Drug and Alcohol Rehab Centers That Accept EmblemHealth

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

April 10, 2019

Paying for drug or alcohol addiction treatment is one of the leading reasons why people choose not to seek help. Luckily, insurance companies like EmblemHealth provide coverage options to its clients when it comes to substance abuse services.

EmblemHealth is one of the nation’s largest not-for-profit insurance companies. It serves more than three million people throughout New York and the tristate area. EmblemHealth provides a wide range of high-quality and affordable plans for individuals and employers.

Several of EmblemHealth’s plans provide at least some coverage for drug and alcohol addiction treatment. The exact amount of coverage will vary depending on the specific plan you have.

Does EmblemHealth Cover Drug And Alcohol Addiction Treatment?

Thanks to the Mental Health Parity and Addiction Equity Act, insurance companies like EmblemHealth must provide “the same level of benefits for mental and/or substance use treatment and services that they do for medical (or) surgical care.” This means that no matter what plan you have, if it covers medical services, it will also cover addiction treatment to some degree.

There are a number of different plans offered by EmblemHealth. Each plan will vary in regards to what type of addiction treatment is covered and how much is covered. The state you live in will also determine the type of substance use treatment you are eligible for.

Substance Use Treatment Services Covered By EmblemHealth

There are a number of different options when it comes to drug and alcohol addiction treatment. Not every treatment program or service may be covered under your EmblemHealth plan.

Common substance use treatment programs and services covered under EmblemHealth include:

• family, group, and individual therapy
• medically supervised detox programs
• medication that may be used during and after treatment
• mental health and dual diagnosis treatment
• drug testing

Some addiction treatment services may require prior authorization before EmblemHealth will provide coverage. This means that the medical necessity of the service must be proven. This is often done through a medical assessment that is then submitted to EmblemHealth.

Inpatient Rehab Programs

Inpatient treatment is a step up from outpatient programs. This type of treatment requires people to live residentially at a rehab facility for a set period of time. How long a person will spend in inpatient treatment will depend on his or her level of addiction.

Many inpatient programs offer customized plans for recovery based on each person’s needs and condition. Plans of recovery may include a variety of addiction services, including medication management and therapy.

Not every EmblemHealth plan may cover inpatient treatment. Additionally, some plans may require prior authorization before providing coverage for an inpatient program.

Outpatient Treatment Programs

Outpatient programs are typically the first recommendation for someone who is seeking treatment for the first time. They are less intensive than inpatient programs and allow people to keep up with daily responsibilities if need be.

Outpatient treatment is typically offered in a doctor’s office, rehab facility, or hospital setting. There are several different types of outpatient programs. These include standard outpatient treatment, intensive inpatient programs (IOP), and partial hospitalization programs (PHP).

Standard outpatient programs are the least intensive and give patients the most freedom. People only need to attend treatment once or twice a week for a few hours each session.

Intensive outpatient programs (IOP) consist of therapy several days a week, often in the evening. This enables patients to continue going to work or school during the day. People will spend 10 to 20 hours each week in the program.

PHP is the most intensive form of outpatient treatment. Partial hospitalization programs require patients to attend treatment daily for four to eight hours each day. Treatment is typically five days a week.

Most EmblemHealth plans will cover at least part of an outpatient treatment program. Prior authorization may be needed to receive coverage.

What If EmblemHealth Doesn’t Cover All Of My Addiction Treatment?

Many insurance plans will not cover every last penny of a drug or alcohol addiction treatment program. And, a lot of us are unable to afford the cost of rehab right out of pocket. If you are one of the millions of Americans who struggle with addiction but are unable to afford it, know that there are options.

Other ways to pay for drug and alcohol treatment in addition to your insurance plan include:

• government grants
• personal loans
• scholarships from the rehab facility
• payment plans through the rehab facility
• paying on a sliding scale

If even after insurance you are unable to afford treatment, don’t despair. Contact a treatment specialist to explore additional payment options that may be available to you.

How To Find A Rehab Program That Accepts EmblemHealth

There are several factors you must consider before using your EmblemHealth insurance plan to cover an addiction program. One factor is to make sure the treatment facility you plan to attend accepts your insurance plan.

Additionally, a treatment specialist can help you decide which addiction services are right for you. This enables you to determine if these services are covered by EmblemHealth.

Using your EmblemHealth insurance to cover some or all of your addiction treatment doesn’t have to be confusing. Contact a treatment specialist today to discuss your insurance coverage and explore your treatment options.