Addiction Treatment Covered by EmblemHealth Insurance
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EmblemHealth is one of the largest not-for-profit health insurance companies in the United States.1 The company serves more than 3 million customers in the New York tristate area.1
EmblemHealth offers a wide variety of insurance plans for individuals, families, and employers. The company also offers Medicare and Medicaid plans to those who qualify.2
As an EmblemHealth member, some coverage may be provided for drug and alcohol addiction treatment. The amount covered depends on the type of plan you have.
While the company primarily operates in New York, and Connecticut, members might be able to use their plans in Florida for substance use disorder treatment. EmblemHealth is in-network with some local facilities, including Recovery First Treatment Center in Hollywood, FL.
Read on to learn more about the addiction treatments EmblemHealth may cover and what to expect when using health insurance to pay for rehab.
Does EmblemHealth Cover Substance Abuse Rehab?
Most EmblemHealth plans offer coverage for drug and alcohol rehab in some capacity. But the amount of coverage will vary based on the specific policy and extent of treatment required.
Under the Affordable Care Act, treatment for substance use disorders is one of the 10 essential health benefits that must be covered by plans sold on the Health Insurance Marketplace.3,4 That said, employer and large group plans are different than Marketplace plans and governed by separate standards.
Additionally, the Mental Health Parity and Addiction Equity Act mandates that mental health services and addiction treatment are covered at the same level as primary care and surgery.5 This helps ensure some capacity of coverage for drug rehab through EmblemHealth and most other private insurers.
Recovery First may accept EmblemHealth plans from members who live in the tristate area and Florida. As a first step to getting the addiction treatment you need, use our confidential online tool to verify your insurance benefits and learn more about your rehab coverage.
Addiction Treatments Covered by EmblemHealth
Addiction treatments covered by EmblemHealth will vary according to a person’s individual needs. There is no one-size-fits-all approach to recovery.6 Most quality, evidence-based programs offer different levels of care, including detox, inpatient, and outpatient treatment options.
Covered care will also fluctuate based on a person’s specific health plan. EmblemHealth’s various tiers include:7
- Bronze plans have the lowest monthly premiums available and higher deductibles. These plans work well for those who do not see the doctor frequently and don’t anticipate a lot of medical expenses.
- Silver plans offer moderately priced monthly premiums and deductibles. These are a good choice for those who visit the doctor regularly.
- Gold plans offer a low deductible and higher monthly premiums. These are an ideal choice for those who require a lot of healthcare and visit the doctor frequently.
- Platinum plans have the highest monthly premiums and lowest deductibles. These plans are designed for people with ongoing health conditions, costly prescriptions, and frequent doctor visits.
Health Insurance Plan of Greater New York (HIP) and Group Health Incorporated (GHI) merged to form EmblemHealth.1 Under this umbrella, there are many types of plans to choose from, including:8
- Health maintenance organization (HMO) plans require you to select an in-network primary care physician who coordinates all your care and referrals to specialists. If you choose to see a doctor that is out-of-network, or without a referral, the out-of-pocket costs are higher.
- Preferred provider organization (PPO) plans have a “preferred” network of local providers. You do not need a primary care physician or referral to see specialists. You are only responsible for paying a portion of the care received (depending on your plan). In-network providers are typically less expensive than out-of-network.
- Exclusive provider organization (EPO) plans are a hybrid of HMO and PPO plans. They offer a bit more flexibility than HMOs and are more affordable than most PPO plans. You do not need a referral for specialist care with these plans, but pay out-of-pocket for doctors outside of EmblemHealth’s network.
Treatment at Recovery First is covered by some EmblemHealth plans. Call the number on the back of your insurance card to learn more about your benefits.
Or for immediate help, contact us at 585-326-3332. One of our admissions navigators can verify your insurance coverage over the phone and discuss your options, so you can get the care and support you need.
How to Use GHI Emblem Insurance to Pay for Rehab
To use your EmblemHealth insurance to pay for rehab, here a few steps that might ease the process:
- Visit your doctor. Make an appointment with your primary care physician to discuss your struggles with addiction. They can help you determine what type of treatment you need and ensure you get the optimal care.
- Get pre-authorization. Some EmblemHealth plans require pre-authorization before coverage kicks in for rehab and addiction treatment. This means a doctor or other qualified healthcare provider must deem that rehab is medically necessary.
- Understand your coverage. Find out exactly what is and isn’t covered by your health insurance plan—before you begin treatment. Having a financial plan will allow you to focus on recovery instead of worrying about the cost.
At Recovery First, we know that looking into rehab options and navigating the world of insurance can be overwhelming. You don’t have to go through it alone. We’re here to help. Our admissions navigators are available 24/7. Give us a call at 585-326-3332, so we can answer all your questions and get you on the path to a better, healthier life.
If you’re ready to begin treatment, complete the form below with your contact and insurance information. We’ll email you right back with details about your coverage and what to do next.
- EmblemHealth. (2021). Our story.
- EmblemHealth. (2021). New York health insurance plans & coverage options.
- Abraham, A. J., Andrews, C. M., D’Aunno, T., Friedmann, P. D., Grogan, C. M. & Humphreys, K. N., (2017). The Affordable Care Act transformation of substance use disorder treatment. American Journal of Public Health, 107(1), 31–32.
- Office of National Drug Control Policy. (n.d.). Substance abuse and the Affordable Care Act.
- National Alliance on Mental Illness. (2021). What is mental health parity?
- National Institute on Drug Abuse. (2018, January). Principles of effective treatment.
- EmblemHealth. (2021). Individual and family health insurance plans.
- EmblemHealth. (2021). Large group plans.