Suppose you or a loved one is covered under EmblemHealth insurance and requires a medical facility to assist with detox before seeking rehab. In that case, these treatments are normally covered under the plan. It is advised to seek approval for hospitalization at the facility of choice through your EmblemHealth’s network of covered providers to ensure you are covered, as is stated in your coverage benefits.

EmblemHealth is a non-profit health insurance company that covers more than 3 million residents of Connecticut, New Jersey, New York State, and the tri-state New York City area.

EmblemHealth will usually cover substance abuse treatment and mental health disorders, depending on the specific plan. Even if the plan provides coverage, members could still be responsible for deductible costs, copayments, and coinsurance.

What Is Emblem Insurance?

EmblemHealth has provided health coverage since the 1930s, offering various health plans like Medicaid and Medicare, to businesses, families, individuals, retirees, and government workers. EmblemHealth centers on practicing a whole-person method to health care insurance to help members stay healthy for the long-term.

How Does Coverage Work?

Mental health and substance abuse coverage levels will vary for each member based on their state of residence and insurance plan. However, most EmblemHealth plans cover at least a portion of substance-abuse treatment.

In most cases, a treatment program will need to be pre-authorized. Also referred to as prior authorization, the health insurance company will decide if a healthcare service or treatment is medically necessary. Outpatient treatment and emergency visits usually will not require preauthorization.

EmblemHealth will normally require members to meet deductibles, co-payments, or coinsurance for mental health and substance abuse treatment services.

Explanations of a deductible, co-payment, and coinsurance include:

  • A deductible is the responsibility of the member to pay upfront for covered services previous to the health insurer covering costs. For example, members with a $500 deductible plan must pay upfront the first $500 of coverage costs.
  • A co-payment is a set fee that members finance for treatment. It is usually required before, but sometimes after, a member has paid their deductible.
  • Coinsurance is a percentage of the entire cost for a covered treatment a member is liable for after their deductible has already been satisfied. Health plans with more expensive monthly premiums will usually have lower co-payments and coinsurance rates than those with lower monthly premiums.

Does EmblemHealth Cover Substance Abuse Treatment?

When inquiring into substance abuse treatment, it is always important to verify your insurance provider’s approval and confirm what’s covered on your plan. EmblemHealth covers at least part of any routine outpatient treatment program costs at any of their network facilities without requiring prior approval with most plans. However, it usually does not cover residential treatment.

What if My Provider Is Out of Network?

EmblemHealth InsuranceEmblemHealth plans usually offer better coverage when choosing an in-network provider. These providers have contracts with EmblemHealth to offer their services to members at pre-negotiated rates. 

EmblemHealth could require you to pay all costs or a substantial portion of costs when receiving treatment from an out-of-network provider. Emblem health doesn’t have agreements with such providers. Therefore, choosing an out of network provider will likely cause you to pay a higher amount for health care in substance abuse treatment.

Types of Substance Addictions EmblemHealth Typically Covers

EmblemHealth usually covers substance addiction treatment and co-occurring disorders, also referred to as dual diagnosis. A co-occurring disorder is when somebody is suffering from mental health and substance abuse disorder simultaneously.

Substance abuse disorders that are usually covered by EmblemHealth include:

  • Alcohol
  • Cocaine
  • Hallucinogens
  • Heroin
  • Inhalants
  • Marijuana
  • Methamphetamine
  • Prescription drugs 

Most substance abuse treatment centers can treat these listed substance use disorders. The rehab center’s admission counselors will assess the suitable level and care type needed for the subject.

Most patients will start with a higher intensity treatment setting like residential treatment before transitioning to a more moderate level of care like outpatient treatment. A medical detox treatment will be needed before treatment gets started to flush the body of drugs and alcohol.

Medical Detox Treatment

Medical detox treatment helps patients flush the drugs and alcohol from their bodies until they no longer feel the withdrawal effects. The time and length it takes to detox from drugs and alcohol are based on the substance used and addiction severity.

