(Please note: Rehabs.com strives to provide you with the most updated information on each carriers' addiction insurance coverage but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. Rehabs.com is an informational site only and is not affiliated or sponsored by EmblemHealth.)
"If you seek prior approval and are hospitalized at a facility included in EmblemHealth's network of approved providers, the hospital stay should be covered as stated in your insurance benefits."
If you or a family member is covered under an EmblemHealth insurance plan and require hospitalization in order to detox before seeking addiction treatment, this treatment is usually covered under the normal rules for hospital stays. If you seek prior approval and are hospitalized at a facility included in EmblemHealth's network of approved providers, the hospital stay should be covered as stated in your insurance benefits.
Does EmblemHealth Cover Rehab?
When seeking rehabilitation from an addiction to drugs or alcohol, it's always important to check with your insurance provider to see what's covered under your plan. In most cases, EmblemHealth will cover at least part of the cost of any routine outpatient rehabilitation at any one of its network facilities without the need for prior approval, but it usually doesn't cover inpatient rehab.
Addiction Treatment Length EmblemHealth Will Cover
Getting the confidential, discreet treatment you need is important; but it's not always easy to tell the duration or length of treatment your insurance plan will cover. EmblemHealth limits the length of outpatient treatment to 60 visits per person per calendar year. It typically covers 100 percent of these costs at any network facility. If you require private treatment, you'll have to pay for the additional sessions on your own.
Specialty Alcohol and Drug Treatment Through EmblemHealth
Many individuals, such as business executives and celebrities, prefer to seek treatment at exclusive or luxury facilities, which usually have the amenities that appeal to people of their stature. However, this type of inpatient treatment is usually not covered by an EmblemHealth insurance plan, requiring you to pay for treatment out of your own pocket.
Insurance for Inpatient Addiction Treatment vs. Outpatient
EmblemHealth doesn't require pre-approval for any routine substance abuse treatment at any of its network outpatient treatment centers. All of the costs for outpatient visits are typically covered, but the number of visits allowed each year is often limited. If it's determined you need treatment at a residential inpatient facility, you'll need to contact EmblemHealth directly to receive approval, although the majority of its plans won't cover any inpatient treatments.
How to Cover What Insurance Won't
If you're struggling to come up with a way to cover the costs not paid by your insurance plan, you might want to look for providers that offer payment options. In general, you have several different options to cover your expenses, including:
- Payment plans
- Personal loans
- Borrowing from friends or family
Verifying Coverage and Finding the Best Treatment
When it comes to verifying your coverage, EmblemHealth makes the process easy. You're allowed to seek treatment at any approved outpatient facility in its network. This means you can just show up at any network provider and get the treatment you need almost immediately. While some people might be skeptical about choosing outpatient treatment, according to the Substance Abuse and Mental Health Services Administration statistics on addiction treatment, the rates for success between inpatient and outpatient clinics are nearly the same.
"When it comes to verifying your coverage, EmblemHealth makes the process easy."
It's important you find the right facility that can tailor a treatment program to fit your needs. If you need help finding a treatment center, please call your insurance company to learn more about your individual plan.