Does Emblem Health Insurance Cover Drug or Alcohol Rehab Centers?

EmblemHealth provides insurance coverage for the treatment of drug and alcohol addiction. Addiction to many substances may be covered by your plan, including:

• Alcohol.
• Cocaine.
• Hallucinogens.
• Heroin.
• Inhalants.
• Marijuana.
• Methamphetamine.
• Prescription medications.

EmblemHealth will work with the treatment center you choose to provide coverage for the services you receive. A variety of levels of care may be covered by your policy plan.

If EmblemHealth is your insurance provider, your policy may cover the following for drug and alcohol addiction treatment:

• Detox services: Medical detox helps you withdraw safely from drugs and alcohol for the first 3-5 days of your time in treatment. Medical supervision is provided around the clock by understanding medical professionals. You may be prescribed medications to manage your symptoms and ensure you withdraw safely.
• Inpatient or residential care: Inpatient/residential live-in treatment facilities provide drug and alcohol rehab while you live at the treatment center. Most inpatient rehab centers last anywhere from 15 days to several months, depending on the program you’re in and your specific needs.
• Partial hospitalization (PHP): Partial hospitalization programs allow you to live at home while you get treatment, and your days are spent at the treatment facility. This is sometimes referred to as “day treatment” and is optimal for people who know they can stay sober at home during the evenings/nights and can commit to attending treatment during the day.
• Intensive outpatient program (IOP): Intensive outpatient programs generally involve attending treatment programs 3-5 evenings a week. You’re able to live at home and go to work during the day and attend treatment sessions in the evenings.
• Outpatient treatment: Outpatient programs are ideal for people who have completed inpatient treatment and would like ongoing support and care in their sobriety. You can live at home but generally must attend treatment 10-12 hours a week to complete the program.

EmblemHealth usually covers these services as part of your addiction treatment:

• Physical and mental health assessments
• Medications (including medical detox)
• Lab work
• Therapy: both individual and group therapies
• Costs for inpatient and residential programs, including room and board and meals

The EmblemHealth health plan you have and the details of your plan—including monthly premiums, copays, deductibles, and potential out-of-network costs—affect your out-of-pocket total cost of drug and alcohol treatment. Some parts of treatment may or may not be covered, depending on your plan, but treatment should be at least partially covered under EmblemHealth regardless of the plan you have.

Does Emblem Health Insurance Cover Mental Health Treatment Facilities?

Many people who have substance use disorder also have mental health conditions, such as anxiety, depression, PTSD, 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 with substance use disorder also had a co-occurring disorder.³

To ensure optimal treatment outcomes, it is important to treat both co-occurring disorders and to treat them at the same time. These conditions often influence each other. If you look for an addiction treatment facility that also offers mental health counseling and treatments for mental health conditions you will be able to access care for both at the same time.

Under the Affordable Care Act (ACA), substance use disorder is listed as one of the 10 elements of essential health benefits that insurers must provide. As a result, all US insurance providers are required to provide coverage for mental health care and treatment.⁴ Both co-occurring disorder treatment and stand-alone rehab for drug and alcohol addiction fall under this mandate. EmblemHealth plans cover mental health treatment while in rehab, but the amount covered varies depending on your policy.

EmblemHealth offers many different types of policies and plans. Each policy’s coverage varies. Therefore, the length of time for treatment coverage depends on your specific plan.

Longer treatment times are generally considered most effective when it comes to treatment outcomes. Statistically 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 structured continuing care—such as outpatient treatment and counseling—are associated with better treatment outcomes for individuals with substance use disorder.⁵

You can look up your EmblemHealth plan information online to learn how many days of treatment your plan covers per calendar year or call the number on the back of your insurance card to learn more about your specific plan coverage for drug and alcohol rehab.

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

As an EmblemHealth member, at least some of your treatment should be covered by your insurance plan. If your specific insurance policy does not cover all of your rehab expenses, don’t let that keep you from getting into treatment so you can get on the path to recovery. Getting treatment now is more important than waiting until you have insurance coverage or have the money to pay for it. There’s no doubt about it—getting and completing treatment saves lives.

Many drug and alcohol treatment centers work with EmblemHealth to provide coverage for drug and alcohol addiction. Don’t give up on your desire to get sober due to lack of coverage. There are many options to help you pay for treatment, including:

• Payment plans offered by the rehab center so you can pay the costs over time
• Scholarships and grants
• Crowdfunding (asking family and friends for support)

Talk with an admissions navigator at the rehab center(s) you are considering to discuss your payment options. They can help verify your insurance, determine what is covered by your plan, and help you formulate a plan to cover any out-of-pocket expenses.

In-network drug and alcohol rehab centers have an agreement with EmblemHealth to offer treatment for individuals at a lower rate than other providers. Out-of-network facilities do not have an agreement with EmblemHealth. If you choose an out-of-network facility, this generally means higher out-of-pocket costs for you.

The difference in cost in selecting in-network vs out-of-network can be significant, as some insurance companies may not provide any coverage for facilities that are not in-network, and you may be expected to cover all costs at the drug and alcohol rehab center.

Whenever possible, work with a rehab center that is in-network with your insurance provider. Selecting a treatment facility that is in-network with EmblemHealth can decrease your out-of-pocket costs and provide much-needed peace of mind so you can focus on what truly matters—your recovery.

In some cases, EmblemHealth may cover out-of-network treatment facilities, though it generally requires a lot of work on your part to get some coverage for an out-of-network provider. Sometimes, EmblemHealth may provide coverage for some individuals who are in an out-of-network facility. For example, if you live in an area where you cannot access treatment at an in-network facility, or you belong to a certain population (e.g., veteran) and need treatment at a veteran-specific facility.

Before you select a rehab facility to attend, check your EmblemHealth policy benefits to determine which costs will be covered by your provider, and which will be out-of-pocket for you. Knowing ahead of time what to expect financially can help provide much-needed peace of mind while in treatment. Call the number on the back of your insurance card to speak with an EmblemHealth customer service agent. Or, login to your account on EmblemHealth’s website to learn the details of your policy, including copays, and/or if a deductible must be reached before coverage kicks in.

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4. Office of National Drug Control Policy. Substance Use and the Affordable Care Act.
5. 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. doi:10.1016/j.jsat.2018.02.001
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