The withdrawal timeline from specific substances are:

  • Alcohol can last between 2 and 10 days
  • Benzodiazepines can last 2 to 8 weeks, and sometimes longer
  • Stimulants like amphetamines and cocaine normally last between 3 and 5 days
  • Short-acting opioids, like heroin, can last between 4 and 10 days, while long-acting opioids, like methadone, can last between 10 and 20 days

A detox could require withdrawal management, which entails round-the-clock supervision by a specialist who can administer medications. Withdrawal from benzodiazepines and alcohol can cause severe reactions like hallucinations, seizures, and extreme agitation.

Residential Treatment

Residential treatment programs offer patients a safe, substance-free controlled environment to help them recover. 

These living facilities offer 24-hour support of medical supervision and access to medications when needed. Some residential treatment programs are equipped to treat patients with more severe medical conditions like experiencing psychiatric trauma. These live-in programs are usually found in hospitals or medical centers. Residential treatment also provides round the clock support, but these rehab programs are usually housed in freestanding buildings rather than hospitals.

Residential treatment programs are best for those who don’t have a supportive or sober living environment at home. Residential treatment programs provide patients with individual and group therapy, with patients usually staying between 30 and 90 days.

Partial Hospitalization Program

Partial hospitalization programs will meet during the day, several days a week, for roughly 4 to 6 hours each day. Patients enrolled in a partial hospitalization program will receive many of the same treatments and therapies as those in residential programs without round-the-clock monitoring. The patient returns home each night and visits the treatment center periodically to receive substance addiction treatment.

Intensive Outpatient Program

Patients in an intensive outpatient program will meet for therapy several days a week, for 3 to 5 hours per day. Intensive outpatient programs will offer the same therapies as partial hospitalization programs and residential treatment programs but meet less often. Like partial hospitalization programs, patients can return home at night.

Outpatient Treatment

Outpatient rehab programs will normally meet 1 to 2 days a week and offer more flexibility for work, school, and family obligations.

Luxury Alcohol and Drug Treatment 

Patients like celebrities and business executives prefer to seek substance addiction treatment at luxury or private facilities. These usually have the amenities that appeal to patients of their stature. However, these inpatient treatment programs are usually not covered by an EmblemHealth insurance plan, requiring treatment to be paid for out of pocket.

Treatment Services Covered

EmblemHealth usually covers addiction treatment services that include:

  • Assessments
  • Exams
  • Lab work
  • Medications
  • Therapy

Length of Addiction Treatment EmblemHealth Covers

Receiving confidential and discreet substance addiction treatment is important, but there is no typical rehab duration that your insurance plan will cover. EmblemHealth does limit the length of outpatient treatment to 60 appointments per patient per calendar year. Staying within that limit will typically have 100% of the costs covered for any network rehab center. For the patients that require private treatment, payment for additional sessions will be completely on them.

How to Cover What EmblemHealth Insurance Won’t

For those with an EmblemHealth plan who don’t have upfront money for addiction treatment that your plan doesn’t cover, you may want to check with providers that can offer payment plans. Overall, patients usually have several different choices to cover substance addiction treatment, which include: 

  • Borrowing from friends or family
  • Payment plans
  • Personal loans

Verifying Coverage and Finding the Best Treatment

In regards to verifying coverage plans, EmblemHealth makes the process quite simple. Members can seek treatment at an approved outpatient treatment facility within its network. This means members can show up at any network provider and receive substance addiction treatment that is needed almost immediately. While some members might be skeptical in choosing outpatient treatment, according to statistics on substance addiction rehabs, residential and outpatient treatment centers, success rates are almost the same.

It would be best to locate the appropriate rehab facility to tailor an addiction treatment program to fit your specific substance-abuse needs. For those who need help finding a rehab center, it is advised to call EmblemHealth to learn more about your plan.

Unity Behavioral Health is In-network with EmblemHealth Insurance 

EmblemHealth is in-network with Unity Behavioral Health. Therefore, your first step should be to call our facility to verify your health insurance plan and learn more about the treatments and services you are eligible for. From there, we can help you determine the best addiction treatment approach based on your coverage and personal circumstances. 

The best way to verify your EmblemHealth insurance benefits is by reaching out to our admissions specialists to discuss your addiction treatment options. Everything is confidential to speak freely about your mental health or substance abuse disorder.

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