Ambetter Health Insurance Coverage for Addiction Treatment

Using Ambetter Health Insurance Coverage to pay for addiction treatment: One of the first things that someone thinks of when considering going to treatment for substance or alcohol abuse is the cost of the program. Substance abuse treatment can be very expensive. Fortunately, your Ambetter health insurance plan will cover alcohol and substance abuse treatment. In fact, treatment could be free or at a fraction of the costs that you would expect. Our addiction treatment specialists can help you find treatment options for substance abuse and mental health disorders that your insurance plan will cover. We work with programs that are both in-network and out-of-network with Ambetter Health Insurance. If you would like to verify your own benefits yourself,  you can call the phone number on the back of your insurance card, or log into your Ambetter insurance portal and verify what your specific plan will cover there. You can also call us to find out if there are any drug rehab centers nearby that take Ambetter Insurance. If you would like to find out more about drug rehab programs near you, give us a call and we can get your insurance verified today.

1-800-513-5423

What you will learn:

• Levels of coverage and plans
• Types of Rehabs Covered by Ambetter Insurance
• Ambetter coverage for outpatient rehab center programs
• Does Ambetter cover medication-assisted treatment programs (MAT)?
• Sober Living Covered by Insurance
• How to verify your insurance
• How to check your Ambetter insurance benefits

Levels of coverage and plans

Ambetter does cover drug and alcohol treatment programs. Depending on your plan and list of providers you may be out little to no out-of-pocket expense for your rehab stay. Every Ambetter health insurance plan is comprehensive and will include the following essential services.

• Pediatric services
• Emergency services
• Therapeutic services including physical therapy
• Prescription drugs
• Wellness preventative services
• Laboratory services
• Mental health and substance abuse services
• Detox
• Hospitalization

The amount of coverage depends on a variety of factors, including the location of treatment, and the type of insurance plan you have chosen. Depending on your plan you may have higher out-of-pocket expenses including co-payments. Coverage plans are broken into three categories and two different types of plans.

The 3 different insurance plans available are:

Bronze Plan is the Ambetter essential care plan which will cover essential services with a high deductible. This plan has the lowest monthly premiums but has the highest deductible.

Silver Plan is the balanced care plan. Arguably the best value for the everyday person. The silver Ambetter plan offers a balance between the deductible and the premium you would pay.

Gold Plan by Ambetter also known as the Ambetter secure care plan, offers a low deductible with a high premium. This plan will lower the out-of-pocket expense for those needing extensive care.

There are 2 different types of insurance coverage, HMO and PPO. HMO plans use a primary doctor who recommends further treatment at one of the contracted providers from the list they have been given by the insurance company. With PPO plans, you can go out of network to find a program that you would like to enter for your recovery. With that being said, it is less expensive usually to stay in-network as your insurance provider has negotiated the price they are willing to pay for treatment and you will never see a bill outside of your initial co-payment.

Types of Rehabs Covered by Ambetter Insurance 

With each insurance plan being different in terms of coverage, types of programs available, and other variables it is best to contact them directly to ensure you are covered. The different programs for substance abuse that may be covered include:

• INPATIENT REHAB CENTERS: Ambetter covers Inpatient treatment centers. Inpatient treatment programs offer a safe place to stay with 24-hour supervision while you undergo therapy at their center. These programs can last from 2 weeks and up to a year depending on your chosen program. Ambetter may limit the number of days you can receive treatment for addiction by calendar year.

• OUTPATIENT CARE: Ambetter covers Outpatient rehab programs. In outpatient treatment programs patients live at their residence or a sober living home while they attend meetings and therapy sessions. Usually, there is a set number of hours in a calendar year that insurance will cover. Copayments and deductibles may have to be covered by you before insurance kicks in.

