Once you make the life-changing decision that you want help for a substance use disorder, you need to know where to turn. One of the things that holds many people back is the perceived cost of care. You shouldn’t have to worry if you have insurance, but does Ambetter cover rehab?
Under the Affordable Care Act, all insurance companies must cover rehab to the same extent that they would cover a medical issue. The tiers of your plan will dictate how much you’ll pay out of pocket, but there are no lifetime limits or exclusions for pre-existing conditions with your Ambetter coverage.
Changes Healing Center accepts Ambetter insurance and can help you verify your benefits with a quick phone call. This takes the guesswork out of your treatment and allows you to rest easy knowing what you will owe when all is said and done. Keep reading to learn more about what your Ambetter insurance should cover.
Like most insurance coverage options, Ambetter is mandated to cover drug and alcohol rehab under the 2010 Affordable Care Act (ACA). This legislature includes ten essential health benefits that all insurance companies must cover, regardless of the location or situation. Substance abuse treatment and mental health services are part of these benefits.
That means that Ambetter insurance has no choice but to cover your stay in our rehab center, but that doesn’t necessarily mean it’s covered in full. Here’s what you need to know about using Ambetter for your stay.
One of the most important aspects of understanding your coverage is the ACA’s parity protections. This important component of the Affordable Care Act mandates that all insurance companies must cover all essential health services similarly.
That means that mental health and substance use disorder must be covered to the same extent as a medical issue.
Consider it this way: you head to the hospital for emergency services because you have a kidney stone. Chances are that your insurance coverage is going to kick in to help you find relief from the pain. Maybe they cover all of your stay or at least a significant portion. The point is that you know what medical care will cost you.
In the past, they could have denied you access to treatment for mental health and substance use. Now, they must cover it to the same extent as a kidney stone. If your hospitalization would have cost you 40 percent of the sticker price, your rehab stay must be covered identically.
There used to be instances where your insurance company might have told you that you exhausted the resources available for your care. If you spent too much time in a rehab center or went too many times, your Ambetter health insurance might have denied you future stays, saying that you reached a lifetime limit.
This was a stumbling block for many people because substance abuse treatment can require several efforts to sustain it for the long term.
The good news is that your rehab will be covered by Ambetter, no matter how many times you enroll in addiction treatment. They can’t cut you off at a certain point and stipulate that you pay the full price of care out of pocket. This ensures that you always have access to the care you need at the right time.
Along with those lifetime limits that insurance companies used to impose, it was possible that you would have been denied coverage altogether based on a pre-existing condition. That meant that many people who would have been excellent candidates for drug and alcohol addiction treatment tried getting through it on their own to preserve their coverage.
Once you sought help for mental health or addiction treatment, you could have faced a greater struggle the following year when it came time to reenroll with your health insurance company.
You might have found it difficult to receive health insurance again once your file had been branded with a pre-existing condition. If Ambetter insurance coverage were to extend a plan to you, it may have been with the caveat that your pre-existing condition didn’t have coverage.
Now, insurance companies can’t deny you for a pre-existing condition and must cover your care.
What can you expect to pay with your Ambetter addiction treatment coverage? Knowing what you could be on the hook for when enrolling in Changes Healing Center’s treatment center is crucial. This can help give you peace of mind that your care is covered by Ambetter so that you can focus on your sobriety.
Here is what you should know about your Ambetter insurance benefits.
Not every plan is created equal, even if they all originate with the same insurance provider. The Health Insurance Marketplace allows people to enroll in different tiers depending on their needs. You might be able to prioritize your monthly premiums or your out-of-pocket costs. But how does it work?
All plans start at the bronze level, which typically comes with the lowest monthly premiums but doesn’t cover as much as other plans. You’ll be responsible for around 40 percent of the cost of your substance abuse treatment services. You can progress through the metal tiers to help offset the costs of care.
