Does Ambetter Insurance Cover the Costs of Opioid Rehab?

The U.S. is battling a continuing health and social crisis caused by an opioid epidemic. There were more than 33,000 deaths due to opioid misuse in 2015, while in the year 2019 that number rose to 49,860, meaning that opioid-induced overdoses took more than 136 American lives every day.^{1, 2}

To fight this problem, the government introduced legislation that greatly increases the availability of mental health treatment nationwide by improving the available mental health coverage. The first effort happened in 2008 with the passing of the Mental Health Parity and Addiction Equity Act (MHPAEA) which mandates parity between mental health benefits and medical/surgical benefits. In 2010, the Affordable Care Act was passed that defined 10 essential health benefits that all marketplace health plans must cover.³

Since opioid addiction falls under the category of essential benefits as a mental health issue it means that if you have an Ambetter mental health insurance policy, you’ll in all probability enjoy coverage for opioid rehab.³ American Addiction Centers (AAC) runs a nationwide network of facilities that provide top-quality addiction rehabilitation programs to those that hold Ambetter health insurance.

What Types of Opioid Treatment Does Ambetter Insurance Cover?

Since addiction is a disease that affects the brain as much as it influences a person’s behavior, successful treatment should be structured to include both medical and mental health services along with follow-up care according to individual patients’ needs.⁴ Ambetter coverage for opioid rehab offers all proven and clinically tested approaches to the treatment of opioid addiction and can include:⁵

• Medical screenings that identify problems early which increases the probability of successful treatment.
• Detoxification which is a required first step of rehabilitation on the road to sobriety.
• Inpatient drug rehab programs at dedicated facilities nationwide.
• Outpatient rehabs that offer the possibility of living at home while under treatment.
• Behavioral therapies that can include individual and group counseling.
• Treatment for co-occurring disorders for those that suffer from a combination of addiction and diagnosed mental health disorders.

If you need help in understanding your condition, you can call AAC’s dedicated hotline for prescription drug abuse or addiction to other substances. Their dispatchers will guide you through the treatment process and provide you with all the information necessary to make the right choice.

What Elements Ambetter Insurance Won’t Cover for Opioid Treatment?

Most Ambetter healthcare plans won’t provide coverage for optional and non-mandatory procedures that your doctor hasn’t identified as a necessary part of your treatment.⁶ The same holds for most cosmetic procedures like beauty treatment, eyeglasses and contact lenses, diet plans and weight loss programs, and, unless otherwise specified, dental services.⁷

Your insurance is also unlikely to cover unproven procedures like alternative therapies such as acupuncture, or different types of holistic care and experimental treatment options. This also applies to any form of treatment that hasn’t been clinically proven and standardized by relevant US medical authorities or is still considered experimental, insufficiently tested, or awaiting approval.⁶

Custodial care that includes assistance with everyday activities like dressing and taking care of personal hygiene, or preparation of meals and eating, along with other types of domicile care in the home won’t be covered. It may be included in your coverage if it constitutes a mandatory part of your Ambetter addiction treatment plan and is proscribed as such by your doctor.⁷

How Much Would Ambetter Opioid Rehab Cost?

When designing a mental health recovery and rehabilitation plan, the first thing that your doctor will keep in mind is that no two cases are the same. So, treatment has to be adapted and tailored to specific individual situations and needs.⁵

It’s almost impossible to calculate the total costs of addiction treatment upfront. There are several proven techniques and procedures that are designed to deal with mental health issues related to or caused by opioid misuse. These procedures are:⁵

• Inpatient rehab.
• Outpatient rehab.
• Partial hospitalization programs (PHP).
• Medication-assisted treatment (MAT).

All of these rehab approaches can be very similar in some respects, like intensity and duration of rehabilitation, but they can also vary greatly. For instance, treatment plans can include different types of services and amenities, which makes them pretty variable when it comes to overall costs of treatment with insurance.⁵

Cost of Inpatient Treatment for Opioid Addiction

Inpatient opioid rehabilitation takes place at a dedicated substance abuse treatment medical facility where patients reside for the duration of the treatment. The cost of such rehab depends largely on the type of facility, whether it provides luxury or executive treatments options that are more expensive, and the duration of stay. In general, patients struggling with opioid addiction may need to commit to longer programs that have many phases in order to achieve full sobriety.⁸

