Will Ambetter Coverage Work for Nationwide Alcohol Rehab?

Despite the huge number of people struggling with alcohol use disorder (AUD), only 2% of individuals who need treatment actually proceed to get it. This devastating number is greatly due to people not having the funds required to get treatment. In fact, about 11% of people have named this as the main reason for their lack of treatment.¹

Out of people who do manage to get the funds they need, most use insurance coverage as a way to help finance their rehab. About 21% of people use state-funded insurance providers, such as Medicaid. Around 10% use private insurance. One of these options is Ambetter insurance coverage.¹

Ambetter was founded in 2014, and by 2022, it has gathered more than 2 million members. This provider offers a variety of healthcare plans to ensure the health needs of their members are met. One of the services Ambetter provides is coverage for alcohol treatment in in-network and out-of-network rehab centers.²

How Much of Nationwide Alcohol Addiction Treatment Is Covered by Ambetter?

Thanks to the Mental Health Parity and Addiction Equity Act (MHPAEA), ever since 2008, all health insurance companies, such as Ambetter, must cover treatment expenses related to substance abuse and mental health in the same way as they would for any other medical procedure.³

However, treating substance use disorder (SUD) is not the same as treating most other medical conditions. This is because there isn’t a single treatment approach that can work for everyone with SUD. Instead, treatment has to be personalized and set to fit a person’s individual needs. As Ambetter insurance should cover all forms of substance abuse treatment, your coverage might include:⁴

• Assessment that will determine the severity of your SUD.
• Detox programs to help battle the withdrawal symptoms.
• Outpatient treatment programs, as well as intensive outpatient programs (IOPs).
• Partial hospitalization programs (PHPs).
• Treatment in residential rehab facilities.
• Long-term inpatient treatment in safe rehab facilities.
• Assessment for the existence of co-occurring disorders.
• Adequate treatment for existing co-occurring disorders.

What Does Ambetter Not Cover for Alcohol and Drug Rehab?

For Ambetter insurance provider to cover drug treatment and detox in nationwide rehab facilities, the treatment needs to be medically necessary and FDA-approved. Anything that doesn’t fall within these categories won’t be covered. This might include any non-medical expense, such as amenities not mentioned in your referral, holistic care, recreation programs, food delivery, and other similar costs.⁵

Not just that, but most Ambetter healthcare plans still include deductibles, copayments, as well as coinsurance.⁵

What Are the Expenses of Alcohol Treatment?

It might be challenging to determine the cost of alcohol treatment before you are admitted into the facility, as there are many factors that might affect the expenses. This might include:^5,6

• Specific services included in your healthcare plan.
• How intense these services are.
• How long your alcohol treatment will lasts. As most rehab facilities charge per day, a long-term addiction treatment program that lasts 60 days is likely to be more costly compared to rehab programs that last 30 days or less.
• Amenities that aren’t a part of your referral, such as same-day admittance for people who need it or couple’s therapy for you and your partner if you’d like to go to treatment together.

Most of these details will be discussed before or once you are admitted into a rehab facility that accepts Ambetter Insurance and after a team of experienced admission navigators and medical professionals assesses your specific situation. This is also when you should consider what type of payment option is the best for your situation.⁵

What Are the Expenses of Inpatient Alcohol Treatment?

Inpatient alcohol treatment is generally suitable for people battling severe, long-lasting types of AUD. This might be the best type of rehab, as people spend time in a controlled and supervised environment.⁴

Nationwide inpatient alcohol and drug rehab centers that are covered by Ambetter insurance offer treatment that can last for various amounts of time. For example, you can find long-term programs that last 6 months or even more. As inpatient treatment is paid according to each day spent in rehab, these costs can pile up. Due to its potentially long-lasting AUD treatment, accommodation expenses, and extensive care, this type of rehab can be prolonged based on each individual patient.⁴

Fortunately, some Ambetter insurance healthcare plans might be able to help you cover the costs of inpatient rehab. You should contact your healthcare provider to see whether you’re covered.³

What Are the Expenses of Outpatient Alcohol Treatment?

Outpatient alcohol rehab is usually the most affordable type of treatment. This is because it doesn’t provide the same amount of care as inpatient treatment does. There are no accommodation options or 24/7 medical care. Instead, the patient can come to therapy, which can be held in either a group or individual setting, and then continue with their everyday activities.⁴

Most alcohol and drug rehabs in any state, such as CA, that accept Ambetter insurance, are likely to cover outpatient treatment. Contact the Ambetter helpline to check the details of your coverage.³

What Are the Expenses of Alcohol Partial Hospitalization Programs (PHP)?

Partial hospitalization programs are similar to inpatient treatment, in that they provide high-quality extensive care. At the same time, they are similar to outpatient care in that they don’t require patients to stay at a facility. Most PHPs will provide therapy that lasts 8 hours, and after this, the patient will spend the rest of their day according to their liking.⁴

PHP is more affordable than inpatient treatment, as it doesn’t provide any accommodation. Still, due to the level of care this model provides, it’s more expensive than outpatient treatment.⁴

What Are the Expenses of Medication-Assisted Treatment (MAT)?

