly based on how many visits are made.
How does AmeriHealth Decide my Claim?
AmeriHealth makes decisions about their coverage based on your health plan. Each claim decision is reviewed on a case by case basis and varies by state. In general, AmeriHealth will look at services you use. They then follow national guidelines and other policies to determine if you’re covered. Services that may be covered can include drug addiction rehab, blood-tests, surgeries, or hospital stays.
If your claim is denied, AmeriHealth will notify you. You DO have the right to appeal. To start an appeal with AmeriHealth, call their Member Services number on your AmeriHealth ID card. They typically allow 90 days from the date of the initial payment or denial notice to file. If Member Services doesn’t resolve your issue, ask for an appeal.
All AmeriHealth appeals are responded to compliance with state, federal and NCQA guidelines. It is possible to get appeals expedited.
Follow this link to see more about AmeriHealth’s Appeal Process (note: this is an example of a NJ Form and may not apply to your location).
What Else does AmeriHealth Provide?
AmeriHealth has a host of health, wellness options, and discounts.
They serve over 5.3 million people.
Dental, Vision, and pharmacy benefits.
A variety of plans and the ability to manage and adjust your plan.
Per HIPAA laws, anything that you say is kept confidential. You don’t have to worry about anyone knowing you may have trouble with alcohol or drugs.
Get an Approved Amerihealth Drug and Alcohol Rehab
Verifying what insurance will cover can be a time-consuming process. This hassle usually involves lots of waiting and multi phone calls back and forth. Our knowledgeable staff can verify your coverage for you and take the stress and annoyance out of this already difficult time. You have enough to worry about already. Verifying insurance coverage for rehab shouldn’t be an additional burden.
Instead, give us a call now and let us handle this step, at no cost to you! We are totally confidential. Our number is 877-348-7494