Cost of Outpatient Treatment for Opioid Addiction

Outpatient treatment will cost less than inpatient programs because it’s structured in a way that allows patients to continue living at home and attending work or school.⁵ This makes outpatient care an ideal choice for those that don’t lack support in fighting their addictions, as well as those who have strong willpower to avoid triggers and temptation to continue using during the rehab.⁵

Outpatient treatment can last for a couple of weeks and offer different types of group counseling or even resemble a basic drug education for those that are not far down the line in their opioid addiction.⁵

However, it can also be quite similar in its intensity and approach to inpatient rehab. Some patients may need to commit to long-term programs that require several long sessions per week before scaling back the intensity to just a couple of hours a week or enrolling in a short-term rehabilitation program.⁵

Cost of PHP for Opioid Addiction

Partial hospitalization programs (PHP) could be described as structured programs that are an alternative to inpatient rehab. In many ways, they’re similar to intensive outpatient programs but with more weekly visits to a hospital and longer sessions that can last for up to 10 hours a day.⁹

Partial hospitalization can be ideal for those that can’t afford to spend their nights in a hospital or leave their jobs but require intense treatment before they can be gradually reintegrated in a normal living environment.¹⁰

Cost of MAT for Opioid Addiction

Medication-assisted treatment combines counseling and behavioral therapies with clinically proven medication that FDA has approved for opioid addiction treatment. Thus, it’s difficult to determine the exact cost of MAT.¹¹ There are three drugs that are certified as safe and effective in opioid treatment:¹²

• Methadone.
• Buprenorphine.
• Naltrexone.

Medication-assisted treatment is intended to help patients achieve full recovery that will enable them to lead normal and fulfilling lives. In general, this type of treatment helps:¹³

• Increase patient survival rates.
• Increase retention and positive outcomes of treatment.
• Substantially decrease opioid misuse as well as individuals’ involvement in criminal activities.
• Enhance patients’ capacity to seek and maintain employment.
• Improve birth outcomes for women that have previously suffered from opioid misuse issues.
• Greatly reduce the potential of relapse.

To check whether your insurance will cover your medication-assisted treatment, it’s advisable that you call the Ambetter helpline and check the details of your coverage.

Opioid Rehab vs. the Cost of Opioid Addiction

It’s almost impossible to fully calculate the strain that the opioid epidemic has on the US population and local communities. The economic cost of opioid use disorder and resulting overdoses are estimated to amount to more than 1 trillion dollars, ranging from $1,200 per capita in Hawaii to $7,000 in places like West Virginia and the states that are located around the Ohio Valley and New England.¹⁴

However, these are just rough dollar estimates that can’t provide a full picture of how devastating opioid addiction can be for struggling individuals. Even though rehab can seem expensive, its costs pale in comparison to the cost of substance abuse that eats away all the available resources before a person is made to resort to crime to finance their habit.¹⁵

Opioid addiction is very hard to hide and has long-term effects on people’s mental and physical health, leaving them unable to perform everyday tasks.¹⁵ In many cases, struggling individuals will miss out on potential career and income opportunities or even lose their jobs completely which will put them in a very unfavorable position.¹⁵

How Long Does Ambetter Coverage Last for Opioid Addiction Treatment?

Most people don’t seek treatment before the situation becomes chronic and serious, making it harder to treat. In certain cases, patients might go through several relapse episodes that will require their treatment to be reevaluated and readjusted.⁵ Since opioid misuse affects users’ brain chemistry, people become unable to resist urges and just stop using drugs straight away because it can lead to a painful withdrawal.⁵

For this reason, recovery from opioid addiction for some patients means long-term structured care at a treatment facility that will help them stop using drugs, maintain sobriety, and make life decisions without the malign influence of drugs.⁸ To achieve this, people should stay in treatment for an adequate period of time depending on the state of their mental and physical health, as well as their individual needs and problems.⁸

Therefore, if you need information on how long your Ambetter insurance coverage will last, call the number that’s written on the back of your insurance card.

Should I Go to an Outpatient or Inpatient Program With Ambetter Insurance?