• DETOX CENTERS: Ambetter covers detox. Patients in a detox program are medically monitored while under the supervision of a healthcare provider. Detox is there to help you rid your body of substances as comfortably and safely as possible. If you need detoxification services, you may need to see your primary care provider to ensure it is medically necessary before being covered by your insurance plan. Ambetter will cover part, or all of your detoxification needs as long as it is medically needed. You may need to get a doctor’s approval before being covered just to make sure that it is necessary and medically needed to ensure your safety. Depending on the level of addiction and physical dependency will determine if they cover the costs of detox.

Ambetter coverage for outpatient rehab center programs

Ambetter insurance plans generally cover outpatient treatment programs, levels of coverage depend on the plan you have chosen. Outpatient treatment programs offer substance abuse counseling, and alcohol dependency programs on specific days at specific times, for group therapy, individual counseling sessions, and other treatment sessions. Outpatient rehabs do not have housing normally, so you stay at home or in a sober living environment while enrolled in their program.

Does Ambetter cover medication-assisted treatment programs (MAT)?

Ambetter uses ASAM criteria to determine which services are medically necessary including MAT services. MAT (Medication-Assisted Treatment) is approved by the (FDA) Food and Drug Administration and is used in conjunction with counseling and therapy to help address the underlying issues that have led to the addiction in the first place. The FDA has approved specific medications for different drugs including alcohol, opioids, and benzodiazepines. MAT may be covered by your insurance plan, but it will depend on your coverage and what the treatment program you have chosen recommends and deems medically necessary.

Sober Living Covered by Insurance

Sober living can be used in conjunction with outpatient treatment, and for aftercare programs to give a safe place to transition from inpatient rehab to life back in the real world. This important step in the recovery process may be covered by Ambetter insurance plans. Sober living can be thought of as a less restrictive program than an inpatient treatment program. Your Ambetter insurance coverage may cover this form of treatment depending on your policy and the plan you have chosen.

Sober living environments have their own set of rules, curfews, and schedules, and administer drug and alcohol tests to ensure the safety of the group. These sober living homes provide a safe space while providing an opportunity to recover while living a life free of substance addiction. Learning to navigate life and relearn to have fun without the need to self-medicate is an important part of everyone’s recovery. sober living gives the person a good start on living a life and enjoying activities without drugs or alcohol.

How to verify your insurance

When you have decided to get help for a substance abuse or alcohol dependency issue the last thing you need is to try and navigate the world of insurance. This can be overwhelming when trying to get help and leads to frustration. Fortunately, there are admissions specialists at drug rehab centers who are here to help you navigate such problems. If you have Ambetter insurance, you may be covered for part or all of your treatment for alcohol or substance abuse. It does not matter if you are struggling with alcohol dependency or drug addiction, Ambetter insurance can help cover expenses related to the treatment for addiction.

Find out if your insurance is in-network with one of the facilities near you. It is sometimes beneficial for the client to go to treatment further away from home. Getting away from temptations and friends who may still be using is often better for many people. Clients who go to rehab in another state also have a harder time leaving treatment early as well. Depending on the situation, our counselors may suggest looking for substance abuse programs that are a plane flight away. Our addiction specialists have over 22 years of experience and can help you locate treatment for addiction anywhere in the United States.

How to check your Ambetter insurance benefits

Navigating your Ambetter insurance coverage can be simple if you know what to look for and who to contact for help. If you would like to speak to an Ambetter representative and find out which providers are in-network with your current plan, call the number on the back of your insurance card. Your health insurance representative will be able to discuss the entirety of your behavioral health benefits. Ambetter representatives are available most business days. Ambetter also has its own online insurance portal where you can confirm your insurance coverage benefits.

If you have found a treatment center that you would like to go to, you can also have the provider contact your insurance company and inquire about having your insurance cover your addiction treatment services at the center of your choice. Our counselors can help you verify your insurance coverage. Our admissions specialists are available to help you 24 hours a day, 7 days a week. 

1-800-513-5423

Sources

Ambetter Member Handbook

Medications, Counseling, and Related Conditions

Erik Epp – Content Author