Amerigroup Insurance Substance Abuse Rehab Coverage

Amerigroup provides insurance coverage for mental health conditions and the treatment of substance use disorder. Depending on your state and the type of policy you have, Amerigroup will work with different rehab treatment centers to provide services for those looking to attend rehabilitation for drug and alcohol addiction. A variety of levels of care may be covered by your policy plan.

Addiction treatment services that Amerigroup policies may cover include:

• Medically assisted detox.
• Inpatient treatment.
• Medication-assisted treatment.
• Dual-diagnosis treatment programs.
• Outpatient detox.
• Partial hospitalization programs.
• Outpatient treatment.

The most popular drug and alcohol treatment services that may be covered by Amerigroup include:

Medical detox: Addiction to some drugs and alcohol often require a complex withdrawal process that is best done under direct medical supervision. Medications are often used during the withdrawal process to help you safely detox from the substance(s). This is known as medication-assisted treatment. Amerigroup plans may cover medical detox when it is deemed medically necessary. This may require pre-authorization before coverage is provided, whether your medical detox is inpatient or outpatient.

Inpatient treatment: Inpatient rehab is a level of treatment that is beneficial for overcoming addiction. This treatment involves living in a rehab facility 24/7 for a period of time that may last anywhere from 30 to 90 days. Patients attend counseling sessions and group therapy to learn healthy coping mechanisms and lifestyles to get and stay sober. With pre-authorization, many Amerigroup plans offer coverage for inpatient rehab treatment. Getting prior authorization often requires a referral from your primary physician to prove inpatient rehab is medically necessary. Policies that require prior authorization vary between states and plans. Some Amerigroup policies may not cover all costs for inpatient treatment. Your plan may require meeting a deductible before Amerigroup covers any costs or a copayment. Some plans may offer full coverage for a specified number of days per year.

Outpatient treatment: After completing an inpatient treatment program, many people enter an outpatient program. Day programs—such as partial hospitalization programs and intensive outpatient programs—are recommended for anyone who needs significant support but cannot or does not want to enter inpatient rehab. These programs typically require a person to attend treatment at a rehab facility for 3-10 hours a day, from 2-7 days a week. Your Amerigroup plan may cover the cost of outpatient treatment. Working with an in-network provider can reduce or eliminate any out-of-pocket costs you may otherwise incur. If working with an out-of-network provider, you may be able to submit a claim to Amerigroup to request coverage.

Drug and alcohol counseling: everyone who attends treatment must participate in counseling sessions, both individually and in group settings. Counseling can help identify reasons and triggers that contribute to substance use disorder and can help you manage those in the future to prevent relapse.

Knowing what your Amerigroup plan covers can help you avoid unexpected costs while you or your loved one are receiving treatment, providing you with better peace of mind without worrying about financial struggles on the path to sobriety. For more information on Amerigroup insurance plans and to check what your plan covers, you can call the number on the back of your insurance card or call us at . We’d be happy to help.

Does Amerigroup Insurance Cover Mental Health (Treatment) Therapy?

Some people who have a substance use disorder also have a mental health disorder, such as anxiety, depression, and mood disorders. These are known as co-occurring disorders or dual diagnoses. According to the 2016 National Survey on Drug Use and Health, more than 8 million adults aged 18 or older had a mental illness and substance use disorder.²

It is important to treat co-occurring mental health and substance use disorders at the same time, as they often impact each other. Treating just one will not cause the other to improve. In order for treatment to be most effective, both disorders must be treated at the same time.

Under the Affordable Care Act, health insurance must cover mental health care and treatment. Both co-occurring disorder treatment and stand-alone rehab for drug and alcohol addiction fall under this mandate. Amerigroup understands the importance of mental health and facilitates both physical and behavioral health services as a vital part of health care. Most Amerigroup plans cover mental health treatment while in rehab to ensure improved quality of life and outcomes.³

Longer treatment times are generally considered most effective, even though each patient’s individual needs are a little different. Generally speaking, a longer stay in rehab leads to fewer instances of relapse, and better rates for long-term sobriety. According to a recent study, a longer duration of treatment (3-6 months) and provisions of structured continuing care, such as outpatient treatment and counseling, are associated with better treatment outcomes.⁴

Because there are many different types of policies and tiers of coverage, the length of time covered by your Amerigroup policy will depend on your specific plan. You can look up your plan information online or call the number on the back of your insurance card to learn more about what your specific plan covers for drug and alcohol rehab.

What if My Amerigroup Insurance Policy Does Not Cover Rehab?

If your Amerigroup insurance policy does not cover rehab expenses, don’t let that keep you from starting on the road to recovery and sobriety. Getting treatment now is more important than waiting until you have insurance coverage or have the money to pay for it with cash. Entering and completing treatment saves lives. Depending on the rehab center you choose, there may be financial or scholarship options available to you or your loved one.

When a drug and alcohol rehab center is “in-network”, that means they have an agreement with an insurance company—such as Amerigroup—to offer care at a lower rate than other providers.

Receiving services from out-of-network facilities means the insurance company does not have an agreement with the provider and may not cover costs. If you choose an out-of-network facility, this may mean higher out-of-pocket costs.

Generally speaking, it is better to choose an in-network provider for drug and alcohol rehab. Selecting a rehab center that is within your Amerigroup network can decrease your costs. The difference in cost in selecting in-network vs out-of-network can be staggering, as some insurance companies may not provide any coverage for out-of-network facilities and you may be expected to cover all costs at the drug and alcohol rehab center.

In some cases, Amerigroup may cover treatment at an out-of-network facility. This may be the case for people who live in rural areas and need to travel elsewhere to get treatment.

There are rehab facilities around the country that accept Medicare for coverage of alcohol or drug addiction treatment. American Addiction Centers (AAC) has AdCare treatment centers that accept Medicare. AdCare provides an integrated system of care with a nationally recognized hospital facility in Worcester, Massachusetts, an inpatient treatment center in North Kingstown, Rhode Island, and a network of outpatient offices located throughout Massachusetts and Rhode Island.

There are various treatment programs for individuals struggling with drug or alcohol addiction, so don’t give up if the first program you check out doesn’t meet your individual needs. To learn more about the addiction treatment process, click here. There are various rehabs near me that can provide the treatment you need. Check out the directory to find a list of facilities and programs. You can search by location and filter by public or private insurance

Before deciding on a rehab center, check your Amerigroup policy benefits to determine which costs will be covered by your provider and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on Amerigroup’s website to determine if there will be co-pays and if a deductible must be reached before coverage kicks in.

American Addiction Centers can verify your insurance coverage for you. You can call our helpline at to speak to a person who can check your benefits while you’re on the phone.

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Does Amerigroup Medicaid Cover Alcohol and Drug Rehab Centers?

Yes, Amerigroup will partially or fully cover rehabilitation for substance use disorders depending on a member’s health insurance plan.5 Patients can check their Amerigroup plan to see if they can expect coverage for alcohol or drug rehab and find a healthcare provider that is in the Amerigroup network.6

1. Amerigroup. The states we serve.
2. Center for Behavioral Health Statistics. (2017). Substance Abuse and Mental Health Services Administration Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
3. Amerigroup. Behavioral health.
4. Eastwood, B., Peacock, A., Millar, T., Jones, A., Knight, J., Horgan, P., … & Marsden, J. (2018). Effectiveness of inpatient withdrawal and residential rehabilitation interventions for alcohol use disorder: A national observational, cohort study in England. Journal of Substance Abuse Treatment, 88:1-8.
5. Amerigroup. Individuals with Mental Health and Substance Use Needs. 
6. Amerigroup. Find Healthcare Providers.