As substance abuse struggles continue to prevail as one of the leading causes of death throughout the United States and the globe, there has been a significant shift in how health insurers provide coverage. In the years past, not all insurance carriers offered options for their policy members to get the proper treatment desperately needed to assist on their recovery journey and live a life of sobriety- but thanks to the progression in the ever-growing healthcare sector, more insurance companies now more than ever provide varied insurance packages for those who need it the most. Whether you currently have health insurance, are in the market for a new plan, or are thinking of switching to a new insurance company, we are here to walk you through the necessary yet confusing world that is health insurance coverage.

About Insurance Coverage EmblemHealth Insurance Rehab Programs

While it is entirely possible to attend a rehabilitation facility without an insurance policy, the costs can quickly add up over time. The weight of being financially overwhelmed is something that should be prevented if possible. So before we begin to dive into EmblemHealth and its benefits, let’s ensure we have a complete understanding of the basics of health insurance.

What is a deductible?

A deductible is the general amount of money that is paid out of pocket, by you the policyholder, before the insurance company pays out any monetary funds.

What is a copay?

A copay is a secured amount of money paid from the patient to the provider of the service needed.

What is coinsurance?

A form of insurance where the insured party contributes to the cost paid against a claim.

What is an HMO?

An HMO is a health maintenance organization that supplies health insurance at a secured rate annually.

What is a PPO?

A PPO is a preferred provider option that allows flexibility in payment and allows more cost-effective options with providers within the insurance network.

In most cases, EmblemHealth will likely request its policyholders to meet the standard deductibles on their health insurance plans, and it would not be ad hoc for copays to apply to specific medications and treatments provided, whether in-network or out-of-network. However, it is essential to review your insurance plan’s specifics with your healthcare provider and rehab admission counselors to ensure there are no little surprises along the way.

Substance Abuse Treatment Services Your EmblemHealth Plan Will Cover

A little background on EmblemHealth, EmblemHealth was incepted in 2006 as a derivative of Group Health Incorporated. For over 50 years, the GHI has consistently provided quality care to individuals, families, and groups, focusing on treating the whole patient and leaving no loose ends or room for error or future complications. As of 2021, EmblemHealth is now one of the largest not-for-profit healthcare providers that operate throughout the entirety of the United States, with over 3.1 million members part of its diverse network. EmblemHealth is well-known for providing excellent coverage to its members when they pursue treatment within their network umbrella. As for treatment sought outside of the network, there will likely be out-of-pocket costs that will need to be paid by the policyholder individually, which is often the standard for most insurance companies. The usual coverage that is often likely to be covered by EmblemHealth is:

  • Alcohol
  • Cocaine
  • Methamphetamine
  • Marijuana
  • Fentanyl
  • Heroin
  • Prescription drugs (Benzodiazepines, opioids, etc.)
  • Psychedelics
  • Amphetamines

Additional services that will likely need coverage are

  • Comprehensive blood work
  • Aftercare prevention services
  • Medication or MAT
  • Medical examinations
  • Pre-detox and post-detox assessments
  • Outpatient/ Inpatient care

What are the types of drug and rehab treatment that EmblemHealth might cover?

Residential Inpatient Care

This form of treatment is residential 24/7 around-the-clock-care with highly trained doctors and nurses that will manage every aspect of your recovery from the initial detox and withdrawal to varied recovery therapies. Residential treatment can last 30, 60, 90 days, or more, totally depending on the specific needs of the patient and any issues that might complicate the case.

Outpatient Care

This variety of treatment is partial residential that can be completed part time-evenings or weekends and does not interfere much with a traditional work or university schedule. How long does outpatient alcohol treatment last? There is really no standard answer for how long rehab treatment might continue; this is assessed on a case-by-case basis; supplementing outpatient care with recovery support groups, the length of treatment is likely to be reduced dramatically.

How to Find an Alcohol or Alcohol Rehab Program that Works With EmblemHealth?

After processing all of this information, you might be asking yourself…what’s next? The first step is to get into contact with your insurance company and verify what plan you currently have and determine what level of care you are eligible for and what additional costs might come into play- or if you currently do not have insurance coverage, communicate with the insurance company to evaluate what the eligibility requirement is and what type of coverage you can acquire. Once your insurance information has been approved, now it is time to verify your insurance with the drug rehab of your choice and obtain more information about the costs involved with treatment and what portion of the treatment is covered.

Reviewing insurance plans, determining what coverage you are eligible for, and finalizing the treatment plan with the rehab of your choice can seem overwhelming.

We get it.

Life is already overwhelming as is. The added stress of trying to understand insurance jargon and eligibility requirements can be frustrating and make one want to give up the search altogether.

But don’t give up!

We are here to help guide you through the technicalities and streamline the entire process so you can focus on your journey to healing.

If you find yourself faced with questions you can’t find answers to or need guidance, don’t hesitate to call our admissions staff to help answer any of the unknowns you have regarding insurance eligibility and treatment.

We are here for you.

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