For example, a gold plan will have higher monthly premiums but lower out-of-pocket costs. Insurance coverage at the gold level usually covers about 80 percent of your treatment.
This means that you’ll have to balance your needs when enrolling in insurance coverage if you know that you’ll be seeking addiction treatment. Balance monthly spending on premiums with the cost of care that you’ll be responsible for out of pocket.
While Ambetter must cover both physical and mental health, you might wonder what the cost will be for different levels of care. After a medical detox at one of our partner facilities, you will usually transition to inpatient treatment, where you reside with us 24/7 and have constant access to care and support.
As you might imagine, inpatient treatment in Phoenix at Changes is more expensive because it encompasses everything you need for around-the-clock support for your sobriety or mental health. Your Ambetter insurance plan should help you offset the treatment costs, but you’ll typically face lower costs with intensive outpatient programs.
Once you have completed inpatient treatment, most people aren’t yet ready to return to their day-to-day life without support. Outpatient treatment at our treatment facility is usually the best option. Plus, enrolling in this treatment program with Ambetter insurance will likely be less expensive.
If you want the maximum amount of your treatment to be covered, you need to consider whether the treatment center you’re enrolling in is part of your insurance provider’s network. In-network providers have negotiated discounted rates with the insurance company, meaning that your cost of care will be lower.
Out-of-network providers often have higher costs, but that doesn’t mean they aren’t covered. You simply might have to pay a slightly higher sticker price for your treatment at a rehab center.
Changes Healing Center in Phoenix is in-network for many providers and may include your Ambetter insurance plan, including Arizona Complete insurance as administered by Ambetter. Our enrollment team can help you verify your benefits in a quick and confidential call, enabling you to better understand the costs if you seek treatment.
Just because Ambetter covers addiction treatment doesn’t necessarily mean that you should go to just any treatment program. Changes Healing Center offers a robust and comprehensive solution for your drug and alcohol addiction or mental health needs.
We’re proud to be a Joint Commission-accredited facility, meaning we uphold the most stringent patient care and safety standards. Our facility meets all OSHA standards and those set specifically by the Joint Commission.
You can rest easy knowing that you’re in good hands with our team and that all your needs will be met according to strict standards.
Our treatment program can accommodate you no matter what addiction treatment services you need. While we believe that an inpatient program is a great first step, it won’t work well for everyone. If you need to be there for your family or keep working, we also offer less restrictive care levels.
Our partial hospitalization program allows you to spend your days and afternoons with us while you return to your own home and bed at night. You can even step down to intensive outpatient programs where you’ll spend just a few hours in therapy each week.
The important thing to note is that we offer comprehensive care for everyone who needs it. We start with an evaluation that takes into account your substance abuse and mental health issues. Then, we recommend a level of care that will give you the tools you need to thrive when you graduate.
According to the Mental Health Services Administration, one in four adults with a mental illness will also struggle with a substance use issue. That means that you need to find a specific rehab center that will cater to both issues. Fortunately, this might be easier to find than you think.
Change Healing Center is well-versed in the most common conditions that often accompany your substance use, allowing us to treat you as a whole person.
There is no additional cost for dual diagnosis treatment. It’s all included under the umbrella of your addiction treatment cost, whether you’re in our residential treatment or our outpatient treatment programs. Rest easy knowing that we use the best evidence-based therapies for your rehab treatment.
Are you ready to think about what it would mean to enroll in substance abuse treatment with Changes Healing Center? Our enrollment team is ready and waiting to help you make a life-changing decision to live without drugs and alcohol while improving your overall mental health.
Instead of navigating the labyrinth of the insurance company’s hotline, our enrollment team can help you verify your benefits in a quick fifteen-minute phone call. This lets you know what costs you can expect upon graduation, but we can also work with you on a manageable payment plan.
Don’t delay your treatment another day just because you aren’t sure about your Ambetter coverage. Changes Healing Center can help you get the health services you need right now!