Many medical professionals prefer using medication as a form of alcohol abuse treatment. MAT can be used in combination with any other form of treatment. Most of the time, the medication can help ease withdrawal symptoms that can be quite uncomfortable. This is why it can be challenging to determine the expenses that go with MAT.⁷

Some Ambetter healthcare plans might cover the costs of MAT, either partially or in its entirety. This is something you should discuss with your insurance provider.³

Is Alcohol Addiction Expensive?

Many people feel like the cost of AUD treatment is too high. However, what they are not aware of is how much alcohol abuse can cost them if they let it continue.⁸

Alcohol abuse can get into every aspect of an individual’s life. It can decrease productivity in the workplace, which might even lead to the struggling individual being fired from their job. Either way, it will certainly lead to some loss of income. All the while the expenses will pile up, as alcohol abuse can significantly damage a person’s health and even get them in legal troubles.⁸

Additionally, alcohol abuse can alter the way a person’s brain works. As these changes are usually progressive, the more the person delays the necessary treatment, the more expensive the care. This is why it’s always better to get treatment as early as possible.^5,9

How Long Do Nationwide Ambetter Alcohol Treatment Programs Last?

Not everyone will benefit from the same length of treatment. For some people, short-term weekend rehabs can be all they need to start their recovery better. For others, it’s necessary to complete months of inpatient rehab, as well as undergo detox programs to eliminate the substance from their systems.¹⁰

Still, there are some indications that a person struggling with alcohol abuse should consider completing at least 90-days of treatment to stay sober for a year or longer. Anything that lasts less than that might not be enough to prevent relapse. Either way, a program should last at least until all the alcohol leaves the person’s system, but it’s important to note that short-term AUD treatment programs might not have long-lasting effects.¹⁰

Ambetter rehab centers offer various lengths of substance abuse coverage. For how long you’ll be covered, you need to check with your insurance provider. For more information, you can call the number located on the back of your card or reach out to an available local alcohol hotline to see for how long you’re covered by your insurance.

Are Nationwide Ambetter-Covered Inpatient Facilities Better Than Outpatient Rehabs?

There are several differences between inpatient and outpatient treatment programs. In general, it all comes down to this:⁴

• Inpatient treatment requires patients to stay inside a rehab facility while medical experts provide them with extensive care 24/7.
• Outpatient treatment consists of patients coming in for therapy sessions that can last for up to a few hours several times a week. This way, a person can keep on with their everyday activities.

Both inpatient and outpatient therapy can be very beneficial. Any type of treatment is better than no treatment at all. As long as a person tries to get help for themselves or their loved ones and contacts a specialized local rehab center, it is possible to get sober.¹⁰

However, there are a few advantages to going inpatient, as it can help struggling individuals stay away from triggering environments. Also, inpatient treatment centers help people who’ve been through similar situations get together and help each other, providing a supportive environment. At the same time, this will leave patients feeling accountable for their own actions, encouraging them to make the changes they need.¹⁰

It’s important to note that, while there are some types of self-assessment methods for substance abuse and alcohol abuse disorder, only a medical professional can determine what type of treatment is necessary for every specific person.¹⁰

How to Apply for Ambetter Alcohol and Drug Coverage?

The process of getting into Ambetter drug rehab centers is pretty much the same, whether you’re trying to get treatment in Southern Texas or Wisconsin.¹¹

The main thing and a first step everyone should take is to get a referral that would state that treatment is medically necessary. The main place to get a referral is from your primary care doctor, but this might vary from one insurance company to another. Therefore, you should always contact the Ambetter helpline to be sure.¹¹

When you get a referral, it’s time to contact your insurance provider once again so you can get in touch with a representative that can help you locate a facility suitable for you. This is when you’ll also talk about other details of your treatment.¹¹

Locating Ambetter Substance Abuse Treatment Facilities in Your Area

In addition to considering possible ways to pay for your treatment, you should also take time to locate alcohol rehab facilities that can meet your needs and accept your insurance.

The first step you might want to make is to contact your insurance provider and ask them about local facilities that might help you get treatment. If there is a facility that seems fitting for you, you might also want to contact them and see what treatment options they offer.

You might also call a local hotline. For example, if you live in Texas, there is a local helpline for people struggling with alcohol abuse. All hotlines are confidential and free, so they are a great place to check for facilities that will accept your coverage.¹²

Lastly, you might contact American Addictions Centers (AAC), a reputable treatment provider that’s in-network with all large insurance companies, including Ambetter. You will get in touch with a professional dispatcher who will help verify your insurance and talk about the benefits that are a part of your healthcare plan.

You might even be eligible for treatment in some of the leading nationwide treatment centers owned by the AAC. This might include:

• River Oaks Treatment Center in Florida, suitable for people looking for detox and professional treatment.
• Recovery First Treatment Center located in Hollywood, Florida, which provides not only alcohol treatment but also dual diagnosis.

Greenhouse Treatment Center located in Texas, an amazing choice for TX residents or people willing to travel for treatment.