APS Health Insurance Coverage for Drug & Alcohol Addiction Treatment

Puerto Rico residents who are struggling with alcohol or drug addiction may be wondering how they can find affordable, reliable rehab treatment. APS Health, a managed behavioral health organization, works with Medicare, Medicaid, and other commercial health plans to connect covered members to behavioral health care providers.¹ While it is not an insurance company or plan per se, it can help those covered get the care that they need to overcome their addiction, which can include alcohol and drug rehab treatment programs.¹

To find out what may be covered through an APS Healthcare program, you can call the number on the back of your APS Health card. You can also call rehab centers directly to learn whether their facility works with APS Healthcare.

Check APS Healthcare Insurance Coverage for Addiction Treatment

Navigating the complexities of insurance coverage for addiction can seem like a daunting task. Fortunately, we’re here to help you. At American Addiction Centers (AAC), we specialize in recovery and addiction care. From the educational stage to undergoing treatment, we’re here to support you. By calling our confidential helpline today, you can speak to a real person who can help you learn more about recovery options and help you check whether your APS Healthcare coverage extends to addiction treatment near you.

APS Healthcare coverage may vary based on your plan’s construction, so it’s always best practice to verify your benefits before seeking care whenever possible. You can call the AAC helpline to do so, and you can also enter your information in the form below to instantly check your benefits.

What is APS Healthcare Insurance?

APS Healthcare is a company that provides managed behavioral health organization services.^{1 para 1} Since 1999, they’ve been delivering recovery-oriented services to various health plans, including Medicare, Medicaid, and private health plans.^{1 para 1} The behavioral health services, which are organized through APS Healthcare’s network of over 1,000 mental health providers, are available to its 1.3 million covered members at 16 community-based clinics.^{1 para 1}

Specifically, APS Healthcare uses a total care management system, which involves specialized provider call centers, a network of 16 community-based clinics called APS Clinics, and pharmacy, case, and quality management services.^{1 para 2} As a whole, APS focuses on behavioral health of all sorts, including addiction, and helps children, teens, and adults with mental health and/or addiction disorders get the care they need.^{1 para 3}

APS Healthcare Health Plans

APS Healthcare isn’t a type of health insurance but rather an organization that provides managed behavioral health care services in conjunction with your traditional healthcare offerings, such as a commercial plan, Medicare, or Medicaid. It provides adults, teens, and children who may have mental or behavioral health conditions, including addiction, with a variety of healthcare services to treat their condition.^{1 para 4}

APS Health has a team of professionals from all disciplines.^{1 final para} There are psychiatrists for adults, teens, and children, as well as social workers, psychologists, registered nurses, physicians, and counselors who specialize in substance abuse and mental health.^{1 final para}

The following services are typically offered through APS Healthcare:^{1 bulleted list}

• Evaluations (psychological and psychiatric)
• Therapy (individual, couple, group, and family)
• Medication management
• Homebound services
• Detox (outpatient setting)
• High-risk patient case management
• Telemedicine services

Be sure to check with your healthcare provider and insurance provider to determine what your coverage for such services may be.

What will APS Healthcare insurance cover?

Because AHS Health is not a specific health plan, you will need to check with your healthcare insurance provider, which could be Medicaid, Medicare, or another commercial insurance company (e.g., Humana, Cigna, etc.), to find out what is and is not covered under your plan. If your insurance plan partners with APS to provide managed behavioral health services, you may have access to 1 or all of the following common addiction treatment methods:

• Inpatient or residential rehab. An inpatient or residential treatment program typically involves a patient staying at a facility for the duration of their program, where they’ll receive round-the-clock medical care and supervision.^{2, Pg 8, “What types of treatment programs are available?”}
• Outpatient rehab or therapy. An outpatient addiction treatment program typically involves a patient receiving 1 or 2 treatment sessions a week, or fewer, but returning home after the session is over.^{2, Pg 10, Para 2}
• Intensive outpatient programs (IOP). An IOP typically involves a patient receiving more structured outpatient care than standard outpatient programs but less structured care than inpatient or residential programs. Usually, you must attend a minimum number of hours of outpatient care each week.^{2, Pg 10, Para 3}
• Partial hospitalization programs (PHP). A PHP offers patients structured care without needing to stay overnight in the facility. With a PHP, patients typically attend sessions for 4–8 hours a day, multiple days a week.^{2, Pg 10, Para 1}

Please check with your mental health provider to see whether any of the above treatment methods are recommended for you. Additionally, contact your insurance provider to find out whether you have coverage for any of these treatments.

Does APS Healthcare Insurance Cover Mental Health Care Treatment Facilities?

Under the Affordable Care Act (ACA), almost all U.S. health insurance plans must provide some level of coverage for mental and behavioral health services, including substance use disorder treatment, as it is considered as 1 of the 10 essential health benefits (EHBs).³ What this means is that your health insurance plan must provide coverage in some capacity for mental health care facilities, where you may receive treatment.

However, because APH Healthcare isn’t a specific health insurance plan, it isn’t federally mandated by the ACA to provide these coverages. That said, it is a managed behavioral health organization that helps covered members get the care that they need.

With the help of APS Healthcare and your health insurance program, you may be able to get full or partial insurance coverage for treatment like standalone drug rehab or co-occurring disorder treatment.

A co-occurring disorder is when someone has both a mental illness and substance use disorder.^{4, para 2} While it’s not believed that having a mental illness directly causes a substance use disorder, and vice versa, those who have either condition are twice as likely to develop the other in their lifetime.^{5 “Does one cause the other?”}

Because of the interconnected nature of the 2 conditions, if a patient has a co-occurring disorder, integrated treatment, where both conditions are treated in tandem, is often recommended.^{4, “What should I do?} Talk to your APS Healthcare contact to learn more about how they can help connect you to providers for the treatment at mental health care facilities you need.

How Long Does APS Healthcare Insurance Cover Rehab?

The length of time at rehab that may be covered for you will depend upon your specific health insurance plan. Your APS Healthcare plan representative may be able to help you check your insurance plan’s benefits to find out coverage length details. Or, you can call the number on the back of your health insurance card to speak with an insurance plan representative.

Finally, you can usually also work with rehab facilities directly and ask them what your plan may cover at their location. Keep in mind, however, that the coverage may vary based on the plan you have, as well as where you seek treatment, and what type of treatment you’re receiving.

Regardless of what may be covered under your plan, remember that staying in treatment for long enough is essential to the success of your recovery. While every person is different, most treatment programs should last for at least 90 days to improve positive outcomes.^{6, bullet 5}

To find out what’s covered under your plan, call the number on the back of your insurance card or ask the facility directly.

What if my APS Healthcare policy does not cover rehab?

It is possible that neither APS Healthcare nor your health insurance plan will cover all or some of your rehab costs. If that happens to you, be sure to ask the rehab facility whether there are alternative payment options. Depending on where you attend rehab, you may be offered payment plans, special financing, or scholarships, which can all help you pay for your rehab costs. Remember that getting care should be of the utmost importance and should not be pushed down the road.

APS Healthcare Insurance In Network vs. Out of Network Rehab Centers

Because APS Healthcare is a managed healthcare service, you may only be able to see providers within the service’s network. For more information about in-network or out-of-network coverage under your specific health insurance plan, please call the number on the back of your insurance card. Every health plan is different, which underscores the need to check your benefits before seeking care whenever possible.