EmblemHealth Insurance Coverage for Alcohol and Drug Rehab

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If you or a family member has EmblemHealth insurance, and you have a substance abuse problem that requires detox in a hospital before you can enter rehab, then you should be covered under the terms and conditions of your policy. As a rule of thumb, hospital detox services are covered in the same way as any other hospital service. EmblemHealth has a network of preferred providers, preferring that you attend one of those, however, they do not need you to seek pre-approval from one of their representative. As long as you meet those requirements, you should see your detox costs covered.

EmblemHealth Insurance Coverage for Alcohol and Drug Rehab

If you want to access rehab treatment for an addiction or a dependency to alcohol or drugs, you should always try to speak to your insurance company representative first. They will be able to tell you what is and isn’t covered, whether there are any restrictions in place in terms of where you can go and which treatment you can receive, and how much they will pay towards your treatment. If you have a policy with EmblemHealth, at least some of the cost of outpatient rehab will be covered, but only if the facility is within their network. They also don’t require you to seek prior approval. Unfortunately, EmblemHealth usually does not cover any of the costs of inpatient rehabilitation.

Quick Stats:

55% of all inhalant-related deaths are nearly instantaneous, known as “Sudden Sniffing Death Syndrome.”

How Long EmblemHealth Will Cover Your Rehab Treatment

If you want to access rehab treatment for an addiction or dependency to alcohol or drugs, you should always try to speak to your insurance company representative first. They will be able to tell you what is and isn’t covered, whether there are any restrictions in place in terms of where you can go, which treatment you can receive and how much they will pay towards your treatment. Generally speaking, if you have a policy with EmblemHealth, at least some of the cost of outpatient rehab will be covered for you, but only if the facility is within their network. Usually, they also don’t require you to seek prior approval. Unfortunately, EmblemHealth usually does not cover any of the costs of inpatient rehabilitation.

Quick Stats:

90% of deaths from poisoning are directly caused by drug overdoses.

How Long EmblemHealth Will Cover Your Rehab Treatment

It is very important that you get the discreet, confidential, professional, and effective treatment that you require. Every individual and addiction is unique; it is often impossible to be able to tell exactly how long you will have to be in treatment. It is equally complicated to find out how long the insurance will cover you.

EmblemHealth does have some guidelines in place. They will cover 100 percent of the costs of outpatient treatment, but no more than 60 individual visits per year. To receive that level of coverage you do have to go to an in network facility. Should you wish to have access to private treatment or any treatment above the 60 visits that the insurance company will cover, you will need to pay for it out of your own pocket.

Quick Stats:

Over 200,000 people have abused Ketamine within the past year.

EmblemHealth Insurance Coverage for Specialty Drug and Alcohol Treatment

There are many reasons as to why people may want to go to a center that offers specialty treatment. Busy executives may prefer to go to an executive rehab facility, where they can work remotely. Those in the public eye will require additional privacy; many also prefer to have more upmarket services, if they are available. This is all possible, but it is rare for EmblemHealth to cover it. This means that the payments will have to come fully out of your own bank balance.

This should not stop you from seeking treatment. While there is no real evidence that staying in a luxurious facility improves outcomes for addicted people and their dependents, it is recognized that comfort is very important. If you believe that you will feel more comfortable in one of these specialty facilities, then you may want to look into any other form of payment available to you.

EmblemHealth Insurance for Inpatient and Outpatient Rehab

EmblemHealth does not require you to seek pre-approval for any form of routine treatment, so long as it is at an outpatient facility that is within their network. They will cover 100 percent of the costs of your visit, although they limit how many visits you can make every year.

Some people will require inpatient treatment. This could be because they are truly in the grips of an addiction, because they have no support network, or because they have relapsed several times before. If you hope that EmblemHealth will pay for these costs, you will have to contact them first. With some exceptions, the company does not cover inpatient rehab costs and, if they do, they will require you to seek pre-approval.

How to Pay for What EmblemHealth Doesn’t Cover

It is very much possible that the cost of your rehab treatment will exceed what is covered by EmblemHealth and that will require inpatient treatment, which isn’t covered by your insurance carrier. This should not stop you from seeking treatment, though, as the financial aspect of rehab is one that can be overcome and should never discourage you to get the help that you need. Treatment is an investment in yourself and one that has a high rate of return over the course of a lifetime.

That doesn’t take away from the fact that you simply do not have the money to pay for the cost of treatment, even if you would be happy to pay for it out of your own pocket. There are plenty of options available to you in terms of how to pay for the expenses that are not covered by EmblemHealth. These options include:

  • Taking part in a sliding scale payment plan offered by the rehab facility that you intend to enroll in
  • Taking out a loan to cover the cost of treatment
  • Getting the money through other means, such as asking your family members and friends if they would be willing to lend you the money

Making Sure You Have the Right Coverage

If you feel you’re ready to got to rehab, the first thing you should do is complete an EmblemHealth insurance check. They have made this very easy, since you don’t need to get any approval for treatment, so long as it fits within their guidelines and the provider is in their network. By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.