Does EmblemHealth Insurance Cover Alcohol and Drug Rehab? - Treatment Solutions

Does EmblemHealth Insurance Cover Alcohol and Drug Rehab?

EmblemHealth Insurance for Addiction Treatment

EmblemHealth is a not-for-profit health provider located in the New York tri-state area.1 With its emphasis on primary and specialty care, EmblemHealth is a solution-based healthcare company that serves more than 3 million people.1 If you are struggling with substance misuse, you may be interested in getting more information about EmblemHealth insurance coverage for substance abuse treatment. Seeking help for substance misuse is an important first step to a sober life.

There are 3 components to EmblemHealth insurance: EmblemHealth Neighborhood Care & ConnectiCare Centers, a group of companies that deliver care at a neighborhood level; AdvantageCare Physicians, a specialty and primary care company; and WellSpark, a digital health practice.1(beneath Our family of companies) Each entity focuses on a specific healthcare need.

EmblemHealth offers several types of health plans. The main categories are:2

  • Individual and family plans.
  • Medicare Advantage.
  • Medicaid.
  • Enhanced Care Plus (Health and Recovery Plan).
  • Medicare Supplement.
  • Small group plans.
  • Large group plans.
  • Child Health Plus plans (CHPlus).

You can choose which tier level you prefer within an individual or family plan through EmblemHealth insurance.3 Each one has pros and cons. A plan with a higher premium will have fewer out-of-pocket costs, while one with a lower monthly premium will have higher costs for services.3

To find out more specific information about your coverage, you can call the number on the back of your insurance card. The insurance administrator will assist you with additional details.

What Will Emblemhealth Insurance Cover?

You can count on EmblemHealth rehabilitation coverage to help with substance abuse issues. All the EmblemHealth tiers and policy levels include coverage for substance addiction. Substance addiction issues are managed through EmblemHealth mental health via their partner Beacon Health Options.4 Their behavioral health plan provides coverage for treatment for substance misuse to the same extent they cover any other condition.4

When it comes down to what specific types of EmblemHealth insurance for addiction treatment will be covered, it’s best to find out what treatments and programs are helpful for your situation. However, no matter what type of assistance you need, EmblemHealth may assist with the following treatments:

  • Inpatient substance use services.
  • Outpatient substance use services.
  • Intensive outpatient programs.
  • Partial hospitalization programs.

The out-of-pocket costs or copays for these services will vary depending on your tier level. For example, the EmblemHealth Platinum tier has the following costs:5(pg2)

  • Inpatient substance use services: $500 copay for each admission.
  • Outpatient substance use services: $15 copay, up to 20 visits per year.
  • Intensive outpatient programs: $15 copay.
  • Partial hospitalization programs: $15 copay.

Does EmblemHealth Insurance Cover Mental Health Care?

Mental health conditions often occur simultaneously with substance misuse. 6(how common section) This is known as a co-occurring disorder. The National Institute on Drug Abuse (NIDA) states that substance misuse and mental illness disorders quite commonly co-occur. 6(how common section) They also explain how addiction may change the brain, which may indicate why there is a link between the 2 conditions.6(sub use and addiction can contribute section) Whether substance misuse leads to mental illness or the other way around is still up for debate; the important thing is to seek a comprehensive treatment plan that treats both conditions together.6(points to remember section)

You don’t need to worry about EmblemHealth coverage for co-occurring disorders. Under the Affordable Care Act, insurance providers are not allowed to discriminate based on your condition. 7 Mental health and behavioral are considered essential care.7 You are eligible to receive the proper care no matter what condition(s) you have.

How Long Does EmblemHealth Insurance Cover Rehab?

The NIDA provides information about addiction treatment and how best to treat it. It’s important to note that not everyone will have the same recovery path. Some people may be advised to participate in inpatient programs, while others need a partial hospitalization program. The length of time you stay in treatment is vital.8(#5) The recommended stay in rehab is at least 3 months because drug use causes structural changes to the brain.8(#5&1)

The length of time that EmblemHealth rehabilitation is covered will differ according to your plan’s specific policies, tiers, and levels of coverage. You can look at your insurance card for more information about your plan.

What if My EmblemHealth Policy Does Not Cover Rehab?

Don’t give up if you’re worried about EmblemHealth network coverage not covering your costs, and don’t delay seeking help for your situation. There may be other options that you didn’t consider. Some EmblemHealth rehab centers may provide financial aid or scholarships. Others may give you a discount or allow you to arrange a payment plan. Let the admissions navigator know what you’re dealing with and ask if any programs or assistance are available.

EmblemHealth In-Network vs. Out-of-Network Rehab Centers

In-network providers have a contract with facilities and doctors to provide their services for a discounted rate. 9Because of this agreement, you can go to an in-network EmblemHealth treatment center and know you’ll have coverage. You can also go to an out-of-network facility, but you will incur costs along the way.9 It makes sense to stay with in-network providers to keep your costs low.

There are a few ways to check for an in-network provider. One way is to create an online EmblemHealth account and complete a search. To register for online access, go to the myEmlemHealth registration portal and enter your date of birth and Member ID. After validation, you’ll complete identifying information and select a User Name and Password. Then you can sign in here.

If you don’t want to go through the registration process, you can search for a doctor on EmblemHealth’s “Find a Doctor” website. Select the plan that you have and conduct your search.

Finally, you can verify your EmblemHealth insurance rehab coverage by contacting the rehab facility directly.

Check EmblemHealth Insurance Coverage for Addiction Treatment

EmblemHealth Insurance drug treatment programs cover a range of treatment options for addiction. Whether you have a Medicare Advantage plan or an Essential Plan, you can move forward with EmblemHealth recovery and sobriety.

You can also verify your EmblemHealth insurance benefits with American Addiction Centers (AAC). Fill in the form on this page for quick and confidential verification of your EmblemHealth insurance benefits for rehab. You can also call the helpline if you have additional questions at .

AAC offers 2 EmblemHealth insurance drug and alcohol rehab centers in Florida. Recovery First Treatment Center features specialized programs for veterans, first responders, and impaired professionals and offers the following treatment programs:

  • Co-occurring disorder treatment
  • Medical detox
  • Inpatient residential care
  • Partial hospitalization program
  • Intensive outpatient program
  • Outpatient therapy

River Oaks Treatment Center offers several groups and activities that aid in the recovery process:

  • Group therapy
  • 12-Step programs
  • SMART recovery
  • Art and music activities
  • Stress management and mindfulness

Both facilities provide a full range of rehab programs to assist in the treatment process.