With Amerigroup insurance, you can reduce the cost of rehab to make addiction treatment more accessible. But what rehab programs are covered by Amerigroup insurance? And how can you maximize Amerigroup rehab coverage to make treatment more affordable?
Use this guide to learn how coverage works and what out-of-pocket costs to expect at various levels of care.
Understanding Amerigroup Insurance for Addiction Treatment
Amerigroup is a primary provider of Medicaid, Medicare, and state-sponsored health insurance. Plans with Amerigroup are fully compliant with the Affordable Care Act’s behavioral health mandates.
Does Amerigroup Cover Drug and Alcohol Rehab?
Yes, Amerigroup provides essential coverage for substance use disorders. Because Amerigroup often administers government-sponsored plans like Amerigroup Medicaid, the level of coverage can vary heavily by state and specific policy tier.
It is recommended that you check with both your insurance provider and the rehab facility to confirm coverage before you enroll in any treatment program.
The Role of Medical Necessity and Pre-Authorization
Before approving coverage for intensive addiction treatment, insurance companies typically require that treatment be deemed medically necessary. The pre-authorization process may include a formal clinical assessment to prove that specific levels of care are required for the patient’s safety and recovery.
Please note, skipping this pre-authorization process can lead to claim denials. You can contact a primary care provider or obtain a referral from the rehab facility to schedule a pre-authorization assessment with a qualified clinician.
What Types of Addiction Treatment Does Amerigroup Cover?
Addiction treatment is available at various levels of intensity. A full continuum of care begins with medical detox and progresses through ongoing aftercare services. Amerigroup offers various coverage options for each level of treatment.
Medical Detox and Medication-Assisted Treatment (MAT)
Medically supervised detox is important for safe management of withdrawal symptoms associated with alcohol or opioid use cessation. This is typically the first phase of addiction treatment and may also involve initiation of medication-assisted treatment (MAT).
Often deemed medically necessary, supervised detox and MAT can be covered at least in part by Amerigroup plans. This coverage often includes necessary medications like Suboxone or buprenorphine when prescribed as part of a comprehensive recovery plan. Note that MAT often continues past this phase as the patient transitions to an inpatient or outpatient program.
Inpatient vs. Outpatient Rehab Programs
Inpatient or residential rehab involves living at a facility (usually for 30, 60, or 90 days) while engaging in a variety of therapeutic methods to treat addiction. These residential stays are typically covered for a specific number of days based on medical necessity.
Outpatient services such as intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) involve attending treatment sessions at the facility, without overnight stays. This step-down care is often more readily covered by insurance plans.
Out-of-pocket costs also differ significantly between inpatient and outpatient settings. With higher costs overall, inpatient settings typically incur more out-of-pocket expenses.
Dual Diagnosis and Co-Occurring Disorders
A dual diagnosis (also referred to as co-occurring disorders) is defined as the presence of both a substance use disorder and a mental health condition, such as depression or anxiety. It is important to address both disorders at once, since causes and symptoms are usually interwoven and have direct impact on one another. Treating the underlying mental health condition is proven to reduce relapse rates.
Due to this significance of dual diagnosis treatment, Amerigroup coverage of this treatment is generally robust.
How to Maximize Your Benefits and Minimize Costs
Because coverage varies, it is important to understand your treatment options and insurance plan so you can fully leverage your benefits and reduce out-of-pocket costs.
In-Network Providers vs. Out-of-Network Coverage
Choosing in-network Amerigroup providers ensures the highest level of Amerigroup rehab coverage. Many Amerigroup HMO or Medicaid plans strictly limit out-of-network care to emergencies. This means, if you choose to go out-of-network for rehab treatment, you will likely be responsible for the entire bill.
When staying in-network, be aware that you still may experience some out-of-pocket costs, such as deductibles, copays, and coinsurance. However, these costs will be much lower than what you would encounter when receiving out-of-network services.
Frequently Asked Questions
Have more questions? Find answers to common inquiries here:
It depends on your specific plan. HMOs and Medicaid plans often require a referral from a primary care physician to secure coverage for specialized addiction treatment, while some PPO plans may allow self-referrals.
Amerigroup rehab coverage typically covers standard, evidence-based medical treatments and therapies but generally will not cover the inflated costs associated with luxury amenities (such as private chefs, equine therapy, or spa services).
To check your Amerigroup rehab coverage, call the customer service number on the back of your insurance card or use a free insurance verification tool provided by prospective in-network treatment centers.
