Will Amerihealth Insurance Cover a Heroin Detox Center?

amerihealth detox center

Like any form of healthcare, drug rehab costs can run high. This is especially so for people coming off chronic or long-term drug problems, which tend to require longer stays in treatment.

Having a health insurance plan that picks up some of the costs of treatment can mean the difference between overcoming addiction and remaining stuck inside a painful drug-abuse cycle. Fortunately, Amerihealth plans do provide coverage for drug rehab, including heroin detox.

Before choosing a heroin detox center, it’s important to understand how your plan benefits work. In this way, you’re in a better position to make the most of your Amerihealth insurance coverage.

The Need for Heroin Detox

Heroin, Fentanyl and Oxycontin all belong to the opiate class of drugs. These substances produce pain-relieving effects that impact the body as well as the mind and emotions.

Heroin, one of the strongest opiate drugs on the market, has a chemical makeup that closely resembles the brain’s natural endorphin chemicals. This similarity reinforces heroin’s highly addictive qualities. In effect, heroin is so addictive that some people can become addicted as of the first time trying the drug.

Once the body gets used to heroin’s effects, attempts to cut back or stop using the drug will bring on extremely uncomfortable withdrawal symptoms, including:

  • Insomnia
  • Fatigue
  • Depression
  • Severe drug cravings

Heroin detox centers provide treatments that bring relief from withdrawal. In the process, you’re able to work through the destructive thinking and behaviors that fuel drug-using urges.

Amerihealth Plan Coverage

Amerihealth offers coverage for heroin detox through Magellan Behavioral Health, a subsidiary company. Magellan Behavioral Health handles coverage claims for heroin detox as well as for drug rehab treatment in general.

While it’s likely your health policy will cover heroin detox, the extent of your coverage will depend on the type of plan you have. Amerihealth offers plans for individuals, families, businesses and Medicare recipients, all of which provide different levels of coverage.

Plan coverage varies, with some plans covering only a portion of your treatment costs while other more comprehensive plans covering most or all of your treatment costs. For this reason, it’s important to review your plan so you know what types of services are covered.

In-Network vs. Out-of-Network Plans

Amerihealth offers both in-network and out-of-network plan types. A plan network consists off all of the physicians, hospitals, rehab centers and any other healthcare facility that accept Amerihealth insurance.

Amerihealth plans work within HMO and PPO networks. HMO-based plans only cover services offered by in-network providers. PPO plans also work with a specified group of providers, but these plans will also cover out-of-network providers under certain conditions.

Since PPO plans offer more flexibility, they’re more expensive than HMO plans. Knowing whether you have an HMO or PPO plan can help you narrow down your choices when it comes to heron detox centers.

Plan Coverage Duration

Regular and long-term heroin abuse causes widespread disruption to the chemical processes that maintain the body’s major systems. Long-term and chronic heroin addictions can cause other serious conditions to develop alongside the addiction. Full-blown psychological disorders, such as anxiety and depression and chronic medical conditions such as diabetes and heart disease are commonly associated with heavy heroin use.

In effect, the longer you’ve abuse the drug, the more difficult heroin detox will be. Under these conditions, longer detox stays are more the norm than the exception. The length of time your Amerihealth plan will cover heroin detox depends on the type of plan you have, though most plans will cover up to 90 days provided your condition warrants this long a treatment stay.

Out-of-Pocket Cost Considerations

The type of Amerihealth plan you have will determine the amount of out-of-pocket costs you’ll pay when entering a heroin detox center. Out-of-pocket costs include anything that exceeds your plan limits plus any copayments and deductible amounts listed.

Your particular plan should specify:

  • The percentage of costs covered
  • The number of days of treatment covered
  • The amount paid out per day of treatment

Any costs that exceed your plan’s stated benefit coverage will have to be paid out-of-pocket.

In general, the least expensive plans tend to have the highest deductible payouts. This means, you’ll have to pay a certain amount upfront before your plan benefits can be applied. Copayment requirement amounts also tend to be higher with the lower cost plans.

Conditions

Medically Necessary vs. Not Medically Necessary

Medical necessity ultimately determines what services your Amerihealth plan will and will not cover. Medical necessity has to do with whether a particular service is needed to treat a particular condition.

As far as heroin detox goes, medical necessity not only dictates what your insurance plan will cover, but also the type of detox center and the number of days of treatment. This means if you’re recovering from severe heroin addiction, your plan is more likely to pay for centers that offer intensive treatment care, such as inpatient programs.

Ongoing Insurance Coverage Considerations

While there’s no getting around the need for heroin detox, it’s important to consider your ongoing treatment needs once you complete detox, especially if you’re coming off a severe addiction problem. Since the detox program you choose will likely draw an aftercare plan, it helps to know what your options are as far as insurance coverage goes. In this way, you can keep on top of any potential out-of-pockets costs down the road.

Treatment Considerations

Heroin addictions can be some of the most difficult to overcome so it’s important to ensure you choose a heroin detox center that provides the level of care you need to succeed in recovery. Since your Amerihealth plan will only cover so much, it’s best to make the most of what it has to offer. Also keep in mind that medical necessity carries a lot of weight, so being open and honest during your time in treatment can go a long way towards ensuring you get the help you need.

If you have any questions about your insurance plan or need help finding a program that accepts Amerihealth coverage, please feel free to call our helpline at 866-802-6848 to speak with one of our program counselors.