EmblemHealth Insurance Coverage for Drug & Alcohol Rehab

Does Emblem Health Cover Drug or Alcohol Rehab?

EmblemHealth will likely cover treatment for substance abuse and mental health disorders, but it depends on the plan. Even if the plan provides coverage, the member may still be responsible for some of the costs through deductibles, co-pays, and coinsurance.

How Does EmblemHealth Coverage Work?

EmblemHealth Coverage levels for substance abuse and mental health treatment will vary for each member based on their plan and state of residence. However, most EmblemHealth plans will cover some form of substance abuse treatment.

In many cases, treatment will need to be preauthorized. Also known as prior authorization, preauthorization is when a health insurer decides a treatment or healthcare service is medically necessary. Emergencies and routine outpatient visits usually do not require preauthorization.

Additionally, EmblemHealth often requires its members to meet deductibles and/or pay co-pays or coinsurance for substance abuse and mental health treatment services.

• A deductible is the amount a member must pay for covered services before the health insurer starts to cover costs. For example, members with $1,000 deductible plans must pay for the first $1,000 of covered treatment types.
• A co-pay is a fixed fee that members pay for treatment. It may be required before or after a member has met their deductible.
• Coinsurance is a percentage of the total cost for a covered treatment that a member is responsible for after their deductible has already been met. Health plans with higher monthly premiums will normally have lower co-pays and coinsurance rates than health plans with lower monthly premiums.

What if My Provider Is Out of Network?

EmblemHealth health plans typically offer better coverage if you choose an in-network provider. These providers have contracted with EmblemHealth to offer services to members at pre-negotiated prices.

EmblemHealth may require you to pay all costs or a large portion of costs if you receive treatment from an out-of-network provider. Such providers do not have agreements with EmblemHealth. Therefore, choosing an out-of-network provider will likely result in you paying a higher amount for healthcare and addiction treatment.

If you want to receive treatment from an out-of-network provider, ask about other available payment options like payment plans that can help make treatment more affordable. Many rehab centers are willing to work with you so you or your loved one can receive treatment and successfully recover from addiction.

Types of Addictions Covered by EmblemHealth Insurance

EmblemHealth typically covers treatment for most addictions as well as co-occurring mental health disorders, also known as a dual diagnosis. A co-occurring disorder is when someone suffers from a substance abuse disorder and a mental health disorder at the same time.

Types of Treatment Covered by EmblemHealth Insurance

An admissions counselor at a drug rehab center will perform an assessment to determine the appropriate level and type of care needed for you or your loved one.

Many patients begin with a higher-intensity treatment setting such as residential rehab before transitioning to a relatively lower level of care such as standard outpatient rehab. Many people also need detoxification before they begin formal treatment.

Detoxification

Detox helps people complete withdrawal from drugs and alcohol. The length of time it takes to withdraw from drugs and alcohol will vary based on factors such as the substance being used and the severity of physical dependence to that substance. For example:

• Withdrawal from stimulants like cocaine and amphetamines usually lasts between 3 and 5 days.
• Withdrawal from alcohol can last anywhere between 2 and 10 days.
• Withdrawal from short-acting opioids (heroin) can last between 4 and 10 days, while withdrawal from long-acting opioids (methadone) can last between 10 and 20 days.
• Withdrawal from benzodiazepines can last for 2 to 8 weeks or longer.³

Drug Detox may require the use of medications for withdrawal management; close medical supervision helps to ensure a safe, comfortable experience. Withdrawal from alcohol and benzodiazepines can be severe and include seizures, hallucinations, and extreme agitation.³

Inpatient and Residential Rehab

These live-in programs frequently offer 24-hour support, supervision, and access to medical care. Certain inpatient rehab programs are equipped to treat people who require around-the-clock monitoring, such as those with serious medical conditions or who are experiencing a psychiatric crisis. These programs are located in hospitals or medical centers. Residential rehab also provides 24-hour support, but these programs are often housed in freestanding facilities instead of a hospital.

Inpatient and residential programs offer patients a safe, controlled environment away from drugs and alcohol and from homes that may be unhealthy or unsafe. Both inpatient and residential programs provide group and individual therapy, and they may also offer detox.

Partial Hospitalization Program

These outpatient programs meet during the day, several days per week, for at least 4 to 6 hours per day. Patients in partial hospitalization programs (PHPs) receive many of the same therapies and treatments as those in inpatient and residential programs, but without 24-hour monitoring. Patients live at home and visit the treatment center daily to receive addiction treatment.

Intensive Outpatient Program

Participants in these programs meet for therapy several days per week, usually for at least a few days hours per day. Intensive outpatient programs (IOPs) offer many of the same therapies as PHPs and inpatient programs, but meet less frequently. Like PHPs, people in these programs return home at night.

Standard Outpatient Rehab

Standard outpatient rehab programs usually meet once or twice a week and offer more flexibility for those with jobs, families, and school.

Treatment Services Covered

In addition, EmblemHealth typically covers the following addiction treatment services:

• Assessments
• Exams
• Medications (MAT)
• Lab work
• Therapy
• Costs for inpatient and residential programs, such as room and board and meals

How Do I Get Started?

Your first step is to verify your insurance benefits with American Addiction Centers and learn more about the services and treatments you can receive under your health plan. Then we can help you choose the most appropriate addiction treatment center based on your coverage and individual circumstances.

There are several ways to verify your insurance benefits. Call us at Our admissions navigators are available 24/7 to answer your questions and discuss your options for addiction treatment. You may also use the live chat feature on our website or fill out our easy-to-use insurance benefits form.

Everything is confidential so you can speak freely about your substance abuse or mental health disorder and get the help and information you need to become healthier.