Depending on the model and suggested treatment, some inpatient programs can be short-term, while others can require patients to stay in rehab for 6 months or even longer if needed. Inpatient care is usually followed by outpatient therapy. Addiction is treated in relation to patients’ social and psychological issues, focusing on resocialization that will help them develop personal accountability and responsibility.¹⁶

If you’re not sure whether to undergo inpatient or outpatient treatment, you should keep in mind that inpatient care offers some invaluable benefits. For instance, inpatient programs can benefit people who have tried other forms of treatment but couldn’t stay sober, require detox, a secure and supportive environment, 24-hour medical monitoring, or who just feel that they would benefit from a change in their everyday habits and activities. Of course, a medical professional should make the decision, referring a patient to a facility that is equipped to provide them with an appropriate level of care.¹⁰

How to Use Ambetter Insurance Coverage to Pay for Opioid Rehab?

Ambetter is a relatively new player on the marketplace that operates in 26 states nationwide. It serves more than 2 million people with a variety of insurance plans and health services that are designed to meet their health needs.¹⁷

To be able to use Ambetterto pay for treatment, you will need to consult with a doctor who is qualified to determine your ability to use insurance, give you a referral, and suggest a suitable rehab program appropriate for your medical condition. After that, you can start deciding on the Ambetter rehab center that will best match your needs and preferences. Once you’ve made your decision, you can call the facility of your choice and they will also check the extent of your Ambetter insurance coverage.

How to Find Treatment Facilities That Offer Opioid Addiction Treatment & Accept Ambetter Insurance

If you or someone close to you is suffering from opioid misuse, American Addiction Centers network offers proven medical solutions that can help in the fight against addiction. AAC offers Ambetter members the opportunity to choose one of its leading addiction treatment facilities located across the U.S. that offer a variety of individually tailored rehabilitation programs.

You can reach out at any time by calling AAC’s free opioid helpline number that is available 24/7. All calls guarantee privacy and confidentiality while carrying no obligation to enter treatment on your part. AAC’s admission navigators are people who are best equipped to offer knowledgeable and valuable advice because many of them went through the same struggles so they understand and empathize with people that suffer from addiction challenges.

Once they helped with the verification of your rehab coverage, looked into various benefits that you might be entitled to, and offered guidance and treatment recommendations, you will have enough information to make the right decision about the type of treatment you need.

What Rehab Centers Take Ambetter Insurance for Opioid Addiction?

American Addiction Centers (AAC) operates facilities across the U.S., offering advanced alcohol and drug addiction treatment services. If you have an Ambetter insurance coverage policy, you can reach out to multiple AAC facilities that accept Ambetter, including:

• Greenhouse Treatment Center: Located in Grand Prairie, Texas, Greenhouse provides personalized treatment services and different levels of care. The scope of services include detox, comfortable residential treatment, intensive and regular outpatient treatment, dual-diagnosis treatment, and tele-health service. Patients can enjoy a luxurious environment with high-end perks.
• Desert Hope Treatment Center: As a recognized facility in Las Vegas, NV, Desert Hope has specialized treatment programs tailored to each patient. The facility and its staff offer evidence-based services such as detoxification, intensive outpatient and extensive residential services,  tele-health assistance, and treatment for co-occurring disorders.
• Oxford Treatment Center: This recognized facility is available to patients from Etta, Mississippi, as well as from other areas across the country. Oxford Treatment Center has gender-specific treatment programs suitable for individuals looking for men- or women-only settings. It also enables its patients to try new recreational activities and enjoy beautiful natural surroundings. Some of the available services include inpatient and residential treatment, intensive outpatient and standard outpatient care, safe detoxification, dual-diagnosis treatment, and tele-health services. Treatment programs are suitable for each patient’s individual needs.
• Recovery First Treatment Center: Located in Hollywood, Florida, Recovery First treats substance use disorders by combining evidence-based therapeutic modalities with top-level care. Recovery First provides a personalized continuum of care tailored to each patient. Individualized programs may include safe and medically managed detox, evidence-backed treatment in a residential setting, treatment for patients diagnosed with co-occurring disorders, intensive outpatient care, standard outpatient programs, and tele-health.
• River Oaks Treatment Center: Located in Riverview, Florida, River Oaks addresses addiction treatment by combining evidence-based therapies with world-class amenities. The facility staff can provide their patients with detox services, residential addiction treatment, behavioral disorder treatment, co-occurring disorder treatment, outpatient services, and tele-health services as parts of individualized treatment programs.

With AAC, you have numerous addiction treatment options at your disposal, helping you battle alcohol or drug addiction in a safe, comfortable setting. So, don’t feel discouraged from seeking treatment since you can find accredited treatment facilities near you that can meet your needs. You can browse the facility directory and explore the available options. Filter the facilities by your preferred insurance provider or by location.