Updated on May 3, 2024
6 min read

Does AmeriHealth Cover Addiction Treatment?

AmeriHealth insurance plans offer coverage for addiction treatment and rehab services for substance abuse disorders. This is great news, particularly if you seek addiction treatment coverage with an insurance plan.

The Affordable Care Act (ACA) mandates that all health insurance plans cover substance abuse treatment as an essential health benefit. That means help is available, and AmeriHealth should offer some coverage for substance abuse treatment.

AmeriHealth Insurance Addiction Treatment Coverage

The specific details of AmeriHealth's addiction treatment coverage can vary depending on your plan type and state of residence.

However, some critical points about AmeriHealth's addiction treatment coverage include:

  • AmeriHealth plans cover services like detox, inpatient rehab, outpatient treatment, and medication-assisted treatment for substance use disorders.
  • Your plan will determine the amount of coverage, approved treatment providers, and out-of-pocket costs (deductibles, copays, and coinsurance).
  • AmeriHealth offers various plan types (HMO, PPO, EPO, POS) across different states, and the addiction coverage details can vary by plan type.
  • They have dedicated resources, such as a behavioral health hotline, to help members find in-network addiction treatment providers and understand their coverage.
  • The length of treatment covered by AmeriHealth can depend on factors like the type of substance abuse disorder and medical necessity.

What Types of Addiction Does AmeriHealth Insurance Cover?

AmeriHealth insurance plans cover treatment for various types of addictions, including:

  • Cocaine
  • Methamphetamine
  • Heroin
  • Opioid painkillers (such as oxycodone)
  • Benzodiazepine (such as Xanax and Klonopin)
  • Marijuana
  • Stimulants (such as Vyvanse and Adderall)
  • Alcohol

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What Is the Process for Addiction Coverage Under AmeriHealth?

Here is the typical process for enrolling in addiction treatment under an AmeriHealth insurance plan:

1. Determine Medical Necessity

Before AmeriHealth will agree to cover addiction treatment benefits, they first need to determine that the treatment is medically necessary for your condition. This process is known as preauthorization.

You and your treatment provider will need to provide information to AmeriHealth about your addiction severity, substances used, mental health issues, past treatment attempts, etc.

AmeriHealth will review this information to determine if the recommended level of care (e.g., inpatient or outpatient) is medically necessary based on your situation.

2. Find an In-Network Partner

AmeriHealth has a network of approved treatment facilities and providers considered "in-network." Using in-network providers will ensure maximum coverage.

You can contact AmeriHealth's behavioral health hotline to get assistance finding in-network addiction treatment options in your area that are covered under your plan.

3. Understand Your Coverage Details

Coverage details like deductibles, copays, number of covered inpatient days or outpatient visits can vary significantly between different AmeriHealth plans.

Contact AmeriHealth to verify what is specifically covered by your plan, including detox, residential rehab, medication-assisted treatment, etc.

4. Admission and Continued Stay Review

Once admitted to treatment, AmeriHealth may review periodically to ensure continued medical necessity for that level of care.

Your treatment provider must provide updated information to AmeriHealth to justify continued treatment coverage.

5. Appeal for Denials

If AmeriHealth denies coverage for any portion of your recommended treatment, you have the right to appeal that decision and request a review.

You and your provider must submit additional supporting documentation to AmeriHealth justifying why that level of care is medically necessary.

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How Much Should You Pay Out of Pocket for Addiction Treatment?

We understand finances can be a big concern when seeking addiction treatment. Here's a breakdown of potential out-of-pocket costs with AmeriHealth, explained clearly:

  • Deductible: This is like a down payment you make before insurance kicks in. Deductibles can range from a few hundred to a few thousand dollars annually.
  • Coinsurance: After the deductible, you might have coinsurance. Think of it as a copay percentage (usually 20 to 40%) you share with AmeriHealth for covered services.
  • Copays: These are fixed amounts (like $20 to $30) you pay for each treatment visit or service.
  • Out-of-Pocket Maximum: Thankfully, AmeriHealth plans usually have an annual out-of-pocket maximum. Once you reach this limit through deductibles, coinsurance, and copays, AmeriHealth covers 100% of covered treatment costs for the rest of the year.

Using treatment centers approved by AmeriHealth (in-network) typically minimizes your out-of-pocket costs. Contact AmeriHealth directly for specifics on your plan's deductible, coinsurance, copays, and out-of-pocket maximum.

Out-of-pocket costs can be higher if you choose out-of-network providers. Specific coverage limits, like the number of covered rehab days, can also impact your out-of-pocket costs if you exceed those limits.

Don't let financial worries keep you from getting the help you deserve. AmeriHealth should cover a significant portion of your treatment, and their health hotline can answer your questions about specific costs and coverage details. Focus on your recovery, and AmeriHealth can help with the financial part.

What Treatments Does AmeriHealth Insurance Cover?

Getting the right addiction treatment is crucial. Here's a breakdown of what AmeriHealth typically covers to help you on your path to recovery:

  • Detox: This medically supervised process helps you safely withdraw from substances.
  • Inpatient/Residential Rehab: This intensive program involves living at a treatment facility and participating in structured therapy sessions. AmeriHealth usually covers these programs for severe addictions when medically necessary.
  • Outpatient Treatment: This allows you to continue living at home while attending regular therapy sessions and support groups.
  • Aftercare and Continuing Care: Recovery is a journey. AmeriHealth may cover programs to help you stay sober after rehab.
  • Medication-Assisted Treatment (MAT): Medications like Suboxone can help manage cravings and withdrawal symptoms. AmeriHealth generally covers MAT as part of a complete treatment plan.

Does AmeriHealth Insurance Include Mental Health Services?

Addiction often goes hand-in-hand with mental health struggles. The good news is that AmeriHealth recognizes this and covers mental health services as part of their addiction treatment plans. This means you can get the support you need for both issues simultaneously.

Federal law (parity laws) requires fair coverage. AmeriHealth can't limit your mental health or addiction treatment coverage compared to other medical conditions. You deserve comprehensive care.

AmeriHealth Insurance Exclusions or Limitations

Here are some potential exclusions or limitations on addiction treatment coverage under AmeriHealth insurance plans:

1. Length of Treatment

AmeriHealth plans may limit the number of days you can receive coverage for detox in a calendar year. There may be limits on the number of days you can spend in inpatient/residential treatment in a calendar year.

The number of outpatient visits covered each year for addiction treatment could be capped.

2. Special Treatments

Some AmeriHealth plans may not cover certain types of therapies like equine therapy, music therapy, hypnotherapy, or other alternative treatments for addiction.

3. Medical Necessity

AmeriHealth must first determine that the recommended level of addiction treatment (inpatient, outpatient, etc.) is medically necessary before agreeing to provide coverage through the preauthorization process.

If AmeriHealth denies preauthorization for a treatment that is not medically necessary based on your specific situation, that treatment may not be covered.

4. Network

Treatment received from out-of-network providers not approved by AmeriHealth may not be covered or could result in higher out-of-pocket costs.

Some AmeriHealth plan types, like HMOs, may only cover in-network addiction treatment with no out-of-network benefits except for emergencies.

5. Medications

While medication-assisted treatments like Suboxone are generally covered, AmeriHealth may place certain requirements or limitations around which medications are approved for opioid addiction treatment.

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Updated on May 3, 2024

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