Does AvMed Insurance Cover Inpatient Alcohol and Drug Rehab Programs?

If you or a loved one is struggling with drug or alcohol addiction, you may need to seek out rehab programs in order to fully recover and overcome addiction. If you have health insurance, in many cases, the cost of attending rehab may be fully or partially covered under your plan. This means that you could get the care you need at little to no cost to you.

If you live in Florida and have an AvMed health insurance plan, your drug and alcohol rehab may be covered, but the level of coverage can vary based on your specific plan. AvMed health insurance provides Medicare Advantage plans, employer-sponsored plans, and individual and family plans to approximately 290,000 Floridians.¹

It’s important to verify your benefits and coverage prior to entering rehab. You can confirm your benefits and other payment options with American Addiction Centers (AAC) or by calling the number on the back of your insurance card.

What Different Types of Addiction Treatment Does AvMed Insurance Cover?

The summary of benefits and coverage will vary based on what type of plan you have. However, thanks to mandates under the Affordable Care Act (ACA), every health plan is required to provide some level of coverage for essential health benefits.² Mental and behavioral health is considered to be one of the 10 essential health benefits, which means your AvMed health insurance plan should provide some type of coverage for such services.

Depending on your unique situation, you may be recommended a course of treatment that falls in line with the below common treatment methods:³

• Inpatient/residential treatment involves staying overnight for a set period of time, which can range from a few days to a few months, either in a hospital or residential setting. Here, you’ll receive round-the-clock care and treatment, including medical care, therapy, drug education, and various other activities.
• Partial hospitalization programs (PHPs) typically operate in conjunction with inpatient hospital rehab programs, and often involve several hours of day programs or therapy. Unlike inpatient or residential programs, though, you typically can return home at the end of the day. AAC provides a variety of different structures for PHPs, and can usually provide room and board for those who are enrolled in a PHP with them. The PHP may be operated in connection with inpatient hospital rehabilitation programs.
• Intensive outpatient programs (IOP), similar to PHPs, combine various elements of inpatient and outpatient treatment methods. With an IOP, you would meet for a few hours each day, several days a week, to receive treatment or therapy. It’s typically more intensive than a traditional outpatient program, but less involved than a PHP or inpatient program.
• Standard outpatient treatment is typically what most people are familiar with when discussing rehab programs. With outpatient treatment or therapy, you’ll visit a facility 1-2 times per week to undergo therapy.

Does AvMed Insurance Cover Inpatient Mental Health Treatment Facilities?

Per the ACA, mental health care is required to be covered in some capacity by all health plans, including your AvMed health insurance plan. Specifically, coverage for mental and behavioral health inpatient care, substance use disorder treatment, and behavioral health treatment must be provided in some capacity.² This mandate is incredibly important because it means that those who may have a mental health disorder, substance use disorder, or both (i.e., co-occurring disorder), can get the standalone or co-occurring treatment they need. According to the National Institute of Drug Abuse (NIDA), 7.7 million Americans suffer from a co-occurring disorder, which makes dual treatment necessary.³ The ACA’s mandate makes sure that those who need care can get it at an affordable cost.

How Long Does AvMed Insurance Cover Inpatient Rehab Programs?

All mental health disorders and substance use disorders, or co-occurring disorders, should be evaluated on a case-by-case basis because every single person is different. And, because of these differences, no treatment path should look the same from person to person. It should be up to you and your provider to determine the best course of treatment for you and not just for the insurance company.

Moreover, because treatment is so individualized and insurance plans can vary widely, AvMed health insurance doesn’t publish standard coverage times or lengths of time that a rehab program or facility would be covered under its plans. However, it is common knowledge that the longer you’re in treatment, the more likely you are to fully recover and not fall back into bad habits. Experts and research indicate that treatment should be at least 3 months in length to reduce the risk of negative outcomes.^{4 (numbered list number 5)} Once you and your provider determine your best treatment options, your insurance company will then determine what is covered.

It is possible to check whether an AAC facility or your AvMed health insurance plan can work out coverage details prior to enrollment in a program. Be sure to call the AAC helpline or the number on the back of your AvMed health insurance card to learn more.

What Should I Do if AvMed Insurance Plan Won’t Cover the Total Cost of Rehab?

It is possible that your AvMed health insurance policy will not cover the cost of rehab in full, or at all. Depending on the rehab center you choose, they could be considered an out-of-network provider, and so your plan may not cover the costs. Or, there may be various limits to coverage imposed on your plan, including a deductible that you have to pay before insurance kicks in.

Regardless of the reasoning, if your plan doesn’t cover rehab fully or partially, you may be responsible for footing the bill. However, there are a few things you can do to see if you can lower your out-of-pocket costs. First, you can ask whether there is a cash discount for paying your balance in full. Next, you can ask whether they have financing options or special terms for paying off a balance. Finally, you can ask whether they have any scholarship opportunities available that you can apply for. It’s not guaranteed that facilities have such programs, but it never hurts to ask.

Remember that getting immediate care is critical. Rather than delaying care, you will never regret prioritizing your health and becoming sober.

AvMed Insurance In-Network vs. Out-of-Network Rehab Centers 

In order to keep your health care costs as low as possible while still receiving quality care, it’s important to know the difference between in-network and out-of-network rehab centers. An in-network center is one that is within the network of approved providers under your insurance company’s contract. Typically, the facility and AvMed health insurance have entered into an agreement surrounding pricing and out-of-pocket rates. When you visit an in-network provider, your bill will likely be lower than the bill from an out-of-network provider. Out-of-network providers may not be covered at all under your policy, which means that your out-of-pocket costs will be higher.

To check whether an AAC facility is an in- or out-of-network rehab facility under your plan, you have a few options. First, you can call the number on the back of your AvMed health insurance card to talk to a representative. Or, you can call the AAC helpline and provide your insurance information so that a representative can verify your benefits for you. AAC works with a wide variety of insurers, so it’s possible that your AvMed health insurance policy will consider an AAC facility near you to be an in-network provider.

Finding AvMed Health Insurance Covered Rehab Centers in Florida

The most popular AvMed health insurance plans will provide coverage for addiction rehab treatment at an AAC facility near you. However, please be sure to verify this information before visiting and enrolling in one of our facility’s programs. AAC has 2 world-class treatment centers in Florida, and the staff at these facilities is waiting and ready to help you take the steps you need toward recovery. Click on the links below to learn more about the Hollywood and River Oaks AAC locations.

• Recovery First Treatment Center
• River Oaks Treatment Center 

When you’re ready to take the next step, give our helpline a call to immediately identify whether the AAC location is an in- or out-of-network provider. Prioritizing your health and getting the care you need to overcome your addiction is of the utmost importance.