Seeking treatment for substance addiction requires a lot of courage. Changing old behavior patterns can feel awkward at first, and the logistics of finding an appropriate rehab center and paying for everything are sometimes complicated. If you’re currently enrolled with the AmeriHealth Family of Companies, however, then you’re working with a provider that covers treatment programs for substance use disorder. Review all the information in this guide to see how AmeriHealth can help you pay the costs of your treatment plan.
Getting the Most Out of Your AmeriHealth Insurance Plan
With joint headquarters in both Pennsylvania and New Jersey, AmeriHealth serves roughly 260,000 employers and individuals in the northeastern U.S. AmeriHealth’s family of insurance companies offers casualty services, third-party administration, individual health insurance coverage, and coverage for employers. Green Mountain Treatment Center proudly accepts patients with AmeriHealth policies, and we are one of many facilities around the country that do so.
AmeriHealth’s insurance offerings include HMO options, the HMO Plus plan, point-of-service programs, POS Plus, EPO coverage plans, and PPO arrangements. All of this jargon can be a bit overwhelming, so it’s important to review what each plan provides.
The HMO plan, with HMO being short for Health Maintenance Organization, is for individuals who already have a primary care physician (PCP) who works with other specialists and experts. Think of your primary care physician as the quarterback of your health. Your PCP takes your health history into account, looks at where things are headed, calls the next play, and brings in other experts to execute the game plan.
AmeriHealth’s basic HMO plan includes coverage for doctors in their network, and it’s best for simple situations. For your HMO plan to cover a visit to a specialist or another doctor with the HMO plan, your PCP must write a referral. In addition, the specialist you go to must be a doctor who’s within your plan’s specific network.
The HMO Plus program, on the other hand, also lets you select a PCP from an approved list. The difference, however, is that this program lets you select a treatment center, an addiction specialist, and a hospital without needing a referral from your PCP. When it comes to choosing your addiction center, both the basic HMO and HMO Plus plans offer less flexibility than point-of-service (POS) plans.
A POS plan from AmeriHealth is an excellent option for covering a stay at a treatment center. Your PCP can still work with a rehab facility to coordinate your stay if you have this plan, and this type of coverage offers the most benefits. With a POS Plus plan, you have a bit more flexibility. The center that you choose doesn’t need to be in AmeriHealth’s network of providers, and you don’t need a referral from your PCP to visit a center for treatment.
Similar to the POS plan, an AmeriHealth PPO plan also gives you more freedom than the standard HMO program. If you have coverage under a PPO plan, then you can also choose any primary care provider that you’d like.
Will You Ever Need to Pay Anything for Treatment Services If You Have an AmeriHealth Plan?
While AmeriHealth covers different treatment options for a wide range of substance use disorders, they don’t provide full coverage in every possible circumstance. Depending on your coverage type, your deductible level, and the terms of your insurance contract, you may be expected to pay for some of your treatment costs. This occurs more often for patients who seek inpatient rather than outpatient treatment.
Whether you have a standard HMO plan, a PPO plan through your employer, or a POS plan, most AmeriHealth insurance agreements come with what’s known as a “deductible.” Simply put, a deductible is a small amount of money that you contribute to your treatment before your insurance coverage kicks in. You’re probably familiar with the concept behind a deductible if you’ve purchased car insurance before, and the same idea applies here. In addition to a deductible, some AmeriHealth plans have a copay.
Think of your copay like a service-specific version of a deductible. It is a flat-rate fee that you pay to your insurance company separate from your deductible, but copays are usually much smaller than deductibles. To learn how you’ll be affected by these added costs, call your AmeriHealth insurance agent or view your plan’s terms via your online coverage portal. In most cases, your deductible amount accumulates throughout your coverage period and goes down as you pay more. In other words, let’s say you have one year of coverage from AmeriHealth. If you’ve already contributed to your deductible for other health services during the current term of your coverage, then this amount may be subtracted from the out-of-pocket expenses associated with your deductible.
Understanding Options for Outpatient Treatment With an AmeriHealth Insurance Plan
Generally speaking, outpatient treatment is the most basic rehab service for people with substance use disorder. Patients will live outside the center and sleep in their own beds every night. This type of program is better for people with less severe addictions and those with more work or family responsibilities. Depending on your schedule and treatment, you could visit the rehab clinic anywhere from one to four times a week. Outpatient services include therapy sessions, counseling appointments, and other treatment modalities.
AmeriHealth’s outpatient coverage tends to be pretty flexible. Even if a treatment modality that you’re interested in isn’t completely covered under your plan, your AmeriHealth agent can sometimes figure out a way for you to get a sizable discount.
AmeriHealth Coverage for Inpatient Rehabilitation Services
In situations where withdrawal and relapse may be an issue, inpatient rehab services are preferable. This type of program requires living on-site at a residential treatment facility. Many people do better with inpatient services because it can be nice to change their environment for a fresh start. Inpatients sleep, eat, and stay at the facility as full-fledged residents for the duration of their treatment, which typically lasts around three months. That doesn’t mean you won’t be able to switch to an outpatient program when you’re ready.
Overall, the inpatient experience provides a nourishing environment where the entire focus is on healing without distractions. You’ll have access to a professional staff whenever you need to speak with somebody. Many patients find this type of unrestricted access to be an absolute game changer in their recovery.
Depending on the relationship that you have with the primary care provider who’s on your AmeriHealth coverage plan, your doctor may choose to initially refer you for outpatient services. If your situation is serious enough to warrant inpatient services from the start, then the AmeriHealth PPO Plus plan usually provides the highest level of coverage.
AmeriHealth Usually Covers Some Additional Rehab Programs
Addiction often leads to other health issues. When this happens, other medical specialists often have to step in and deliver additional care. For patients with severe withdrawal, medications and pharmaceuticals may be needed. AmeriHealth usually covers these items the same as if you were to receive them from any other hospital, so their coverage extends well beyond the cost of our behavioral therapy services. In cases of serious withdrawal symptoms that lead to a visit to the emergency room, your AmeriHealth plan will generally kick in with coverage.
To help patients treat heroin or methamphetamine withdrawal, many clinics use compounds like methadone and other synthetic opioids. This helps gradually wean a user off their cravings without bringing on a full-fledged crash reaction. As is the case with other pharmaceutical treatment methods, AmeriHealth typically provides coverage for synthetic opioid drugs with a variable copay.
In addition, your AmeriHealth plan may cover some of our alternative healing methods. More and more, insurance companies are starting to get on board with modalities like art therapy and yoga. These modalities are safe and typically much cheaper than pharmaceuticals. However, your AmeriHealth plans will not cover all forms of alternative medicine as many have not been proven to be medically effective. Most of the time, reimbursement for these services is approved on an individual basis.
You’ll want to speak directly with your AmeriHealth agent to see which holistic healing methods your plan is currently covering. From there, your rehab facility can help you craft a treatment plan that takes your insurance arrangement into account. There’s a chance that some progressive therapies won’t be fully covered, but knowing exactly which expenses you’ll be responsible for during your time in treatment can help you plan ahead.
Checking In to Rehab When You Have Coverage With AmeriHealth