Does Amerigroup Insurance cover Heroin or Drug Rehab?

Written by: Editorial Staff

Last updated on March 17, 2021

If you or a loved one is struggling with heroin or drug abuse, you may be wondering how you can get help. Rehab centers are a great resource for those seeking treatment and many health insurance companies, including Amerigroup Insurance, provide coverage for such treatment.

Amerigroup Insurance provides healthcare coverage to seniors, people with disabilities, low-income families, and those who are enrolled in Medicare or Medicaid in 9 states across America.¹ Your coverage will vary depending on where you live and what plan you’ve selected. Fortunately, you can always call the number on your insurance card or check with your chosen facility to confirm your specific coverage before receiving care.

Overview of Amerigroup Insurance Plans and Policies

As previously mentioned, your level of coverage will vary based on where you live and the plan you’ve selected. You’ll need to verify your coverage with an Amerigroup representative based on your location.

The following Amerigroup plans may be available in your state:²

• Medicare Advantage plans—These plans are designed for people over the age of 65. Benefits typically include drug and medical coverage, lower copays, and nurse advice line access.
• Medicaid plans—These plans are designed for low-income individuals. Coverage is typically available for pregnant women, people with disabilities, children, and adults that qualify. These plans are often available at little to no cost.
• Medicare-Medicaid plans—In Texas, people over the age of 21 may qualify for this hybrid plan.
• Medicare Part D coverage—Medicare Part D plans are designed to be used for additional drug coverage that is not provided under Medicare or Medicare supplement plans.
• Medicare supplement plans—As the name suggests, Medicare supplement plans are designed to provide coverage for services not covered under standard Medicare plans.

As with any type of insurance, your policy may or may not provide coverage for an out-of-state facility. Your rehab center of choice can check your coverage and you can contact an Amerigroup representative to verify your health care benefits.

What will Amerigroup Insurance cover?

Specific coverage of rehab and therapy services may vary based on your plan and your location. However, Amerigroup plans provide basic coverage.

Does Amerigroup Insurance Cover Mental Health Care?

According to the National Survey on Drug Use and Health, nearly half of those with addiction have a co-occurring mental health disorder, underscoring the need for mental health services.³ Under the Affordable Care Act, mental health services are considered to be an essential health benefit.⁴

This means that insurers, including Amerigroup, are legally required to provide coverage for mental health care and treatment. As such, treatment for co-occurring disorders, heroin rehab, and rehab for other addictions must be covered in some capacity.

Inpatient and Residential Rehab

Inpatient and residential rehab services can help affected individuals detox and recover from their heroin addiction. Under these programs, patients stay at a facility and receive care under the supervision of doctors and nurses for a predetermined period of time, hence the name inpatient.

Amerigroup plans provide varying levels of coverage for inpatient and residential rehab services. In some states or under certain plans, your inpatient and residential rehab stay may be subject to duration limits, copays, or coverage.

Outpatient Rehab and Therapy

Unlike inpatient services, outpatient rehab and therapy services are provided to patients within the facility but don’t require the patient to stay on-site. These services may include therapy, counseling, group counseling, or rehabilitation services. Outpatient services are typically covered under Amerigroup insurance plans, but exact coverage may vary based on plan and location.

Intensive Outpatient Programs (IOP)

At American Addiction Centers, IOPs are programs used to address heroin addiction and mental health issues that aren’t severe enough to require inpatient care. This means that patients can receive the care that they need, but continue to live their normal day-to-day life in the majority of cases. Such services are typically covered in some capacity under Amerigroup health plans, but coverage and cost-sharing will vary based on your plan and your location.

Partial Hospitalization Programs (PHP)

For patients that need intensive care for their rehab or mental health care, but don’t require round-the-clock supervision, a partial hospitalization program may be recommended. Amerigroup plans may offer full or partial coverage for PHPs, subject to cost-sharing elements like a copay or deductible. For more information, contact your plan’s representative to check coverage.

In Network vs. Out of Network Rehab Centers

You may have heard the terms “in-network” and “out-of-network” coverage when it comes to insurance coverage levels.⁵ In-network rehab centers refer to centers that have a contract with your insurance company with pre-negotiated rates. Because of their relationship, in-network rehab centers often can provide you with low-cost care. On the contrary, out-of-network rehab centers are those that do not have a relationship with your insurance company. As such, the cost of care is typically higher and is not covered under insurance.

To verify whether a facility is in-network or out-of-network, call the number on the back of your insurance card. In addition, the facility you’ve chosen can contact your insurance company on your behalf to verify coverage type and network coverage.

How Long Does Amerigroup Cover Rehab?

When it comes to helping patients fully recover and rehabilitate from their addiction, it’s generally accepted that longer treatment times are the most effective. However, each patient is different, and, as such, their rehabilitation and recovery plan will be subject to a doctor’s prescription.

Similarly, Amerigroup insurance may vary in how long they will provide coverage for rehabilitation. Many plans set limits on out-of-pocket maximum costs, program coverage, and duration of coverage. These limits vary based on plan coverage and location. Be sure to check with your insurance provider and rehab facility before entering treatment.

What if my Amerigroup Insurance policy does not cover heroin rehab?

If you find out that your Amerigroup policy doesn’t cover your heroin rehab or doesn’t provide enough coverage, don’t worry. Many rehab centers offer alternative financing or scholarship programs to help you get the care you need without digging yourself into debt.

If you’ve chosen to seek care, that’s the most important step. Don’t delay getting treatment because you’re worried about paying for it. Many centers, including the American Addiction Center, will help you figure out financing in conjunction with obtaining the care you need. Delaying care may harm your long-term health.

Check Your Benefits

American Addiction Centers is pleased to be a full-service rehabilitation center. This means that, in addition to creating a personalized rehab and recovery plan for you or a loved one that’s suffering from heroin addiction, AAC can help you manage your insurance responsibilities.

AAC can verify your insurance coverage through Amerigroup Insurance to check the benefits your specific plan provides. This will include determining whether AAC is an in-network or out-of-network facility, your mental health and substance abuse coverage, and cost-sharing requirements.

If you or a loved one is looking for a high-quality and effective heroin rehab facility, please give American Addiction Center a call. Call us now at 1-888-496-8059 Who Answers? to learn more. 

Sources:

1. Amerigroup. (2020). The States we serve.

2. Amerigroup. (2020). Medicaid insurance from Amerigroup.

3. Centers for Medicare & Medicaid Services. Information on essential health benefits (EHB) benchmark plans.

4. Substance Abuse and Mental Health Services Administration. (2020). National Survey on Drug Use and Health: CBHSQ data.

5. Small Business Majority. (2019). In-network vs. out-of-network costs comparison.