Wondering what your out-of-pocket costs for rehab will be with Amerihealth rehab coverage? Trying to decide if you can afford medical detox through Amerihealth?
Use this guide to learn what you need to know about Amerihealth rehab coverage and mental health benefits. Discover how you can tap into these benefits to make treatment accessible.
Does Amerihealth Cover Drug and Alcohol Rehab?
Yes. Under the Affordable Care Act (ACA), behavioral health and substance use disorder services are considered essential health benefits. To comply with this regulation, insurance companies must provide coverage for drug and alcohol rehab as they would for other medical needs.
However, this coverage can vary by plan. Amerihealth insurance provides some level of coverage, but the specific services covered and each patient’s financial responsibility depend on their unique policy.
Types of Addiction Treatment Covered by Amerihealth
Amerihealth covers a full continuum of care for addiction treatment, provided the services are deemed medically necessary by a clinical professional. These services range from initial detox to follow-up outpatient care.
Medical Detoxification
Medical detox Amerihealth services cover medically supervised withdrawal management. This phase of treatment is typically the first step in recovery.
Detox cleanses the body from addictive substances, breaking physical dependence and stabilizing the body’s systems. This process prepares the patient for continued treatment in an inpatient or outpatient rehab program.
To be covered by insurance, policies often require a clinical assessment to determine that the treatment is medically necessary.
Inpatient and Residential Rehab
Inpatient rehab involves 24/7 care within a residential treatment facility. Programs usually last 30, 60, or 90 days and involve individual and group therapies, holistic treatments, and aftercare planning. The length of stay covered by insurance depends on the individual’s progress, provider recommendations, and specific Amerihealth rehab coverage limits.
Outpatient Programs (PHP and IOP)
Partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) are structured daytime treatments. Participants attend multiple hours of treatment sessions throughout the day and week, but they do not stay overnight at the facility. These programs provide flexibility that allows patients to maintain home and work responsibilities while attending treatment.
Amerihealth frequently covers these programs as a step-down from inpatient care or as a primary intervention for moderate substance use disorders.
Medication-Assisted Treatment (MAT) and Dual Diagnosis
Amerihealth’s substance abuse treatment plans typically cover MAT. This treatment provides FDA-approved medications such as Suboxone alongside behavioral therapy. The aim is to treat both the physical and mental health sides of addiction through this combination of medications and counseling.
Another common approach is to treat both substance use and mental health disorders concurrently, since these conditions are often interwoven and directly affect one another. This approach is referred to as dual diagnosis treatment.
Amerihealth mental health benefits cover this dual diagnosis treatment, which is often provided for individuals experiencing co-occurring mental health disorders like anxiety or depression alongside addiction.
Understanding Your Amerihealth Rehab Coverage and Costs
Your specific policy structure directly dictates the final out-of-pocket costs for rehab. This makes understanding the various plan structures important as you consider treatment options and costs.
HMO, PPO, and POS Plan Differences
Amerihealth insurance plans are structured as an HMO, PPO, or POS.
HMO plans usually require treatment at contracted (in-network) facilities and may require a primary care physician (PCP) referral.
In contrast, PPO and POS plans offer more flexibility to choose providers. However, they still incentivize staying within the network, as costs for out-of-network providers are typically higher.
The trade-off for this flexibility is typically a higher premium or deductible for PPO or POS plans.
In-Network vs. Out-of-Network Facilities
Choosing an in-network Amerihealth addiction treatment center keeps deductibles, copays, and coinsurance as low as possible. Also important to consider are coverage tiers (Bronze, Silver, Gold, Platinum). These impact the percentage of costs Amerihealth covers once the deductible is met.
How to Verify Your Amerihealth Substance Abuse Treatment Benefits
It’s important to verify benefits before enrolling in a program to avoid surprise costs. In many cases, securing prior authorization before admission is required to avoid denied claims.
To verify your Amerihealth substance abuse treatment benefits, you have several options:
Contact the member services number on the back of your insurance card.
Log in to the Amerihealth online portal.
Ask an admissions specialist at a rehab facility to run a verification of benefits.
Amerihealth Addiction Treatment FAQs
Amerihealth covers the clinical, medically necessary aspects of addiction treatment. You will likely need to pay out-of-pocket for non-medical luxury amenities, such as private chefs or spa services.
Yes. For most intensive services—such as inpatient rehab and medical detox—Amerihealth requires prior authorization from a provider to prove the medical necessity of the treatment.
HIPAA laws strictly protect your medical privacy, and seeking help for a substance use disorder will not result in canceled policies or increased premiums.
