Guide to Amerihealth Health Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023

Author
Claudia Rose
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Clinically Reviewed
Jim Brown, CDCA
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All of the information on this page has been reviewed and certified by an addiction professional.

Substance Abuse Coverage, Amerihealth Health Insurance Coverage Cares About Your Mental Health

Click Here for a confidential benefits check or call (866) 578-7471 to speak to a addiction specialist.

Addiction is a disease that can affect every aspect of someone’s life. It is believed that some 22.7 million people in this country currently battle an addiction. Many of those are ready to quit, but feel incapable of doing so alone, not in the least because of the significant withdrawal symptoms and cravings that are associated with it. One important reason why many don’t get the help they so desperately need is because they believe they cannot afford it. Thanks to the Affordable Care Act, drug and alcohol treatment is now classed as a type of mental health treatment, meaning insurance companies must pay for it. Exactly what they will pay and how much will vary considerably. The good news is that if you have cover through AmeriHealth insurance, some or all your expenses could be paid for.

Will AmeriHealth Cover a Luxury Treatment Center?

If you have an HMO plan, it is unlikely that luxury rehab will be covered. However, on the PPO, POS and EPO plans, they may very well be. These facilities generally have far more luxurious amenities, and can be important on the road to recovery for some people.

Inpatient or Outpatient Treatment Coverage?

One of the biggest decisions you will have to make once you agree to go to rehab is whether you want to attend inpatient or outpatient treatment. You must make sure that you choose the one that is most suitable to your particular needs. Outpatient facilities are excellent options for those with a strong support network and moderate to mild addiction problems. If the environment in which someone lives enables the addiction then inpatient treatment is generally the better option.

Can I Go to an Out of Network Provider?

It all comes down to the plan that you have. As such:

  • AmeriHealth HMO plans cover for doctors within their network only. You can ask for your care to be coordinated by your primary doctor, who can refer you to an in-network provider.
  • AmeriHealth HMO Plus plans cover for in-network doctors. The Primary Care Practitioner can coordinate your care, but you can pick your hospital or specialist without being referred.
  • AmeriHealth POS (Point of Service) plans have the most benefits for in-network providers. However, you can also choose an out of network provider. Your PCP can coordinate this, or you can choose an out of network provider yourself.
  • AmeriHealth POS Plus plans allow your care to be coordinated by your PCP, but you can choose a hospital or doctor inside or outside of the network, and you don’t need a referral either.
  • AmeriHealth EPO (Exclusive Provider Organization) plans allow you to see any specialist or doctor without a referral, but they must be in your chosen network.
  • AmeriHealth PPO plans allow you to choose your own specialists and doctors, within or outside of your network, and without a referral.

What Happens if My Claim Is Denied?

You will be notified by AmeriHealth if your claim is denied. You can always appeal this decision by contacting their Member Services; the telephone number is on your AmeriHealth ID card. You will have to file an appeal within 90 days. It is possible that Member Services can decide on your issue directly as well. Appeals are in compliance with NCQA guidelines, and you can ask for an expedited hearing if you believe your case to be urgent by calling (866) 578-7471.

What Else Can I Get?

Under your AmeriHealth policy, you will be able to access various discounts, wellness options, and health services. They currently serve some 5.3 million people, covering pharmacy, vision and dental benefits. You may also be able to adjust and manage your plan. You always have the benefit of confidentiality; you can contact AmeriHealth at any point without anyone being able to find out that you have problems with drugs or alcohol.

How Do I Know If I Am Covered?

It can take a long time to check exactly what is covered and what is not. You may need to make numerous phone calls, dealing with lengthy waiting times. Usually, a rehab center that you are considering can also make these checks for you.

Who Is AmeriHealth Health Insurance?

AmeriHealth is a relatively new insurance company that was started in 1995, when it was then known as Delaware Valley HMO. The company currently covers some 265,000 members, with over 37,000 specialists and physicians in their network covering addiction treatment, behavioral therapy and various wellness services.

As part of their plans, AmeriHealth will usually cover drug rehab, which they consider to be part of their Behavioral Health Program. A number of factors will have to be taken into account which will vary depending on the plan. Coverage ranges from partial to full, and you will have to pay yourself anything that they don’t cover.

Deductibles must be paid if they are in place before the insurance takes over as well. Depending on your plan, you may need to be referred to rehab by a doctor for it to be covered. They will usually require you to have prior authorization from them.

While the company has multiple plans, two of the plans with the greatest difference are:

  1. The NJ AmeriHealth HMO, whereby pre-approval is required. Co-payment for outpatient treatment is $50. Co-payment for inpatient treatment is $500 per day. There is a five-visit maximum.
  2. The NJ AmeriHealth PPO, whereby you have a co-payment of $10 for outpatient treatment, and 100 percent coverage for inpatient treatment within their network. For providers, outside of their network, the company covers 80 percent.

Regardless of which AmeriHealth plan you have, you are likely to be covered for:

  • Detox
  • Residential treatment
  • Partial hospitalization
  • Intensive Outpatient Programs
  • Aftercare
  • Behavioral health and mental health programs

How Long Will They Cover Me?

The length of coverage varies according to your plan. Certain plans only cover detox, but not rehab. Within plans where rehab is also covered, it usually lasts between three and 90 days. AmeriHealth is there for you and wants to get you the help you need when you need it. By calling (866) 578-7471 you can determine what your insurance plan covers to decide on how you will proceed with your rehabilitation.