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EmblemHealth Insurance Coverage For Drug And Alcohol Rehab

EmblemHealth offers multiple insurance plans that include coverage for addiction treatment services. Copays and deductibles vary depending on the type of plan. EmblemHealth Insurance Coverage For Drug And Alcohol Rehab

When a person is ready to seek help for an addiction, one of the biggest concerns they are often faced with is how to afford treatment. Will insurance pay for some of the cost of rehab? The good news is that most insurance plans, including EmblemHealth Insurance, offer some type of coverage for drug and alcohol rehab.

EmblemHealth is a privately held, non-profit insurance company and delivers personalized health insurance products at several different levels. The exact behavioral health services covered will vary by plan, although the Affordable Care Act does require insurance companies to cover these services at the same rates as other types of medical services and procedures.

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EmblemHealth Insurance Plans

EmblemHealth offers five types of plans to consumers. Coverage, deductibles, and copays vary from plan to plan. EmblemHealth insurance plans include:

Select Care Basic Plan

The Select Care Basic plan has a $6,850 deductible per individual with a $13,700 cap per family. The plan is designed for people age 30 or younger and other individuals who may qualify based on financial needs. After deductibles, there are no copayments or coinsurance and the plan offers 100 percent coverage for preventive care.

Select Care Bronze Plan

For this plan, the annual deductibles are $3,700 for each person with a $7,000 cap per family. After deductibles, 50 percent coinsurance applies but there are no copays. Preventive-care services are also 100 percent covered with the Select Care Bronze plan.

Select Care Silver Plan

Annual deductibles for the Select Care Silver plan are only $2,000 per person for this plan and $4,000 for families, and copays after the deductible are $30, $50 or $150. Preventive care is covered and coinsurance applies after the deductible on certain services.

Select Care Gold Plan

Although a person will pay more for the Select Care Gold plan, the deductible is just $600 per person with a $1,200 cap per family. This plan includes access to AdvantageCare Physicians, 100 percent coverage on preventive services and coinsurance after deductibles on some services.

Select Care Platinum Plan

The Select Care Platinum plan has no annual deductible. There is a $2,000 per individual out-of-pocket limit and a $4,000 out-of-pocket limit for families. Copays are $15, $25 or $100, and coinsurance applies to selected services. The plan includes access to AdvantageCare Physicians as well as total coverage for preventive care services.

Does EmblemHealth Cover Drug And Alcohol Detox?

For patients with EmblemHealth insurance plans who need drug or alcohol detox before beginning addiction treatment, inpatient detox will generally be covered. Hospitalization at an in-network facility with prior approval is usually covered as a hospital stay.

Out-of-pocket costs for drug or alcohol detox vary based on the type of plan. The basic plan has zero percent coinsurance for detox after the deductible; the bronze plan has 50 percent coinsurance after deductible for detox; and for silver, gold and platinum plans, detox is subject to the specialist office visit copay.

Does EmblemHealth Cover Inpatient Rehab?

For patients requiring a stay at an inpatient drug rehab facility, contact EmblemHealth for exact information on coverage for inpatient rehab. Inpatient rehab stays will require preapproval, although some of the plans offered by EmblemHealth might not cover inpatient rehab.

Does Emblem Health Insurance Cover Outpatient Rehab?

At least a portion of the cost of outpatient drug and alcohol rehab is usually covered by EmblemHealth. When staying within the EmblemHealth network, these outpatient services are usually covered without the need for prior authorization.

The number of covered days may be limited for basic or bronze plans, leaving patients covering extra days of outpatient rehab out of pocket. However, for patients with silver, gold or platinum plans, there’s no limit on the days of outpatient rehab covered, although patients will have copays as detailed in their plan.

Does EmblemHealth Cover Medication-Assisted Treatment?

Medication-assisted treatment using Suboxone (buprenorphine and naloxone) is covered by all plans when administered by physicians who are certified to treat opioid addiction. Physicians providing this treatment must be authorized by the Drug Enforcement Agency.

Methadone may also be used as a treatment for patients trying to overcome an addiction to heroin or opioid painkillers. In most cases, long-term treatment using methadone is not covered by insurance companies, including EmblemHealth.

Does EmblemHealth Cover Sober Living Houses?

Sober living houses provide transitional housing for individuals who have completed an addiction treatment program. These homes, which are sometimes called halfway houses, provide a safe, sober environment for patients who may not be ready to live alone or with their family again.

Since sober living houses are not actually treatment facilities, EmblemHealth does not cover them. Although EmblemHealth plans might not cover sober living homes, it still may prove to be a good option for patients who need a safe environment where they can continue their recovery. Alternative methods of financing a stay in a sober living house are available.

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In-Network And Out-Of-Network Coverage

Choosing in-network treatment centers or hospitals is generally much cheaper for patients since most EmblemHealth plans require patients to pay more for out-of-network treatment. However, patients interested in seeking rehab at centers that are not in the EmblemHealth preferred provider network shouldn’t give up. Verification of a patient’s insurance benefits performed by one treatment center may provide different results than the verification of benefits done by another facility.

How To Find Drug And Alcohol Rehab Centers That Accept EmblemHealth

1) Call Addiction Campuses for immediate verification of benefits. Addiction Campuses can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.

2) Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.

3) Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.

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